Roll Call: Latest News on Capitol Hill, Congress, Politics and Elections
December 19, 2014

Doctors Win, Jobless Lose: The GOP Confronts New Perception Problem

The week is still young, so there’s time left for the Republicans to change course. But for now, the party is moving assertively toward generating one of the most tin-eared headlines of this campaign year:

Congress bails out doctors again but still spurns the unemployed.

Through a confluence of circumstances, the two measures likely to get the most attention at the Capitol for the next several days would each cost about $10 billion, and both include budgetary offsets making them deficit-neutral.

But only one is likely to ever get cleared: Legislation giving physicians significant, if not-quite-total relief, lasting until after the election, from the 24 percent cut in their Medicare fees that is set to take effect next month.

While lawmakers remain unable to agree on a means to pay for a permanent fix in the outdated payment formula, there’s a strong bipartisan sentiment in favor of shielding doctors from a sudden drop in their income. So the odds are strong the House will pass such a bill before departing Thursday, and that the Senate will pretty quickly follow suit without all that much fuss. (As a practical matter, the deadline is not before the end of April, but Congress is on its spring recess the last two full weeks of that month.)

The other bill would extend federal insurance benefits for the long-term jobless for another five months, while also paying claims retroactively since the program lapsed at the end of December.

Senate Democrats look to be standing united behind the measure, and appear to have found just enough Republicans they need to overcome a filibuster and pass their latest proposal, maybe even by the weekend. But the House Republican leadership is sending every signal the measure won’t ever see the light of day on their side of the Capitol.

In a memo to the rank and file on March 21, Majority Leader Eric Cantor, R-Va., listed the so-called doc fix as one of the “must-do items” for the House in coming days. He made no mention at all of the UI fix.

The public policy rationales for the GOP’s disparate views on these very different proposals may well be sound. But the fact that the two bills are now running on parallel tracks along the legislative process — which means they’re simultaneously vying for the same sliver of the public’s attention — heightens this reality: Especially in an election year, sound and considered reasoning is going to get trumped by superficial perception.

Fairly or not, the impression that threatens to stick in such cases is the one that reinforces the conventional narrative. For the Republicans, the storyline is that they are “the party of the rich” and so have minimal interest in narrowing the chasm of income inequality.

That caricature won’t be easily erased if the GOP pursues its current course, which could be summarized this way: They are eager to provide an economic lifeline to some of their most reliable political and financial backers, the 650,000 physicians who treat Medicare patients. But they are not willing to provide an economic lifeline to a significantly larger group that’s probably already inclined to vote against them come November anyway — the more than 2 million people who have been trying without success to rejoin the workforce for longer than six months.

This decision looks all the more curious in light of recent surveys that found between three-fifths and two-thirds of the public supporting continued insurance benefits for the long-term unemployed, which have been extended by Congress 13 times since they were created at the onset of the 2008 recession.

There’s been no comparable polling on the Medicare payment formula. But in general, the public has not been too sympathetic to the anxious pleas from doctors who treat the elderly, given that their income averages range from $160,000 (for internists) to $315,000 (for orthopedists).

Congress has been persuaded, though. Democrats and Republicans agree that a formula designed to rein in physician compensation proved unworkable soon after it became law in 1997, and they have stepped in more than a dozen times to put off the cutbacks. But every time they do that, the next scheduled reduction becomes even deeper, and the argument grows louder that such a sharp reduction in doctors’ income would compel many of them to get out of the business of treating Medicare beneficiaries.

Such a shock to that system is not a smart risk, Congress has concluded, and there’s a deal on a totally new formula that doctors like. But since there’s no agreement on how to offset its cost, as much as $180 billion over a decade, yet another patch is being readied. It will very likely be paid for by trimming payments to hospitals and nursing homes. (That’s because the House GOP’s initial offset idea, saving money on insurance subsidies by delaying for five years Obamacare’s individual mandate to buy coverage, is a non-starter with Senate Democrats.)

On the jobless aid, the proposed offsets — extending some customs fees and tinkering with the taxation of corporate contributions to pension programs — aren’t the impediment for the Republicans. They have two objections, one practical and one theoretical.

Citing the trade association that represents the state offices that administer the UI program, the GOP says it will prove impossible to accurately deliver so many checks retroactively. And, citing their own campaign mantra since 2010, they say strengthening the safety net means little without enacting policies to spur significant job creation for the years ahead.

Both points might have engendered serious discussions in previous years. In 2014, they are destined to be drowned out by simpler rhetoric.

  • topper1960

    I really don’t understand why the houses can’t bring the UI bill to the floor for a vote, Doctor are a big donors to congressional campaigns and still American are waiting for UI relief!

    • donna

      The Majority party in the House decides what bills go to the floor. Even if a bill has enough support to pass, and the unemployment extension is one of those bills, if a majority of the Majority party, in this case the Republicans, don’t support the bill, the Majority leader does not allow the vote. In other words, if a majority of House Republicans do not support the bill, the Speaker will keep it from going to a vote. It is called the Hastert rule and yes, the Republicans came up with this one. IF WE WANT OUR COUNTRY BACK, the Majority in the House must become a minority. To accomplish this, all the poor American voters in the red states must do something different. They must VOTE IN THEIR BEST INTEREST, INSTEAD OF A POLITICAL IDEOLOGY.

  • Robin Jankowski

    Trading a couple million votes from the unemployed and poor (no money to throw into their campaigns) for 650,000 votes from doctors who can make contributions and throw those mega fund raiser for them…sounds about right…Sad to see the state our government is in now…all of our leaders – in the House, in the Senate, in the White House, in the state’s capitals – have sold their souls to these financial backers (not just the docs) and they can’t do anything for we, the little people, because they owe so many favors to the people who paid their way into the positions they now hold…just sayin’…

    • Constituent

      Millions of voters access and share through social media. The internet is equally as effective as campaign funds.

      • donna

        Never thought about that. You are so right! I am about to get busy!

    • Cheryl Thomas

      They still expect the votes from people who don’t believe they are against them. This year hate is at a all time high, why I don’t know. They have always approved unemployment every year, what is so different this year? Why so mean to us?

  • cnourse57

    I have read from many sources that the doctor’s reimbursement for an office visit of a Medicare patient just barely covers the operating expenses of the office (rent or mortgage payment), utility bills, salaries for nurses and office staff) – on a prorated basis, of course. There might be a dollar or two left over to pay the doctor’s salary. Or the visit might actually put him or her into the red.

    The cuts in reimbursement rates voted into law years ago would have been so draconian, it would guarantee that every office visit by a Medicare patient would cost the doctor all salary and not enough to pay to keep the practice open. Thus the “Doc fix” bill that is needed every year. The already low reimbursement is why so many doctors refuse to accept new patients who use Medicare. Some even turn away new patients age 55 to 60 because they will age into Medicare within ten years at the most.

    As a Medicare patient myself, I try to limit my visits to the doctor as much as possible. I don’t want to be a financial burden to my doctor.

  • Jay Va

    Although liberty and collectivism both offer “equality”, liberty offers equality of opportunity while socialism offers equality of servitude.

  • Five Guyz

    Adam Smith first realized that we had stumbled upon ways to cooperate which enabled us to overcome the limits of our own personal knowledge.

  • YONATAN C

    How sad that men like John Boehner will stand in the way of the passing of the unemployment extension bill that would help the more than two million unemployed workers and their families without benefits, and the means to survive economically, while seeking employment. How can he claim to be for fiscal responsibility when millions of our tax payers dollars are going to fund corporate welfare and foreign aid? When tax payers dollars were spent on bailing out the Banking and Airline industries, amongst other companies, where was their “fiscal responsibility” and budgetary concerns then? Why is helping the average working American worker and families, not as important?

  • YONATAN C

    If the extension bill finally becomes a reality, and is passed, I’ll be happy for those families that were still able to hang on since late last December without benefits, and the means to survive economically. Sadly. for far too many of us, we were no longer able to wait while the politicians stalled and debated, and basically played ‘party politics”. Many of us have suffered severely financially, and have become homeless and penniless. I’ve asked myself many times, how can our government spend tax payer’s money freely, for Foreign Aid, and Corporate Welfare, but can’t seem to get it together, in order to help American families who became unemployed due to lay offs and corporate downsizing? This long drawn out debate to pass an extension bill for unemployed workers, is truly a shame. Our government had passed many bills for many less qualified reasons, such as the Banking and Airline industry bailouts, amongst others. These industries were rewarded for bad behavior and corporate greed. I don’t recall them having to wait months and months to be given assistance. Isn’t the rest of Americans entitled to at least a minimum amount of help? I’m not sure what I resent the most, their lack of help, or them labeling us “lazy” and “unwilling” to work. What ever became of “public servants” in our country? We seem to now only have self-centered, self-absorbed, self-promoting, career politicians, that only represent themselves

  • Gary E

    unemployed people are republicans too. Getting laid off, does not discriminate. Pass the bill already. Ukraine and Dr’s get help, but NOT 2 million Americans.

    • Cheryl Thomas

      You would the news media would pick this up, what happened? Why is important let the rest of the world see that they care more people outside the country. You know the 2 million +people have family members and you believe that they will have say at election time. We can fight too, though I don’t know why this year is different from others to have to fight for something that had thing trouble to get in the past.

  • DerekJR321

    I am unemployed. I have a 12-year old son who I raise on my own. I’m sad to say that I have no hope of this bill passing. I believe it will move on. But I strongly believe Boehner will either completely ignore this bill.. or make every effort to stall or kill it. You see.. they don’t care about us. They don’t care about typical Americans who are suffering. They only care about what makes them “look good” for their campaigns. Aid to Ukraine? Sure why not. Here’s 40+ billion. Bail out doctors who already a) have a job and b) make a ton of money? Yep.. that’s a priority. Help the unemployed who are barely scraping by? Well hold on there… no can do.

    I am disgusted that Mr. Boehner wants to turn the plight of over 2 million Americans who are suffering into a political chess game. Now is not the time to try and force through your own bills, just so you can say you won. Unfortunately Boehner will see it as “Giving in” if he allows this to come to a vote. And we all know he certainly can’t give in to something sponsored by Reid. I’m no fan of Reid either, but this is not the time to play party games. People need this and they need it now.

    Of course, they go on vacation AGAIN for two weeks real soon. So any hope I had is fading fast. I really don’t want to have to apply for welfare :( I’ve applied to more jobs than I can count and I’m always told the same thing. Either they aren’t hiring, they’ve had too many applications, or they feel I’m over/under qualified for the position. My story is the same as millions of others. You think I liked giving up my $55k a year job to collect unemployment? No.. It wasn’t my choice. And I would much rather work for a paycheck then have to collect benefits. But the jobs are NOT THERE. I wish people would understand this. We are not lazy. We are not happy to live off of unemployment. But we NEED HELP.

  • Marjie Jugan

    I think that we should all revoly against the house and stop them from being paid see how they can manage with no income and no job, these guys have no clue what is going on in this country they have tons of money so they don’t care.

  • Constituent

    Representatives who vote against their constituents may not be re-elected. Voting against Unemployment Benefits, is a vote against Americans.

    • Cheryl Thomas

      If they really don’t like Americans they can move in with their rich friends somewhere else in the world, and then there will be room in this country for those really want to be here, and can help build this country up for “All Americans”

  • Ron

    I can see that the unfortunate, the unemployed, and the veterans are extremely low on the Republican list of priorities. It is also strange that renewing EUC did not become an issue until President Obama took office. Under President Bush there was never a problem extending unemployment insurance. The immature Republican party is using the most vulnerable of Americans as leverage to get their fecal programs implemented. By the way, wasting the taxpayer’s money 40 times by trying to repeal the Affordable Care Act, wasted billions of dollars. Perhaps the Republican Party should reimburse the American people for their waste of time and money, that would cover the cost of extending unemployment for years. The Republican party holds a grudge against our President, and we the people are the ones to suffer. I was a registered Republican for 36 years, now I an a registered Democrat. Thank you Republican party for showing me how little you care for the people who make this country run. Without us no one would have anything!

    • Cheryl Thomas

      They have a problem with the President, and they want to hurt him, but he is not unemployed. If they are trying to hurt “his people” that would everyone who lives the united states. He is the President we all are his people. The decisions that are made like Obama care and others are for everyone. Isn’t there someone who will listen and understand, WE LOST OUR INCOME ON DECEMBER 2013, WE MONEY TO JOB SEARCH AND TO GET TO THE JOB “IF” GET IT. YOU DON’T HAVE TO BE RICH TO UNDERSTAND THIS!!!!!!!!!

  • Jay

    The united states of embarrassment will burn in hell just like Rome…. only sooner !!!

  • taxessuck

    Ukraine yes. Your neighbor no. Say hey to the antichrist john.

  • Cheryl Thomas

    They don’t seem to get they have been holding us off since December 2013. Why is Eric Cantor so bent on making sure that does not get passed. Why does he hate the poor. Who does he know that did something to him.
    Once again, Can’t the President override this with his executive powers and why would he not? What hold does any one have over him to prevent him from doing?

  • John Carmiche

    But the House Republican leadership is sending every signal the measure won’t ever see the light of day on their side of the Capitol.

  • John Carmiche

    Ive posted everywhere i done a u tube video i have called everyone i can posted facebook tweeted called news station government officials signed petitions Im done im sure ill see those bastards in hell.

  • Kevin M

    We all have lost so much due to the lack of our government officials playing games. John Boehner keeps saying it’s in the hands of the white house to get unemployment benefits passes. If no one really understands what he is talking about, let me explain it. What he is saying is that if the President hops on board for the keystone pipeline deal then he will allow the measure to come forth on the floor for unemployment extension.

    I have already lost everything and to think that our elected officials are holding 2.5 million people life’s hostage for the sake of making the big oil companies richer is amazing. We now have to make a statement to Boehner and friends, we need to get the Democrats out to vote. That’s the only thing they understand because they certainly do not understand what the average american is going through. They can not give the hard working people of this country a raise but they can give themselves a raise. Do people know that they make 77 dollars an hour, it’s true. It’s really not about what we think is the right thing to do, it’s about them lining themselves for the right cause for the 1% so that after their terms they have a nice paying job all lined up for themselves. When are we going to stop telling all of our sad stories and take to the streets, let our voices be heard and fight for our dignity people,if we do not unite then imagine what will happen if they get control of the house and the Senate. My heart is with all of the people who have lost everything just like me and we must now come together to show them we are not weak, that 99% of the people matter. I have one last thing for you all to think about. How does 80 of the top 1% people have the wealth of 43% of the entire world population????????????????

  • erick

    The republican party hates you and hates your way of life.

  • YONATAN C

    The republican party has done itself a huge disservice by blocking the passing of the extension bill in the senate. considering that there are over 2.6 million people directly affected by this bill, they have single handedly handed the opposition party 2.6 million votes in the coming election. These people are angry and will remember which political party failed them, and had refused to help them. Many “former” republicans like myself, will not vote for their party again after this situation. The republicans have clearly demonstrated who they are working for, and it’s not for the average American. The republicans are for big business and pleasing their true constituents “their lobbyists” which support them. The American people have seen the republican party in it’s true light, and will vote their conscience in the coming election. Senator Boehner and all his reoublican cronnies best enjoy their jobs for now, because many of them will not be in office in the future.

  • aftermidnight

    I didn’t think that the GOP is the party of the wealthy and is completely unconcerned with the middle class and poor was the slightest bit controversial. They’ve shown themselves to favor wealthy interests time and time over the rest of the country over the past few years, actually going back to 1980. It will take more than helping to restore EUC to erase that image.

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