House Speaker John Boehner (R-OH) and Minority Leader Nancy Pelosi (D-CA) are aiming to finalize the deal this week and put it to a vote next week, leadership sources said. There's always a possibility of it imploding, but if the plan passes and is signed into law, it would be the most important piece of health care legislation since Obamacare, and a huge achievement for a Congress that has so far been marked by unusual dysfunction.
The deal would end the perennial Medicare "doc fix" problem by replacing the widely-maligned formula for reimbursing physicians, which currently imposes steep annual cuts that Congress has regularly overridden since 2002. It's a huge headache for lawmakers as powerful health industry groups have been clamoring for a permanent fix for years. The cost of repealing the existing "Sustainable Growth Rate" payment formula is $170 billion over a decade.
The plan would also extend for two years the Children's Health Care Program, which helps insure families with children, and runs out of funding on October 1, lawmakers and aides said.
"So far as it goes, I think it's good. We need some of the structural entitlement reform. That's a good thing. I support extending S-CHIP. That's a good thing. What's not good is right now it's not paid for," said Rep. Joe Barton (R-TX), a long-serving conservative who went on to say, "I know how hard this is. Our seniors are having more and more difficulty getting doctors because Medicare doesn't reimburse, and doctors are dropping Medicare."
The big carrot for conservatives: two major reforms that cut billions of dollars from Medicare spending in the long-term. One change would require upper-income seniors to pay higher co-pays; another would reduce spending on supplemental "Medigap" plans that some elderly beneficiaries enjoy. The reforms would be phased in to avoid immediate disruptions.