(AP photo/J. Scott Applewhite)

(Bloomberg) – Members of the U.S. House approved H.R. 4302, a Medicare physician reimbursement bill, by a “unanimous” voice vote Thursday.

The voice vote masked the fact that supporters had trouble rounding up enough votes to pass the bill at all, some lawmakers say.

Lawmakers say House Republican leaders dealt with a lack of certainty about passage of H.R. 4302 by simply not counting votes.

The presiding officer, Rep. Steve Womack, R-Ark., called for a voice vote, asked for the ayes first, and then asked for the nays. He declared the ayes sufficient.

While consideration of H.R. 4302 was already underway, checks of where lawmakers stood on the bill revealed uncertainty about whether it would pass.

Rep. Fred Upton, R-Mich., chairman of the Energy and Commerce Committee, was heard to say on the floor that the House should avoid taking a roll-call vote.

House leaders stopped proceedings on the House floor for about a half hour while mulling their next move. They settled on Upton’s strategy.

The voice vote caught some lawmakers by surprise.

Rep. Lynn Westmoreland, R-Ga., said that, by the time he arrived on the floor after hearing a bell summoning lawmakers to the chamber, the bill had already passed.

“I have no idea” how the vote came about, he said.

The temporary Medicare doc fix bill “was a take-it-or-leave-it deal” worked out by House Speaker John Boehner and Senate Majority Leader Harry Reid, Rep. John Fleming, R-La., told reporters.

Fleming said the strategy was cleared with leaders on both sides and members of the doctors’ caucus, which includes him.

H.R. 4302 now goes to the Senate.

24 percent pay cut

H.R. 4302 is supposed to postpone the effective date of the Medicare “sustainable growth rate” reimbursement system.

Congress created the SGR system in 1997, in an effort to control rising health care costs by tying increases in Medicare physician pay rates to increases in the U.S. gross domestic product.

Congress has never actually let the SGR system take effect.

Lawmakers had hoped to get a “permanent doc fix” bill enacted this year, but they ended up disagreeing about how to pay for a permanent fix.

The replacement bill would postpone the effective date of the SGR system just one more year.

If Congress fails to pass either a temporary doc fix or a permanent doc fix by March 31, or pass a retroactive measure later, Medicare physicians’ reimbursement rates will fall 24 percent.

The replacement bill would increase the Medicare reimbursement rate by 0.5 percent through Dec. 31. There would be no increase from Jan. 1 through March 31, 2015.

Senate leaders plan a March 31 vote on the House-passed measure.

Under an agreement announced by Reid, a 60-vote supermajority will be required for Senate passage of the bill.

Lawmakers of both parties generally agree on delaying the cuts, with one House leader saying there is some “flex time” in the March 31 deadline. They differ on whether to approve a short-term patch over the cuts, or to eliminate entirely the formula that requires them.

The American Medical Association came out strongly against the temporary doc fix bill, arguing that Congress ought to pass a permanent fix.

–With assistance from Kathleen Hunter and Roxana Tiron in Washington.

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