"They want everybody to give this deal a chance. They're saying it's better to do this now rather than fight it during budget reconciliation. Or if we wait, the cost of the doc fix will be higher. Those are the kinds of things they're pitching on," Adcock said. "That is what they're saying: 'If you can't support it, don't oppose it.' But their primary message is that people should withhold judgment until they see the final deal."
On the right, Boehner and his allies are trying to quell conservative members' skepticism. The conservative advocacy group Heritage Action came out swinging against the doc fix proposal, angry that Boehner had started off by negotiating with Pelosi and frustrated that the bulk of the package — about $130 billion—would not be paid for under the Congressional Budget Office's normal 10-year window.
Boehner is leaning instead on strong support from Americans for Tax Reform, the anti-tax group headed by Grover Norquist.
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Ryan Ellis, ATR's tax policy director, said CBO is expected to release a letter Tuesday clarifying that, while the doc fix deal might not reduce the deficit over the next 10 years, it would lead to considerable savings in the long run.
ATR and Heritage Action made their competing pitches Monday to a group of conservative staffers, where Ellis encouraged them not to worry about the 10-year budget window.
"I could care less about the 10 years. It's entitlement reform," Ellis said. "You would never measure entitlement reform in a 10-year window."
Ellis said ATR has come to the bill's defense so aggressively in part because Heritage Action came out so strong with its argument that the bill isn't paid for. "That's kind of forced us to push an alternative narrative here," he said.
Aides are making a similar pitch to health care industries, according to lobbyists following the issue.
On the policy merits, the American Medical Association has endorsed a permanent doc fix repeatedly—it's the group's biggest priority by far, and it's putting together a broad coalition of physician groups to support the measure Boehner and Pelosi are crafting.
Lawmakers might have a harder time with hospitals, which would absorb a significant share of the bill's provider cuts. A spokeswoman for the American Hospital Association declined to comment on the emerging framework Monday.
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But cuts to pay for a short-term patch could also come from hospitals, making it a question of how much the industry would have to absorb now, versus the costs it would incur over time if Congress can't break the pattern of short-term doc fixes.
The framework essentially treats the doc fix itself as the vegetables that Congress needs, with sweeteners for each side. There's already a bipartisan, bicameral agreement on the specific plan to replace Medicare's payment formula, but previous attempts at a permanent fix have broken down over disagreements about how to offset the cost.