By Susan Cornwell
WASHINGTON, March 14 (Reuters) - The Republican-run U.S. House of Representatives on Friday approved a bipartisan deal to spare doctors from looming Medicare pay cuts, but included a provision to undermine Obamacare that critics said made the bill a non-starter in the Democratic-run Senate.
The vote was 238-181, with most Democrats refusing to swallow the Obamacare "poison pill" Republicans included to delay for five years the tax penalty that Americans must pay under President Barack Obama's healthcare law if they decline to sign up for insurance.
Just a dozen Democrats, some of whom face tough re-election races in November, voted with Republicans to pass the bill, which the White House has threatened to veto.
Hundreds of thousands of doctors who participate in traditional Medicare face a 24 percent pay cut on April 1, a situation dating to a 1990s initiative to restrain federal spending on the government healthcare program, which today serves nearly 50 million elderly and disabled people.
Doctors hoped to see a permanent fix to the recurring Medicare payments problem this year after Republicans and Democrats in both chambers of Congress agreed in February on a policy to replace the payment formula, known as the sustainable growth rate or SGR.
But there was no agreement on how to fund the $138 billion cost of the "doc fix" over the next decade. So House Republicans proposed to pay it by delaying the penalty for the individual mandate to buy insurance under the Affordable Care Act, also known as Obamacare.
Democrats charged this was part of a Republican election-year attack strategy on the 2010 law, noting it was the fifty-first vote in the House to repeal or undermine Obamacare.
They also expressed consternation that Republicans would attach their latest Obamacare attack to a bipartisan compromise to fix Medicare payments that had eluded lawmakers for years.
"For what reason have you poisoned his process?" demanded Democratic Representative Frank Pallone. "You have singled-handedly, in my belief, stomped on months and months of hard work and effort by my colleagues on both sides of the aisle and our staffs."
Republicans acknowledged the combined measure may not have a bright Senate future, but said they had to fund the "doc fix" to get it through the House. They said Senate Democrats should propose their own way to pay for the Medicare changes and then negotiate with the House.
The bill the House approved on Friday "is not the destination. It is the key that gets you through the door to that destination," of fixing the Medicare payments system, said Republican Representative Michael Burgess.
But the House Republican approach brought an unusual public rebuke on Thursday from the American Medical Association, one of the most powerful lobby groups, representing 225,000 physicians who hope for a permanent "doc fix" this year. The group wrote to Congress to express "profound disappointment".
Republicans put Democrats on the spot with the vote, knowing that most backed the Medicare payments reform and some favored at least a short delay in the Obamacare individual mandate.
Earlier this week, the House approved some other exceptions to the Obamacare individual mandate affecting firefighters and veterans, and broadened a religious exemption. Last week, twenty-seven House Democrats voted to delay the individual mandate penalty for one year.
But on Friday, one of those Democrats, Representative Carol Shea-Porter, said she couldn't support a five-year delay because it would seriously undermine Obama's healthcare law. (Reporting by Susan Cornwell; Editing by Stephen Powell)