Doctors who treat Medicare patients will face a huge cut, 21 percent, if Congress doesn't act by the end of the month. This isn't a new problem. While Democrats and Republicans on Capitol Hill agree that the formula that pays doctors who treat Medicare patients has long been broken, over the years they've been unable to pass more than temporary patches.
But the leaders of the House from both parties have come up with a plan that they think can fix a problem that has bedeviled Congress since 1997. On Thursday, it goes to the House floor for a vote.
If Rep. Nancy Pelosi and Speaker John Boehner win and their plan becomes law, it would kill what's known on Capitol Hill as the "doc fix," a near-annual exercise. Here's how it works: It would repeal what's called the sustainable growth rate formula, or SGR. Instead, Medicare would increase payments to doctors by one-half of one percent each year through 2019. After that, a system would kick in where doctors would receive bonuses and penalties depending on performance scores from the government.
"We as physicians, look we want to be paid on basically how well our patient does and that creates some challenges because you've got to have buy in for the patient but we know these systems work and they save money," said GOP Rep. Phil Roe (R-TN) is a long-time physician who heads up the House Republican Doctors Caucus.
"I can almost say that with this passage I will have had a successful Congressional career up to date. I really believe it's that important," Roe, who said he was involved in the negotiations, said. "It's the first real change to Medicare in almost the last 20 years."
Boehner and Pelosi's plan would also extend funding for the Children's Health Insurance Program for two more years.
And on Wednesday it gained a powerful ally: President Obama.
"As we speak Congress is working to fix the medicare physician payment system," Obama said during an event marking the fifth anniversary of the federal health care law. "I've got my pen ready to sign a good bipartisan bill"
Later in the day, the administration followed up with a formal statement of support.
Though the bill has the White House's backing and bipartisan support in the House, it hit a snag in the Senate where some Democrats worry about language that would restrict abortions at community health centers.
Pelosi has said that the restrictions included in the bill are not a change in current policy. The bill also has the support of the chairs of the House Pro-Choice Caucus, which boasts 170 members.
"The language included in the bipartisan compromise does not further restrict women's access to abortion and the provisions expire along with funding – just as the current Hyde Amendment does," Reps. Louise Slaughter (D-NY) and Diana DeGette (D-CO) said in a joint statement. "We will be supporting this bipartisan compromise, and we encourage other members of the Pro-Choice Caucus to do the same."
Still groups like NARAL Pro-Choice America and Planned Parenthood Federation of America remain opposed to the bill.
Lingering over the debate on the Medicaid provision was another fight in the Senate, over a human trafficking bill currently being blocked by Democrats over abortion language.
But this week, some Senate Democrats including Democratic Leader Harry Reid looked to differentiate between the two. Reid told reporters Tuesday that "the two provisions in the two bills are different. They're not the same, dealing with abortion."
California Sen. Dianne Feinstein said that she planned to support the Medicare bill too
"My objection in the trafficking bill is that this is private money, not a government fund, so it would establish a new precedent and that's what I don't want to do," she said.
While the debate over abortion-related language was the sticking point among Senate Democrats, there is also the question of cost.
According to a Congressional Budget Office estimate, the bill would cost more than $200 billion over the next decade. The bill would add more than $140 billion to the federal budget deficit. And that's despite some savings that would come from higher premiums for some Medicare beneficiaries and cuts to providers like hospitals and nursing homes.