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White House supports Boehner/Pelosi 'doc fix' plan

It's so rare, it's almost hard to believe: Republican John Boehner and Democrat Nancy Pelosi got together and solved a problem.
With President Obama expressing support for the idea this morning, it's probably time to get up to speed on what may be House Speaker John Boehner's (R-Ohio) first real legislative accomplishment since getting the gavel in 2011.

President Barack Obama pronounced himself "ready to sign" a bipartisan "doc fix" Wednesday. "I've got my pen ready to sign a good, bipartisan bill," Obama said at an event that amounted to a victory lap for the five-year anniversary of the Affordable Care Act. He said he loves to sign bipartisan legislation and hopes to see more efforts to work together, and said the health care law works, crediting it with saving lives while reducing health care cost growth and the deficit.

I suspect there are more than a few folks asking, "What's the 'doc fix'?" This gets a little wonky, but it's pretty important in health care circles, and given the way the solution came together recently, it's a breakthrough that's worth understanding.
In the late 1990s, Congress approved a plan to reduce Medicare payments through a mechanism called the sustainable growth rate, or "SGR." As lawmakers soon after discovered, they'd gone a bit too far -- as health care costs rose faster than the economy, the law would have done real harm to doctors and medical facilities if implemented as planned. So, every year, Congress has approved what's become known as the "doc fix." It's basically a series of short-gap measures, approved regularly for well over a decade, to prevent hitting physicians with an overly severe reimbursement rate cut.
Both parties hate having to deal with the doc fix every year, so to his credit, Boehner reached out to House Minority Leader Nancy Pelosi (D-Calif.) to work out a solution. The Center on Budget and Policy Priorities sketched out the blueprint of the bipartisan deal.

House Republican and Democratic leaders have worked out compromise legislation that would: (1) permanently fix Medicare's flawed physician payment formula, which repeatedly threatens drastic 20- to 30-percent cuts in physician payment rates; (2) offset part of the cost of fixing the payment formula, primarily by trimming Medicare provider payments and modestly raising Medicare premiums for some high-income beneficiaries; and (3) extend funding and current policy for the Children's Health Insurance Program (CHIP) and several expiring Medicare and Medicaid provisions for two years. The compromise also makes permanent both the Qualifying Individual (QI) program, which defrays Medicare Part B premiums for low-income Medicare beneficiaries, and the Transitional Medicaid Assistance Program, which enables families receiving Medicaid to maintain that coverage for up to a year as they transition from welfare to employment. In addition, it extends the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program for two years and provides $7 billion in new funding for community health centers over the next two years.

Like I said, this gets a little wonky -- OK, more than a little -- but think of it this way: the SGR that everyone hates will go away forever. High-income seniors will pay a little more as part of the compromise, and the Children's Health Insurance Program, which is facing a dangerous cliff fairly soon, would get a two-year extension.
Proponents are cautiously optimistic about the package passing the House tomorrow, but it's not yet a done deal. Many on the right aren't happy about the financing -- most of the plan isn't paid for -- and many on the left aren't happy about what are effectively Medicare cuts. There's also some concern in the Senate over abortion restrictions, though the White House's support for the agreement may help move some Democratic votes in the upper chamber.
But the angle that I can't quite get over is how Boehner proactively reached out to Pelosi to -- get this -- solve a problem. Ordinarily, when looking at any proposal, the first question the Speaker asks himself is, "How will I get the far-right on board?" On this, Boehner did the opposite, reaching out first to his Democratic counterpart.
Pelosi, true to form, cared more about policy solutions than simply rejecting Republican outreach out of hand, and she worked on a credible compromise, which now enjoys quite a bit of support.
Note to Boehner: if you'd approached policymaking this way from the start, you would have been a successful Speaker.