WASHINGTON — House lawmakers, in a rare outburst of bipartisan cooperation, approved a bill on Thursday that would end a flawed Medicare payment system and spare doctors and patients the annual threat of severe cuts.
But the breakthrough faced uncertainty in the Senate, as lawmakers prepared to leave for a spring recess and continued Thursday evening to question aspects of the bill.
The House passed the $214 billion package by a sweeping margin, with only 37 dissenting voices and all Massachusetts lawmakers supporting it. The vote marks a rare achievement for House Speaker John A. Boehner and minority leader Nancy Pelosi, who negotiated the compromise.
“Maybe it will be contagious, maybe we will actually start doing things,” said Representative James McGovern, a Worcester Democrat.
The bill would scrap an outdated formula that determines how Medicare pays doctors and replace it with an incentive-based system that prioritizes quality care rather than tying fees to the amount of services provided. It also would provide funding for community heath centers and renew a low-cost children’s health insurance program for two years.
Congress has failed to pass a permanent fix of the Medicare payment formula for more than a decade, turning instead to an annual ritual of costly patches known as “doc-fixes.” Without a solution, physicians face a 21 percent pay cut by April 1.
House Democrats expressed concerns earlier in the week about a portion of the bill that would raise premiums for upper-income Medicare beneficiaries. But only four voted against it. Lawmakers applauded when the vote ended and then darted for the exit. This was the last vote before their spring recess.
Boehner framed the deal as entitlement reform and has called it a “big win for conservatives.” But he spoke of compromise Thursday morning when he took to the House floor.
“We’ve had a patch of this problem 17 times,” he said. “I decided about a year ago that I had enough.”
Pelosi, who also spoke before the vote, said she was “very proud of what the legislation means to women and their health issues.”
And she too lavished praise on her frequent nemesis.
“I hope it will be a model of things to come,” she said.
The significant House support, and President’s Obama’s endorsement of the legislation on Wednesday, puts additional pressure on wavering Senate Democrats. Neither party likes the formula, which came out of a 1997 law aimed at deficit reduction.
Failure to find a solution would cost Massachusetts providers $300 million, affecting close to 20,000 doctors and 1.1 million Medicare patients in the state.
“It would be a major accomplishment, so I hope we can do it,” said Senator Orrin Hatch, a Utah Republican and head of the Senate Finance Committee.
But the odds of quick action appeared to dwindle Friday morning as senators engaged in a marathon round of votes on a separate budget resolution that started at noon and went past midnight.
Some Senate Democrats, including minority leader Harry Reid, have voiced concerns about the length of funding the child’s health insurance program — two years instead of four — and on abortion restrictions on community health centers.
“If you are going to fix this forever for the doctors, you ought to at least do four years for the poor little children,” said Bill Nelson, a Florida Democrat.
Senators may buy themselves time. The Centers for Medicare and Medicaid Services can delay claims processing until April 14, meaning senators would have a day to consider the bill when they return from the two-week vacation without an adverse effect on doctors.
Massachusetts Senators Elizabeth Warren and Edward J. Markey have not said how they would vote, setting up the possibility of a divide in the delegation. Warren on Wednesday said only that she was “disappointed” that provisions in the bill “needlessly threaten to undermine” protections for women and children.
Several conservatives were frustrated that taxpayers would shoulder $140 billion of the total package, including Senator Ben Sasse, a Nebraska Republican. Dissents in the House came largely from fiscal hawks who did not want an increase in the deficit.
“Members may have solved a parochial political problem with today’s vote but they have exacerbated the nation’s policy problems,’’ said Michael Needham, chief executive officer of Heritage Action for America, a conservative advocacy group that opposed the bill.
Doctors groups and health care providers, longtime champions of a permanent solution, applauded the measure.
“The prospects for a permanent solution to the flawed payment formula have never been better,” said Dr. Richard Pieters, president of the Massachusetts Medical Society, which advocates for physicians.