Some Senate Democrats Help Republicans Defeat $247 Billion Medicare Payment 'Doctor Fix'

"Democrats lost a big test vote on health care legislation on Wednesday as the Senate blocked action on a bill to increase Medicare payments to doctors at a cost of $247 billion over 10 years," the The New York Times reports. Senate Majority Leader Harry Reid, a Nevada Democrat, "needed 60 votes to proceed. He won only 47. And he could not blame Republicans. A dozen Democrats and one independent crossed party lines and voted with Republicans on the 53 to 47 roll call." Reid said the bill was needed to ensure doctors would continue taking Medicare patients, but Republicans balked because the bill wasn't paid for." The bill has "become a proxy" for the larger health system overhaul debate, the Times reports.

"Under current law, doctors face a 21.5 percent cut in Medicare fees in 2010 and then annual 5 percent cuts for several years" (Pear and Herszenhorn, 10/21).

The Washington Post: "The 'doc fix' has become a near-annual ritual in Congress: Lawmakers routinely override the formula that sets Medicare payments to doctors, a move to prevent physicians from turning away Medicare patients because they are paid too little for the visits." While most lawmakers agree that the formula, "established in a 1997 deficit-reduction bill, is a failed model, producing the enormous sum needed to eliminate it has proven impossible." The Post reports that "although Republicans participated in talks to find ways to offset the $247 billion, no single revenue source found consensus, and GOP senators decided to turn Wednesday's vote into a referendum on deficit spending and the price tags of the huge health-care reform bills slated to come to the House and the Senate next month" (Murray, 10/22).

The Los Angeles Times reports that Senate Democrats are telling the American Medical Association, which backed the bill, that it cannot include the organization's top priority in their sweeping health care reform measure without jeopardizing the entire legislation. "Despite wide agreement that the payment system should be fixed, Republicans and some conservative Democrats argue that the bill should be deficit neutral" (Hook and Levey, 10/22).

Politico: "The vote served as a test of the majority leader's ability to hold his caucus together for a health care vote — and in the end, he couldn't even muster a simple majority of Democrats or persuade a single Republican to come on board; not even Sen. Olympia Snowe (R-Maine)" (Budoff Brown and O'Connor, 10/22).

CongressDaily: "'Many people are looking at this as the first big vote in the healthcare debate,' Senate Minority Whip (Jon) Kyl said after Democrats not only came up short of the 60 votes they needed, but couldn't even win a majority" (Friedman, 10/22).

The Wall Street Journal reports that Reid intends to proceed with a shorter-term fix for Medicare payment rates that's present in the Senate Finance Committee's health reform bill and adds: "The defeat could make it more difficult for lawmakers to win support for the broader health overhaul from doctors. J. James Rohack, president of the American Medical Association, said the doctors group was 'deeply disappointed' the measure had been blocked. 'Permanent repeal of the payment formula is essential to ensuring the security and stability of Medicare,' he said" (Adamy and Hitt, 10/22).

McClatchy Newspapers/The Miami Herald reports that the Senate Finance Committee's one year fix will increase payments 0.5 percent next year and will cost about $11 billion (Lightman, 10/22).

The Christian Science Monitor has background on the problem: "When Congress passed the 'sustainable growth rate' formula for Medicare in 1997, the aim was to give physicians treating Medicare patients an incentive to rein in costs. Instead, healthcare costs so outstripped the rate of inflation that the formula translated into accelerating cuts for physician payments, driving many in the profession out of the business of serving Medicare patients. Congress has passed a 'fix' every year since 2003 to avert the cuts" (Russell Chaddock, 10/21).

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