Doctors Win, Jobless Lose: The GOP Confronts New Perception Problem
Posted at 4:56 p.m. on March 24
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While lawmakers remain unable to agree on a means to pay for a permanent fix in the outdated payment formula, there’s a strong bipartisan sentiment in favor of shielding doctors from a sudden drop in their income.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.