WASHINGTON (AP) — In uncommon bipartisan harmony, the House approved a $214 billion bill on Thursday permanently blocking physician Medicare cuts, moving Congress closer to resolving a problem that has plagued it for years.
The lopsided 392-37 vote shifted pressure onto the Senate, where its prospects have brightened as Democrats have muffled their criticism and President Barack Obama has embraced the bill. But with some conservatives also balking at the legislation, its fate there remained murky.
Thursday's House vote came on a package that bore victories for Republicans and Democrats alike and was negotiated by the chamber's two chief antagonists, Speaker John Boehner and Minority Leader Nancy Pelosi. That unity contrasted vividly with the usual partisan duels that hamper most congressional efforts on budget, health and other major policies.
The vote even gave House GOP leaders a respite from the large-scale rebellions they frequently face from tea party conservatives, including on a measure last month that prevented a Homeland Security Department shutdown. Republicans backed the Medicare bill 212-33, while Democrats tilted "yes" by 180-4.
"I want to give John Boehner and Nancy Pelosi credit," said Obama while visiting Birmingham, Alabama. "They did good work today."
The bill contains funds for health care programs for children and low-income people that Democrats touted as victories. Republicans won long-term though modest strengthening of Medicare's finances, including cost increases for higher-income recipients.
Buoyed by such incentives, House members more accustomed to gridlock found themselves with little to argue about. Instead, they praised the bill and each other — one Republican even wished Pelosi, D-Calif., a happy birthday, her 75th — as they all but marveled at their unity in addressing a problem.
"I just want to say to the American people, don't look now but we're actually governing," said Rep. Renee Ellmers, R-N.C.
Congress planned to leave town by week's end for a spring break, and physicians treating Medicare patients face a 21 percent fee cut on April 1 unless lawmakers act. If the Senate doesn't give final approval before recessing, the government could delay processing doctors' Medicare checks until lawmakers return to the Capitol.
Underscoring dissatisfaction by some conservatives, Sen. Ben Sasse, R-Neb., said the bill would deepen budget deficits and barely strengthen Medicare, adding, "We should use this crisis as an occasion to be talking about real entitlement reform."
Physician groups have long warned that the constant procession of threatened slashes in Medicare payments could mean fewer doctors would treat the program's elderly recipients.
The American Medical Association and other medical organizations urged the Senate to act quickly, saying it would have "a real and lasting impact" on patients and doctors' practices. AARP, the seniors' lobby, criticized the higher costs the legislation would mean for Medicare beneficiaries and offered to help the Senate "improve this important bill."
"This is what we can accomplish when we're focused on finding common ground," said Boehner, R-Ohio. He said Republicans would continue pushing to tighten the finances of Medicare and other costly benefit programs, a battle that has produced stalemates with Obama for years.
In an unusual split with Pelosi, some Senate Democrats and abortion-rights groups complained the bill would cement into permanent law abortion restrictions at community health centers. Pelosi, a longtime abortion-rights advocate, has said the measure's abortion restrictions would be temporary and simply continue limitations Congress has imposed annually since 1979.
Democrats wanted four more years of extra money for the Children's Health Insurance Program, which serves 8 million low-income children, rather than the bill's two years. Yet Democrats seemed mostly eager to back the bill and claim that money as a triumph, along with other funds for community health centers, which serve the poor, and to help low-income people pay Medicare premiums.
"It was my honor to work with Speaker Boehner on this important issue, to do what we came here to do — to legislate," she said.
The measure's chief goal is replacing a 1997 budget-cutting law that tied doctors' Medicare fees to overall economic growth. With medical costs growing, that formula has threatened deep reimbursement cuts that lawmakers have blocked 17 times since 2002, a ritual both parties want to end.
The nonpartisan Congressional Budget Office said the measure's costs totaled $214 billion over the next decade. To pay for it, $141 billion would come from deeper budget deficits while the rest would be divided between Medicare recipients — mostly bigger monthly premiums for the highest earners — and providers like nursing homes and hospitals.
The measure also has money for diabetes research, abstinence education, rural hospitals and schools and training health professionals who agree to serve in low-income areas.