House passes funding bill and health programs but strands doctors

Modern Healthcare – Tuesday, March 11, 2025
By Michael McAuliff

The House of Representatives passed a spending bill Tuesday that funds the government and a number of expiring health programs through September, but leaves intact a cut to physicians’ Medicare pay.

The legislation passed 217-213, with one Democrat voting in favor of the bill, known as a continuing resolution, and all but one Republican voting for it. That included members of the GOP Doctors’ Caucus, who had vowed to use the legislation to overturn the Medicare cuts amid fervent appeals from the nation’s medical associations.

While the bill fails to address the 2.93% cut to physician fees that the Centers for Medicare and Medicaid Services implemented at the start of the year, it does preserve for six months telehealth and hospital-at-home authorities under Medicare. It also forestalls cuts to Medicaid disproportionate share hospital payments for safety-net providers. Community health centers, graduate medical education and other health programs due to expire on March 31 would get six-month extensions, as well.

The failure to add a fix for the doctors’ pay cuts had threatened to stall the measure, as House Republican doctors had declared a fix needed to be included to win their support.

Several of those physician lawmakers, however, said in interviews prior to the vote Tuesday they decided to support the bill because House leaders promised the doctors’ pay cuts would be redressed later in the year.

“It’s going to be in reconciliation,” said Rep. Dr. Greg Murphy (R-N.C.), who has been leading the House effort to restore physician pay.

He added that lawmakers want to find a fix that would last longer that just six months, which will require cuts elsewhere.

“The intention is to try to do a long-term fix so we don’t need to keep doing this nonsense every year,” Murphy said.

More than 100 medical associations, including the American Medical Association, wrote to lawmakers Tuesday pleading with them to deal with the pay problem now, pointing to AMA data that found physicians’ pay in Medicare has fallen 33% since 2001, adjusted for inflation.

But other House doctors echoed a willingness to defer the pay problem to the reconciliation bill.

“I guess we’re going to get around to it,” said Rep. Dr. Scott DesJarlais (R-Tenn.) “First things first, we got to keep things moving, but it’s not being put on the back burner very long, I don’t think. I hope.”

Lobbyists for the various doctors’ organizations, who spoke on background to avoid angering lawmakers, said physicians who count on the GOP Doctors Caucus are getting extremely frustrated.

“What are they there for? It’s always promises, promises, promises, but they never deliver,” one said. “This is a time when one or two people can make a difference.”

Murphy said he’s heard such complaints, but this time would be different.

“I feel good,” he said. “Look, the president wanted a clean [continuing resolution] and with a few anomalies, and it is what it is.”

He echoed the AMA’s arguments for paying doctors better. “You can’t keep cutting the people who take care of patients in this country,” Murphy said. “It’s time to turn the tables back on the people who actually take care of your grandmother at 2 a.m.”

Still, both a reconciliation budget and the government funding bills face obstacles.

The funding bill must pass the Senate by Friday night to avoid at least a partial government shutdown. Republicans hold a 53-47 majority there, but the bill likely will have to meet the 60-vote threshold to overcome a filibuster. Seven Democrats would have to join Republicans in support. Senate Minority Leader Chuck Schumer (D-N.Y.) declined to say whether his members would help.

“We’re gonna wait to see what the House does first,” Schumer told reporters Tuesday ahead of the lower chamber’s vote.

House Democrats hammered the measure, saying Republicans cut them entirely out of negotiations, and produced a partisan spending bill that includes cuts they did not agree to, and which they said will help President Donald Trump and his billionaire adviser Elon Musk continue to slash government programs and workers.

Rep. Frank Pallone (D-N.J.), the ranking Democrat on the Energy and Commerce Committee, said Republicans at least could have revived the bipartisan health package that Trump and Musk torpedoed late last year.

“Rather than voting on this partisan bill, we should be working together to lower costs and expand access to healthcare, like the bipartisan agreement we had in December,” Pallone said in floor debate, noting the December package would have raised doctor pay and included longer extensions for telehealth and other programs.

Senate Majority Leader John Thune (R-S.D.) said Americans would blame Democrats for a shutdown if they don’t help the GOP pass the bill.

“I think the American people are going to be interested to see whether the Democrats are going to filibuster, and by filibustering, shut down the federal government,” Thune told reporters. “It is on them if this happens.”

While the Senate can move quickly when every member consents, it must adhere to various procedural schedules if any single member objects, and the vote could be stalled until the end of the week.

Once the funding bill is dealt with, the doctor pay issue is also uncertain in the budget reconciliation bill. Under budget reconciliation, Congress can make changes to spending or taxes on an expedited basis that circumvents a filibuster.

Raising pay for physicians would be allowed in such a bill, but would also add billions to the cost of the legislation at a time when Republicans have passed a budget resolution that instructs committees to cut $880 billion in healthcare spending.

Murphy and Rep. Dr. Andy Harris (R-Md.), the chair of the conservative House Freedom Caucus, said there are plenty of savings to be found to support physicians by targeting insurers in the Medicare Advantage program.

“There are plenty of places we can save the insurance company the front,” Harris said in an interview, accusing Medicare Advantage firms of “gaming” the system. “There’s over $100 billion of 10-year savings by stopping that egregious practice,” he said.

Still, there’s no guarantee that the Senate will come up with — or agree to — the same plan.

Senate Health, Education, Labor and Pensions Committee Chair Dr. Bill Cassidy (R-La.), who also supports paying physicians more, said in an interview he believed it would be easy to make Medicare physicians’ pay whole for the rest of this year in a reconciliation bill since it would cost a relatively minor $3 billion.

He was less certain about the House doctors’ plan to erase the problem permanently, or even for five or 10 years.

“We’ll see, man,” Cassidy said.

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