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Doctors who serve Medicare patients were looking at sharp reductions in payments come next year. But the House approved a measure, yesterday, that canceled those planned cuts. In the past, such bills were mostly routine and bipartisan. As NPR's Julie Rovner reports, that wasn't the case yesterday.

JULIE ROVNER: Just about everyone agrees that the current system under which Medicare pays doctors is broken. Unless Congress acts, doctors will see their Medicare payments drop by 21 percent beginning January 1st. California Democrat Henry Waxman says that can't be allowed to stand.

Representative HENRY WAXMAN (Democrat, California): Medicare's ability to guarantee healthcare for seniors would be eliminated if these cuts went into effect.

ROVNER: And Michigan Republican Dave Camp said he sent a letter to the American Medical Association signed by all his fellow Republicans on the Weighs and Means Committee.

Representative DAVE CAMP (Republican, Michigan): And in that letter we make a couple of points. And one is that we support fixing the physician payment formula in a long term way.

ROVNER: But at the same time, Camp adds´┐Ż

Representative CAMP: Doctors should not ask us to sacrifice our children's future by adding more than $200 billion to the debt.

ROVNER: And whether to add those billions to the federal deficit was, at least on the surface, what yesterday's fight was about. Republicans claim they didn't want to vote for the bill, because the $210 billion cost wasn't paid for. House Majority Leader Steny Hoyer admitted as much, but pointed out Republicans did the same thing to cancel previous Medicare doctor pay cuts when they were in charge.

Representative STENY HOYER (Democrat, Maryland): As you added to the deficit every time you fixed it, one year at a time.

ROVNER: But underneath the surface there was another fight brewing. Texas Republican Joe Barton.

Representative JOE BARTON (Republican, Texas): This is nothing more than a repayment to the American Medical Association for endorsing the larger health care bill that was on the floor several weeks ago.

ROVNER: Majority Leader Hoyer was quick to deny any quid pro quo.

Representative HOYER: This is not a question of payoff to anybody. This was in the president's budget. It was in our budget. We said we were going to do this. Why? Because it's the right thing to do.

ROVNER: Still, getting the AMA's endorsement for their health overhaul bill was a coup for the Democrats. That's because the AMA is a traditionally Republican-leaning group, as well as one that's respected by the public. That's left Republicans still smarting.

But Democratic leaders in both the House and Senate fear that if the doctors don't get their pay cut restored, the AMA's endorsement of the health bill may not stand. AMA officials haven't said that, but they've been very firm in their determination to get the Medicare cut reversed. Rebecca Patchin is the organization's board chair.

Ms. REBECCA PATCHIN (Board of trustees, American Medical Association): It's time. Congress cannot continue to put Band-Aids on the problem and it's time for a permanent fix or permanent action from Congress to stabilize the security of Medicare for seniors.

ROVNER: Meanwhile, in an effort to stabilize relationships within their own party, House Democrats added to the doctor fee bill that's not paid for, language that would require that most future legislation will have to be offset by other spending cuts or increases in taxes.

And what of the Republicans who didn't pay for previous Medicare fixes but want to now? House Minority Whip, Eric Cantor, was ready with an answer.

Representative ERIC CANTOR (Republican, Virginia): Listen, we were also fired by the voters in '06 and essentially fired in '08. I think we've learned our lesson.

ROVNER: In the end, the bill passed on a nearly straight party line vote. But its prospects in the Senate are bleak. A similar bill failed an early test vote last month. The health overhaul bill now pending in that chamber would cancel the pay cut for a single year, 2010, but it's unlikely to be enacted before the cuts take effect in January.

Julie Rovner, NPR News, Washington.

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