House snuck "doctor fix" through in Pelosi Plan debate rules

Byron York catches Nancy Pelosi playing a shell game with Medicare reimbursement rates and ObamaCare.  Her Pelosi Plan used cost projections that assumed that previously-passed Medicare reimbursement rate cuts would come into effect.  However, unremarked by the media, Pelosi shoehorned the “doctor fix” into the rules bill that governed the debate on the overall bill, adding $210 billion in costs without acknowledging them in her plan:

Something unusual and largely unnoticed happened last week as Democrats pushed the national health care bill through the House. In a complicated, late-night maneuver, on a party-line vote, the House Rules Committee used the health bill to pave the way for a $210 billion increase in Medicare payments to doctors, without any money budgeted to pay for it. Congress then combined that $210 billion with a measure that would force lawmakers to exercise fiscal discipline — except when it came to the $210 billion.

It was a particularly slick move, even by congressional standards. With one vote, committee Democrats managed to propose spending a huge amount of money while also claiming to clamp down on spending. More importantly, they threw a very big bone to several physicians organizations, which badly want the increased doctor payments and to whom Democrats are deeply indebted for support of health care legislation. And at the same time, they gave cover to moderate Democrats, who are under pressure to support health reform but also fear the wrath of voters concerned about overspending. ….

Normally, when the Rules Committee creates a rule, it does so for a single bill. “One bill, one rule,” says a veteran GOP Hill aide. But when it came to the health care bill, Democrats took the unusual step of combining the health bill and the $210 billion physician payment measure in a single rule; they were worried the doctor bill might fail if it were considered on its own.

There are good reasons to consider the “doctor fix.”  Medicare reimbursement rates are already low enough to chase providers from the Medicare market.  The cuts that Congress passed would decrease an already low reimbursement rate by double-digit percentages, which would push many more providers into refusing Medicare patients.  That would have a cascading effect, as providers in the system would have longer wait times and probably have to cut corners on care in order to afford to service that market.

But even with that aside, the question remains on how to pay for the rescission of the cuts — and the dishonest approach taken by Pelosi squelched that debate.  She deliberately chose to hide the fact that she had added over $200 billion in additional costs with no offset in revenues or expenses elsewhere.  It makes the Pelosi Plan explicitly a deficit-buster, even if one credits the Utopian assumptions on  which its economics are built.

That will prove very problematic in the conference committee, because Harry Reid has already lost that option in a filibuster vote.  He will have to either make the doctor fix an explicit part of his bill, which means the CBO will score it as a deficit buster, or leave it out — which will force the AMA and other physician organizations to scream bloody murder.  When it comes to a conference committee, assuming that Reid can actually pass a bill, the same conundrum applies.  Include the doctor fix and bust the deficit, or exclude it and lose the doctors.

These are the wages of dishonesty, of course.