The majority of House Republicans opposed the Democrats’ $210 billion physician payment bill--which passed this afternoon on a 243-183 vote--accusing the legislation of increasing the deficit by relying on federal borrowing through Medicare to pay for itself.  The “doc fix”--which will prevent steep expected cuts to Medicare payments for providers--is nothing but a “shell game designed to mask the true cost of their proposed government takeover of health care,” Representative Wally Herger wrote in a letter to the American Medical Association today, co-signed by ranking Ways and Means Republican Dave Camp. The Republican rhetoric is familiar, of course. But it was only four months ago that Ways and Means Republicans voted for an amendment that’s nearly identical to the bill being proposed today, which would stop a scheduled 21 percent Medicare payment cut next year and implement a permanent change in the payment formula for doctors.

Herger offered the Republicans’ physician payment amendment during the committee’s mark-up of the bill last July. The Herger amendment—the document is available here--was nearly identical to the language that was already in the House bill, but with a provision tacked on at the end to provide loan forgiveness for primary care physicians. As such, it was a way for Republicans to show that doctors that they supported them, even though they opposed the entire reform package. “They offered this amendment because they wanted to make sure their members could be on record specifically supporting this exact policy – the same provision that became H.R. 3961,” said Brian Cook, a spokesperson for Rep. Pete Stark. All of the Ways and Means Republicans ended up voting for the amendment--including minority whip Eric Cantor--but it was defeated 22-18 by the Democratic majority, who opposed the GOP’s political maneuver to take a symbolic vote for a provision already in the bill.

Herger and Camp--who both voted against the Democratic legislation today--took pains to explain to the AMA that they believe the Medicare payment system is “deeply flawed and urgently needs to be reformed,” saying they were only opposing the Democratic bill because isn’t financed and will increase the deficit. But, at the time, Herger’s amendment wasn’t paid for either*. Had the amendment actually made it into the bill, “it would have been paid for” through alternate means of financing that weren't in the jurisdiction of the Ways and Means Committee, says Sage Eastman, a Republican committee spokesman. “We wouldn’t have written a trillion dollar bill.”

The GOP did attempt to offer their own alternative doc fix today, which also staved off the 21 percent cut in payments next year and cut payments by 2 percent over the next four years (a financed-but-temporary fix). Mostly paid for by medical liability reform measures, they boasted their alternative was fully financed, unlike the Democratic legislation (a permanent-but-unfunded fix). But that wasn’t enough to satisfy the AMA, who sent a letter to Camp today saying the group was “disappointed” in the Ways and Means Republicans’ opposition, given their previous support for the Herger amendment--essentially trying to call them out on their flip-flop.

*Corrected explanation of why Herger's amendment wasn't financed when offered up in committee.