WASHINGTON -- The House gave sweeping approval Thursday to a bipartisan plan to alter payment systems for Medicare providers and extend a popular children's health program.
The vote, 392-37, came as Senate Democrats' resistance to the more than $200 billion health package faded and President Barack Obama signaled he would sign the plan. The four representatives from Arkansas, all Republicans, voted in favor of the plan.
The proposal, negotiated by House Speaker John Boehner, R-Ohio, and Minority Leader Nancy Pelosi, D-Calif., has been embraced by liberals seeking increased funds for programs that are key to advancing the Patient Protection and Affordable Care Act and by conservatives cheering an increased premium charged to high-earning recipients of Medicare.
It sets up one of the rare moments in Obama's second term: the approval of a piece of legislation that meets the approval of the president, the speaker and their respective allies.
"I want to give John Boehner and Nancy Pelosi credit," Obama said Thursday. "They did good work today."
Moments before the House vote Thursday, Boehner touted the bill.
"This will be the first real entitlement reform that we've seen in nearly two decades, and that's a big win for the American people. It was a true bipartisan agreement, and I want to thank leader Pelosi," he said.
The linchpin of the assembled package of health bills is a permanent fix to the Medicare pricing system for physicians. Congress and the health care industry have long sought an overhaul.
The system originates from a 1997 law that tied physician payments to the growth of the economy. Doctors soon faced double-digit reimbursement cuts as health care costs grew faster than the economy.
Doctors have complained that the current sustainable growth rate formula created uncertainty with fees, and they argued that payment cuts could force physicians to stop treating Medicare patients.
Since 2003, Congress has on several occasions scrambled to pass legislation to avoid the scheduled cuts in Medicare payments, finding a combined $170 billion in budget savings during that time to offset the cost of making doctors' payments whole again.
Without final approval of the bill, a 21 percent cut in Medicare payments would kick in Tuesday.
Despite the shared desire of Congress and doctors to overhaul the payment system, the price tag over the years was always considered prohibitive. But the cost of repeal has come down as health care spending growth has slowed over the past few years.
The House legislation follows through on a broad agreement that Medicare should better reward health care providers for higher-quality care, instead of just paying them for each service they provide. It is a shift taking place in private insurance, and earlier this year, the Obama administration for the first time set a goal to tie the vast majority of Medicare payments to programs encouraging better care at lower costs.
The bill does away with the scheduled payment cut and gives doctors an annual 0.5 percent raise in Medicare payments through 2019. After that, a new payment system based on the quality of care will take hold.
"Normally, we're here to admit that we've just kicked the can down the road," Boehner said on the House floor. "Today, because of what we're doing here, we will save money 20, 30 and 40 years down the road."
The most conservative Republicans, who have often caused headaches for Boehner, split over the legislation. Some were angry that only about a third of the cost of the legislation is offset by cuts or increased revenue in other areas, complaining that the bill would increase the budget deficit.
However, a significant bloc of conservatives supported the legislation.
Rep. Matt Salmon, R-Ariz., who in January would not even support Boehner for speaker, called the current Medicare payment plan "intellectually dishonest" because Congress intervened every year to prevent the cuts.
"Ending this charade is very important," said Salmon, who also said conservatives were getting a clear victory with another change to Medicare. "Finally, we're going to do something."
He was referring to a provision that will require higher-income senior citizens to pay more toward Medicare premiums for their insurance and prescription drug coverage.
Many Republicans believe that, while the initial estimates of savings hover around $30 billion over 10 years, the Treasury will recoup an exponentially larger sum over the next few decades and help the long-term finances of Medicare.
On the GOP side of the aisle, 212 Republicans supported the plan and just 33 opposed it, a big enough margin that Boehner's caucus was just three votes shy of being able to pass the legislation on its own. Just four Democrats opposed the plan.
Democrats have previously resisted what is known as "means testing," fearing that even a slight increase in premium costs to the top income earners could lead to future encroachments onto other Medicare beneficiaries.
But there are plenty of other things that Democrats like in the legislation, which was drafted by the bipartisan leaders of the House Ways and Means Committee and the House Energy and Commerce Committee.
The bill makes permanent a program that helps low-income Medicare beneficiaries afford their monthly premiums. It also extends by two years enhanced funding to community health centers, which primarily serve low-income patients.
The bill also extends funding for the Children's Health Insurance Program for two years. The program, which is widely credited with helping to cut the rate of uninsured children by half since 1997, is scheduled to run out of federal funding in September.
Senate Democrats on the powerful Finance Committee have been pushing for a four-year extension of the children's program, but health care advocates aligned with the Obama administration have said they are happy to get at least the two-year addition.
Liberals also hailed the level of funding for the children's program and community centers, because it is set at levels that match those required by Obama's health law -- a rare moment in which Republicans are acceding to part of the Affordable Care Act.
Some abortion-rights groups expressed concern about language in the legislation that forbids federal funds to be used to provide abortion services, but the House's Pro-Choice Caucus issued a letter saying that there was nothing in the bill that differed from already existing prohibitions on federal funding.
Pelosi, a longtime abortion-rights advocate, has said the measure's abortion restrictions would be temporary and would simply continue limitations Congress has imposed annually since 1979.
As objections faded throughout the week, Obama's declaration of support made the bill's passage in the Senate more likely. The last remaining question is whether the Senate can clear the legislation before adjourning for spring recess or whether it will take up the legislation upon its return April 13.
Just before the vote, Pelosi predicted that a vote of support in the House would probably help clear any hurdles in the Senate.
"I hope we have a big, strong vote here today and that will encourage the Senate to take up the bill as soon as possible so our work will be done before the deadline," Pelosi said.
Information for this article was contributed by Paul Kane, Jason Millman, Mike DeBonis and David Nakamura of The Washington Post; by William Douglas of Tribune News Service; and by Alan Fram of The Associated Press.
A Section on 03/27/2015