Controversy, Lobbying Surround Reid's Medicare Doctor Payment 'Fix' Plan

Some news outlets are looking ahead to a vote expected next week "fixing" a planned cut in Medicare payments to physicians, as a key White House adviser says the fix belongs in the federal budget. 

The Hill: "White House Senior Adviser David Axelrod on Sunday suggested Democrats' proposed reforms to Medicare payment rates would not have the budget impact some Republicans say it could. The majority party fielded considerable criticism last week for its so-called 'doc fix' reform package -- a bill that would permanently address fluctuations in Medicare reimbursement payments to physicians and hospitals -- because it costs nearly $250 billion and lacks in-kind revenue offsets. But Axelrod on Sunday said 'it will be part of the [president's] budget,' and he insisted it was essential Congress pass it this year."

Republicans, however, see the bill much differently. ... 'President Obama promised deficit-neutral healthcare reform. And the 'doc fix' is part of healthcare reform -- so why's it being done separately?' Sen. Orrin Hatch (R-Utah) charged on Friday" (Romm, 10/18).

In a separate story, The Hill reports that  "Physicians and their lobbyists are preparing to come out in force next week to push for" passage of the fix. "The American Medical Association (AMA) is at the forefront of the campaign and is a huge part of the reason Senate Majority Leader Harry Reid (D-Nev.) is bringing the Medicare bill to the floor without budgetary offsets just a week before he plans to open debate on a broad healthcare reform bill."

"The physician lobby is desperate for the payments issue to be addressed. For most of this decade, the AMA and other groups have had to fight every year to get Congress to block cuts in their Medicare fees that are the result of a payment system widely regarded as flawed. In 2010, payments would be slashed by 21 percent without legislation" (Young, 10/17).

In a larger piece on Medicare and health reform, Christian Science Monitor provided background on the issue: "In 1997, Congress voted to establish a 'sustainable growth rate' (SGR) for Medicare in a bid to rein in federal deficits. But the annual cuts in the growth of payments to doctors serving Medicare patients proved so unpopular that many physicians stopped accepting Medicare patients. Congress has come up with funds to 'fix' the cuts every year since 2003. On Monday, Senate majority leader Harry Reid launches a bid to end the SGR with a key procedural floor vote. ... The vote sets up a tough choice for moderate Democrats, especially coming just days after the US Treasury announced a record $1.4 trillion deficit for FY 2009. It also sets up a clash with House Democrats, who are committed to pay-as-you-go rules requiring offsets for new spending or tax cuts. But if successful, it moves $245 billion in costs off the table, as Democrats work out a plan to pay for healthcare reform" (Chaddock, 10/17).

In a feature story about the impact of health legislation on Medicare recipients, The Dallas Morning News reports "Because of an outdated system for paying physicians, advocates say, doctors are scheduled to face a 21.5 percent cut in their Medicare reimbursements beginning Jan. 1. If that sharp reduction in fees goes into effect, seniors fear that many physicians might refuse new Medicare patients or reduce the number they treat. The House legislation cancels the Jan. 1 cut and reforms the physician payment system. Though the Senate Finance Committee's bill prevents only the Jan. 1 cut, Senate Democrats last week proposed a permanent fix in a separate measure. Both House and Senate bills also contain pay incentives for primary-care doctors, who are in short supply" (Moos, 10/18). 

CQ HealthBeat: "A spokesman for Minority Leader Mitch McConnell of Kentucky said Republicans have agreed to proceed to the bill only if Democrats agree to allow some amendments. ... Republicans could still raise a budget point of order against the measure, because its cost — estimated at more than $240 billion over the next 10 years — is not offset with any spending decreases or revenue increases. Republicans could also filibuster a vote on passing the bill. Either move would require 60 votes to overcome. But a Democratic leadership aide speculated that Republicans are struggling to decide how to address the measure" (Wayne, 10/16).

Roll Call: "Facing stiff bipartisan resistance ... Reid has decided to scrap a planned Monday vote to begin consideration of the plan. ... Originally included in the massive health care reform bill making its way through Congress, Reid carved out the costly Medicare payment plan and announced a cloture vote Thursday afternoon. But Republicans are opposed to it over a lack of offsets for the bill. Several Democrats like Budget Chairman Kent Conrad (D-N.D.) and Evan Bayh (D-Ind.) have also signaled their opposition. " (Stanton and Brady, 10/16).


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