Why the Medicare "doc fix" vote caught the House by surprise

After the House surprisingly passed a bill by voice vote Thursday temporarily halting cuts to the rate in doctors' payments from Medicare, the Capitol was abuzz with questions.

House Budget Committee chairman Paul Ryan, R-Wis., exclaimed, "They voiced it? My God!" while walking onto the floor - leadership struck a deal that forced the bill through without a single member being put on the record as voting for or against.

The fix stops the cuts, which were built into the Sustainable Growth Rate in the late 1990s.

On Wednesday, House Speaker John Boehner, R-Ohio, sounded confident when he talked about the deal he and Senate Majority Leader Harry Reid, D-Nev., had struck. He said that the House would act Thursday and he expected the Senate to act "quickly thereafter."

But that "thereafter" appeared less likely Thursday morning, when key House Democrats appeared on the floor speaking against the bill (because the bill was scheduled to be voted on under suspension of the rules, it needed a two-thirds majority to pass rather than a simple majority, meaning a fair number of Democrats would have to vote for the bill).

The top Democrat on the Ways and Means Committee, Rep. Sandy Levin, D-Mich., said, "We deserve better and we need to do better." He also mentioned how groups like the American Medical Association had come out against the bill because it thinks a permanent fix is needed.

House Minority Whip Steny Hoyer, D-Md., appeared outraged on the House floor, calling the patch, "a fraud."

"And both sides have committed that fraud," by not committing to finding a permanent solution to the issue. "What a lamentable fact we cannot summon the courage and wisdom to do just that."

The plot thickened, when House Minority Leader Nancy Pelosi, D-Calif., said in her weekly press conference that she would be voting for the bill. She called it "a bad choice, but it's the only choice we have." Her interpretation of the Republican leadership's decision to put it up under suspension was that they don't have 218 votes to pass it, so they did it under suspension hoping Democrats would move it across the finish line. And, "if they don't have the votes" they could "blame it on us that this didn't pass."

Debate on the fix and another unrelated bill ended and leadership hustled into closed-door meetings, where a new deal was apparently struck: let the bill pass by voice vote.

Members returned and within seconds the bill had passed, catching members, staff and reporters alike off-guard.

Rep. Peter Welch, D-Vt., said it was "outrageous," that it passed this way, saying, "I didn't know it happened. We should be voting."

Rep. John Fleming, R-La., wasn't surprised by the voice vote, but agreed that members should have to vote on bills. His explanation for letting this one slide is that it was a "choice between bad and worse" because the bill was dropped on members at the last minute.

Members on both sides of the aisle mimicked Fleming's explanation that everyone was caught between a rock and a hard place, a bad choice or a different bad choice, all insisting they're for a permanent fix - but not at the expense of seniors who might be denied coverage come Tuesday if a patch didn't pass, and providers thought they wouldn't be reimbursed at the full level.

A permanent fix remains to be seen. Earlier this month, the House passed a $137 billion permanent fix that included savings from a 5-year-delay of the individual mandate penalty, which was tied to the law. That attachment was the poison pill which made Senate Democrats choose to not take it up, and caused the White House to issue a veto threat against the bill.