WASHINGTON — In uncommon bipartisan harmony, the House approved a $214 billion bill on Thursday permanently blocking physician Medicare cuts, moving Congress closer to resolving a problem that has plagued it for years.
The lopsided 392-37 vote shifted pressure onto the Senate, where its prospects have brightened as Democrats have muffled their criticism and President Barack Obama has embraced the bill. But with some conservatives also balking at the legislation, its fate there remained murky.
Thursday's House vote came on a package that bore victories for Republicans and Democrats alike and was negotiated by the chamber's two chief antagonists, Speaker John Boehner and Minority Leader Nancy Pelosi. That unity contrasted vividly with the usual partisan duels that hamper most congressional efforts on budget, health and other major policies.
The vote even gave House GOP leaders a respite from the large-scale rebellions they frequently face from tea party conservatives, including on a measure last month that prevented a Homeland Security Department shutdown. Republicans backed the Medicare bill 212-33, while Democrats tilted "yes" by 180-4.
The bill contains funds for health care programs for children and low-income people that Democrats touted as victories. Republicans won long-term strengthening of Medicare's finances, including cost increases for higher-income recipients.
Buoyed by such incentives, House members more accustomed to gridlock found themselves with little to argue about. Instead, they praised the bill and each other — one Republican even wished Pelosi, D-Calif., a happy birthday — as they all but marveled that they had united to address a persistent problem.
"I just want to say to the American people, don't look now but we're actually governing," said Rep. Renee Ellmers, R-N.C.
Time was a factor. Congress planned to leave town by week's end for a spring break, and physicians treating Medicare patients face a 21 percent fee cut on April 1 unless lawmakers act. If the Senate doesn't give final approval before recessing, the federal agency that sends checks to doctors could delay processing them until lawmakers return to the Capitol.
Underscoring dissatisfaction by some conservatives Sen. Ben Sasse, R-Neb., said in a Politico column that the bill would add too much to federal deficits and didn't do enough to solve Medicare's financial problems.
Physician groups have long warned that the constant procession of threatened slashes in their Medicare fees could mean fewer doctors would treat the program's elderly recipients.
After the House vote, the American Medical Association and other medical organizations urged the Senate to quickly approve the measure, saying it would have "a real and lasting impact" on patients and doctors' practices. AARP, the seniors' lobby that has criticized the higher costs the legislation would bring for Medicare beneficiaries, conceded it would pass the House but said it would "continue to work with Congress to improve the bill."
"This is what we can accomplish when we're focused on finding common ground," said Boehner, R-Ohio. He said Republicans would continue pushing to tighten the finances of Medicare and other costly federal benefit programs, a battle that has led to stalemates with Obama for years.
"It shouldn't take another two decades to do it," Boehner said.
In an unusual split with Pelosi, some Senate Democrats and abortion-rights groups have complained that the bill would cement into permanent law abortion restrictions at community health centers. Pelosi, a longtime abortion-rights advocate, has said the measure's abortion restrictions would be temporary and simply continue limitations Congress has imposed annually since 1979.
Democrats also wanted four more years of extra money for the Children's Health Insurance Program, which serves 8 million low-income children, rather than the bill's two years. Yet Democrats seemed mostly eager to back the bill and claim that money as a triumph, along with its other funds for community health centers, which serve the poor, and to help some low-income people pay Medicare premiums.
"It was my honor to work with Speaker Boehner on this important issue, to do what we came here to do — to legislate," she said.
The measure's chief goal is replacing a 1997 budget-cutting law that tied doctors' Medicare fees to overall economic growth. With medical costs growing, that formula has threatened deep reimbursement cuts that lawmakers have blocked 17 times since 2002, a ritual both parties want to end.
The nonpartisan Congressional Budget Office said the measure's costs totaled $214 billion over the next decade. To pay for it, $141 billion would come from deeper budget deficits while the rest would be divided between Medicare recipients — mostly bigger monthly premiums for the highest earners — and providers like nursing homes and hospitals.
Republicans touted the increased premiums for upper-income Medicare beneficiaries as a win that would help restrain the $500-billion-a-year program and open the door for future overhauls.
The measure also has money for diabetes research, abstinence education, rural hospitals and schools and training health professionals who agree to serve in low-income areas.