Pelosi Floor Speech on Temporary 'Doc Fix' Legislation

March 27, 2014

Washington, D.C. – Democratic Leader Nancy Pelosi spoke on the House floor today after House Republicans abandoned bipartisan, permanent Medicare “Doc Fix” legislation and instead offered a temporary, 12-month extension for Medicare physician payments and related extenders.  Below are the Leader’s remarks:

“Thank you very much, Mr. Speaker.  I thank the gentleman for yielding.  I thank him for his leadership on issues that relate to the health and well-being of the American people.  I also commend the leadership of the previous speaker, our Ranking Member on the Ways and Means Committee, Mr. Levin, as well as that of Mr. Waxman.  They have been two champions on the subject of health care in America and doing so in a fiscally sound way.  And, while I appreciate the concerns that they expressed here – and I share them, and I will speak to that – I do think that we have to think carefully about the decision that we make.  I know that they have.

“This is an example – the leadership bringing this bill to the floor, on the short fuse that the expiration date is March 31, without most people in this room ever having seen what is in the bill – on what is a missed opportunity.  We should be considering right now a bill that would permanently, permanently speak to the SGR.  For those in the public, I know it's inside baseball talk, SGR, that is the rate that docs are compensated for treating Medicare patients.

“So, don't think of SGR, think of the patients.  And that's what we're doing here.  Think of the certainty that they need in terms of their health care, and that is our seniors.  Think of the certainty that a permanent fix – paid-for or not, but let's say paid-for – would mean to remove the uncertainty from this debate.

“The American Medical Association is opposed to this bill that is on the floor today because it is a patch.  How many times have you heard people talk?  How many times have you heard people talk about a Band-Aid?  “We're just putting a Band-Aid on it.”  We are not getting to the underlying challenge that we face.  This is a Band-Aid and that's why the docs oppose it, this patch.

“Now, I did hear the distinguished gentleman from Florida, Mr. Bilirakis, say: ‘If you don't like these pay-fors, suggest your own.’  Well, we have suggested our own.  It's called OCO.  It’s called OCO – the overseas account.  The Republicans said that’s a gimmick.  But it wasn't a gimmick when it was in the Ryan Budget.  It works for you when it works for you, but you don't want to put it to work for America's seniors.

“So here's the thing: the Senate majority and the House majority came together to produce this patch, this Band-Aid.  It's the wrong way to go.  It does not address the underlying problem.  We could have done that.  We've been trying to do it for 10 years.  And it's always, always, always something that the Republican majority has backed away from and limited and done on a short fuse.

“There's so many things that are wrong with this bill, but the simple fact is that the clock is ticking.  And on March 31, it's bad news for seniors and for the doctors who treat them in the Medicare program.  Our seniors depend on Medicare.  They depend on Medicare, and this is a weakening of it.

“So it's just the same old, same old – let's see what we can do to find some pay-fors that really undermine the health and well-being of the American people.  Those same pay-fors, done properly, could be part of a permanent fix. But instead they are part of the Band-Aid.

“So this is all to say to my colleagues: you are going to have to make your decision as you weigh the equities.  Is it better to just succumb to what we have, no matter how mediocre and how missed an opportunity it is?  Or is it better to say let's hold out until our Republican colleagues agree to the full SGR – essentially a fix forever – paid-for by OCO.  It's really important to note the following: the shorter the fix, the more expensive it is.

“We have been seeing that year in and year out.  If we had dealt with this six or seven years ago, it would have cost much less than it is to patch one year to the next – sometimes less than a year to the next.  So this is not about reducing the deficit.  It's not about the good health of the American people.  It's just an ideological reality that we have to deal with from the Republican side of the aisle.

“So when the ‘docs,’ the AMA, says ‘we’re opposed to this – vote it down,’ that's important to us.  I say to them: talk to your Republican friends.  They have the power to do a permanent fix paid-for by OCO.  They refuse to do it.  So we have something less good that we can do for the American people.  And if this sounds a little confusing, it's because it is.  And Members have to make the decision as to whether they will vote for this just because we are forced into it, or whether they want to hold out for something much better.  This would be a more appropriate debate a month ago, where the clock does not run out over the weekend.  But this is a tactic – it's a technique used by the majority to force the hand without the proper weighing of equities in all of it.

“So my colleagues, I just urge you to try to weigh those equities.  I, myself, come down on the side of supporting the legislation because, frankly, I believe that any uncertainty in the minds of our seniors about their ability to see their doctors will certainly be – the Republicans will say this is because of the Affordable Care Act.  And I just don't want to give them another opportunity to misrepresent what this is about.  If the Affordable Care Act never existed, we would still be here debating SGR.  They are two separate subjects.

“But as we know, any excuse will do to undermine the great legislation that the Affordable Care Act was about: life – a healthier life; liberty of people to pursue their happiness because they have the freedom to do so; better quality, lower cost, more accessibility.

“That's how I come to the conclusion of: let's not give them another false claim.  Let's just get this done.  But let us not give up on the prospect of – even before this expires – of having a long-term, permanent fix to SGR.  It makes all the sense in the world.  It has no partisanship about it.  It is sensible.  And it will cost less to do more for our seniors.  A challenge is there.  The solution is clear.  The Republicans have rejected that, so we are at their mercy.  My conclusion is to vote ‘yes.’  Members will have to come to their own conclusions on it.

“I frankly wish that the Republicans, in their power, would have brought the bill to the floor under a rule so we could have a proper debate on it, instead of requiring a 290-vote requirement to pass it.  But the shortness of receiving this information – only this morning Members are finding out what it is – it's really hard to predict who will vote pro, who will vote con, who will vote ‘aye,’ who will vote ‘no.’

“This is a really a silly decision to bring this to the floor in this form, when we know a path that is much better.  But I'm not going to give you another reason to go out there and make your claims about the Affordable Care Act which have no basis in fact.  With that, I urge my colleagues to pray over it, as I will.  I yield back the balance of my time.”