A week and a half ago, when House Republican leaders realized that their own conservative members might align to defeat legislation protecting Medicare physicians from a big automatic pay cut, they took the unusual step of cutting them out of the tangle altogether.

While negotiations were ongoing, the Majority Leader, Eric Cantor, darted on to the House floor and, after brief consultation with Democratic leaders, cleared the Medicare "doc fix" by voice vote—a procedure that's typically reserved for fast tracking uncontroversial legislation. The yeahs and nays were not recorded. A bill that divided the GOP conference, and might very well have failed in front of God and everyone under the leadership's own rules, had passed the House before many Republicans even knew what Cantor was up to.

He and other Republican leaders have been busily making amends with conservative rank and file members ever since. Those members were understandably furious about the breach of protocol, but some were privately grateful that the bill had passed—even if they would have voted against it had Cantor not done a shady end run around them. Everyone wants to play the fiscally responsible part but nobody wants to answer to the doctors and the Medicare beneficiary when the bill fails, which helps explain the recent thaw.

But I wonder how many of them knew at the time, or know now, that the leaders used the same doc fix bill to smuggle a bipartisan Obamacare fix through the House uncontested.

The tweak itself is relatively minor. It eliminates a provision of the Affordable Care Act that capped deductibles for small-group health plans at $2,000 for individuals and $4,000 for families.