Democrats Seek One More GOP Vote to Stop Medicare
Physician Fee Cut, Target McCain
Physician fee cut also could affect
Tricare, the U.S. military
health care program; Fewer Texas doctors taking new Medicare patients
July
9, 2008 - Democrats are attempting to convince one additional Republican
senator to vote to invoke cloture on a House-passed bill (HR
6331) that would delay a 10.6% reduction to Medicare
physician fees that was scheduled to take effect last week,
CQ Today reports
(Armstrong, CQ Today,
7/8).
TheCenters for Medicare & Medicaid
Services provided Congress with more time to act on blocking the fee
reduction, freezing physician fee rates until July 15 through an
administrative measure.
A spokesperson for Senate Majority Leader Harry
Reid (D-Nev.) said that the Senate will again vote to invoke cloture on
the measure as early as Wednesday. The measure failed to receive cloture
in the Senate by one vote on June 26. The House last month
passed the measure by a
veto-proof margin. The bill is similar to a measure (S
3101) proposed by
Senate Finance Committee
Chair Max Baucus (D-Mont.), which also
failed to receive enough
votes for cloture (Kaiser
Daily Health Policy Report, 7/8).
Senate Majority Whip Richard Durbin (D-Ill.) said
that Democrats are looking to presumptive Republican presidential
nominee Sen.
John McCain (Ariz.) --
who did not participate in the last vote - for the additional vote.
A McCain spokesperson said he again will not be
present to vote.
Sen. Edward Kennedy (D-Mass.) also will miss the
vote for a second time because of his cancer treatment. Presumptive
Democratic presidential nominee Sen.
Barack Obama (Ill.) voted
for cloture on June 26, and a spokesperson said that Obama's vote would
remain unchanged (CQ Today,
7/8).
Medicare Vote Complicated for McCain
McCain has yet to disclose his position on the Medicare bill,
The Hill
reports. However, should he vote no on the measure, "Democratic leaders
are poised to blame [him] for the chamber's failure to advance" the
bill.
According to
The Hill, "McCain could
find himself in a tough spot" because if he votes for the bill, "he
would please physicians' groups but anger insurance companies, many of
his Senate Republican colleagues and the White House."
Fewer Texas
Physicians Accepting New Medicare Patients; Payment Cut Would
Exacerbate Problem
Fifty-eight
percent of Texas physicians are accepting new Medicare
beneficiaries, compared with 90% before 1990, according to a
survey by the
Texas Medical Association,
the
Houston Chronicle reports. The proportion of
primary care physicians accepting new beneficiaries is 38%,
according to the survey.
The
physicians say treating these patients is no longer affordable
because of Medicare reimbursement rates, which have declined by
20% in inflation-adjusted dollars over the last seven years. TMA
predicts that the trend will continue unless Congress develops a
long-term solution regarding physician reimbursement under
Medicare, with
debate in Congress
continuing over how to eliminate a scheduled Medicare physician
payment cut.
The cut was
originally scheduled to take effect last week, but
CMS announced it
would process no new claims until July 15, giving Congress a
chance to block the measure. If the cut, and an additional 5%
cut scheduled for January 2009, take effect, Texas physicians
would lose $860 million treating Medicare beneficiaries over the
next 18 months, according to TMA.
"In my 50
years in medicine, I've not seen the level of frustration and
anger out there now," TMA President Josie Williams said.
Williams added, "Most doctors have got to the point that they
don't think the real problem's ever going to be fixed and are
looking at whether to continue participating. They feel they've
carried Medicare on their backs as long as they can" (Ackerman,
Houston Chronicle,
7/3).
If he does not vote or votes against the measure,
"he would open himself up to attacks of supporting a cut in doctors'
payments and stiff-arming elderly and military veterans' access to
Medicare," The Hill
reports. Durbin said, "There's nothing to stop (the cut) unless the
Republican senators give us one more vote, and we'd like to know where
John McCain is on the issue."
According to
The Hill, "Any one of the
39 Republicans who voted no could rescue McCain from a politically
damaging situation" (Raju/Young,
The Hill, 7/8).
Tricare Affected by Cut In related news, Durbin on Saturday during a Democratic radio
address said that the physician fee cut also could affect
Tricare, the U.S.
military health care program,
CongressDaily reports. Payment rates under Tricare by law
are linked to Medicare rates. However, Tricare is granted more
flexibility to implement the rate cut than Medicare, retired Col. Steve
Stobridge, director of government relations for the
Military Officers Association of
America, said. He added that the rate cut would not take
effect until later in the summer.
MOAA on Tuesday sent a special alert to its members
asking that they e-mail senators about the cut to Tricare, which yielded
about 14,000 e-mails to legislators, according to Stobridge. Baucus on
Tuesday said, "Further delay could endanger health care for military
retirees and even for those on active duty."
According to
CongressDaily, a Baucus
spokesperson said his comments were not intended to elicit Republican
votes on the physician fee measure. "I think as the cut takes effect,
its implications across the board -- including this one outside Medicare
-- are becoming more apparent," the spokesperson said (Edney,
CongressDaily, 7/9).
No Amendments, Reid Says Reid on Tuesday said that if the measure gains cloture and moves to
the floor, he would not allow any amendments,
CQ
HealthBeat reports (CQ
HealthBeat, 7/8). Some Republican senators, especially
Sen. Arlen Specter (Pa.), said they voted against cloture because they
were not allowed to offer amendments, according to
CQ Today (CQ
Today, 7/8).
Reid said that "75% of the Republicans in the House
voted for" the bill, adding that "it seems a little unusual to me that
this bill, they want to change it now, send it back to the House, and
every day that it's not passed, seniors are being affected, doctors are
being affected and veterans are being affected" (Raju,
The Hill,
7/8).
Reid on Tuesday also responded to a 31-day
extension of payment rates that was offered by some Republicans. Reid in
a letter to Republican leaders wrote that the "suggestion of a 31-day
extension is as disingenuous as it is ineffective," adding, "It will
only offer patients and doctors uncertainty and administrative
headaches" (CongressDaily,
7/9).
If the measure receives enough votes to invoke
cloture, it is expected to pass,
CQ Today reports. However, the Bush administration has
vowed to veto it because of cuts to Medicare Advantage. White House
spokesperson Tony Fratto on Tuesday said, "There's been no change in our
position" on the measure (CQ
Today, 7/8).
Opinion Several newspapers on Wednesday published opinion pieces related to
the Medicare bill and the reduction to physician fees. Summaries appear
below.
● Mike Leavitt,
Wall
Street Journal: Congress this week "will demonstrate
if it is serious or not about reining in entitlement spending" with its
vote on the House bill because it contains a provision that would stall
a competitive bidding program for durable medical equipment,
HHS Secretary Leavitt
writes in a Journal
opinion piece. Leavitt continues, "Right now the government is paying
insane rental prices for medical equipment -- prices far higher than it
would cost to purchase the equipment outright." He writes, "Make no
mistake: 'Delay' means 'kill,'" adding, "Killing this competitive
bidding program would cost taxpayers about $1 billion annually, while
unjustly overcharging senior citizens." Leavitt concludes, "If Congress
fails to uphold even this modest effort at entitlement reform, there is
little reason to believe its members will muster the political courage
for the unspeakably harder choices that await them" (Leavitt,
Wall Street Journal,
7/9).
● Nancy Nielsen,
Philadelphia Inquirer: "It's time to put politics
aside and do what is right for patients" by passing the House bill and
stopping the physician fee cut,
American Medical Association
President Nielsen writes in an
Inquirer opinion piece. Nielsen continues, "There's long
been bipartisan support to stop the cuts, and the bill ... should be
considered and passed by the Senate." According to Nielsen, "Only the
health insurers appear content with the status quo" because "private
Medicare plans are making money hand over fist for insurance executives
and Wall Street." She continues, "Without Senate action to stop the
cuts, the promise of Medicare -- that it will be a viable insurer for
our nation's seniors -- will be broken," and "[b]reaking that promise is
the last thing physicians want." Nielsen concludes, "The bill will come
up for a second vote," and "America's physicians call on Senator Specter
to vote yes" on the bill (Nielsen,
Philadelphia Inquirer,
7/9).
● "Viewsday,"
Long Island
Newsday: The
Medicare argument "centers on payments to doctors," but it is "more
about leveling costs between special private plans and their traditional
Medicare cousins," according to
Newsday's opinion blog "Viewsday." A recent audit by the
Government Accountability Office
"indicates that although Medicare Advantage was originally sold as a way
to rein in medical costs, it has generally increased spending -- perhaps
not the soundest way to salve a growing health care crisis,"
Newsday writes ("Viewsday,"
Long Island Newsday,
7/9).
Broadcast Coverage
● American Public Media's "Marketplace
Morning Report" on Wednesday reported on the Medicare bill.
The segment includes comments from Joseph Antos of the
American Enterprise Institute
and Richard Brown of the University of California-Los Angeles
School of Public Health
(Marshall Genzer, "Marketplace Morning Report," American Public Media,
7/9).
● WAMU's "The
Diane Rehm Show" on Wednesday also reported on the Medicare
bill. The segment includes comments from Ron Pollack, executive director
of
Families USA; Stephen
Moore, a member of the Journal's
editorial board and former president of the
Club for Growth; and
Julie Rovner,
NPR's health policy
correspondent ("The Diane Rehm Show," WAMU, 7/9).
