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Medicare Payment Fix Stalls in Senate

By Drew Armstrong, CQ Staff

October 21, 2009 -- Legislation that would stop cuts to Medicare's physician payment rates over the next decade failed to surmount a procedural test in the Senate Wednesday, sending Democratic leaders back to the drawing board.

By 47–53, the Senate failed to limit debate on the motion to proceed to consideration of the Medicare payment bill (S 1776). That was 13 votes short of the 60 needed to invoke cloture and call up the bill.

Majority Leader Harry Reid, D-Nev., indicated Democrats now will settle for the same solution Congress has adopted almost every year—a "patch" to spare doctors a scheduled 21 percent reduction in their Medicare payments next year. Any broader fix, he said, will have to wait until after the Senate passes its comprehensive health care overhaul bill.

Reid vowed, "We're going to make sure that ... Medicare patients have the ability to go to a doctor. We'll take this up again when we finish health care. ... Right now we only have a one-year fix" in the Senate Finance Committee's overhaul bill.

While Democrats control 60 votes, some of their moderates balked at the roughly $245 billion cost of the payments bill, which would essentially eliminate a Medicare cost control formula that each year demands deep cuts to physician pay. The cost would not be offset.

Debbie Stabenow, D-Mich., the bill's sponsor, argued that it "would allow us to do away with a very flawed process," which has seen Congress step in virtually every year for the past decade to stop cuts scheduled under a Sustainable Growth Formula set in a 1997 deficit reduction law.

She said the broad health care overhaul Democratic leaders and the White House are assembling from the Finance bill (S 1796) and a separate measure (S 1679) approved by the Health, Education, Labor and Pensions Committee would help adjust Medicare's payment structure and incentives for the future. "But right now, this needs to be changed," she said.

Reid said too many doctors already decline to take new Medicare patients because of low payment rates. He blamed Republicans for not supporting the bill, calling it "another effort to slow down, divert and stop what we're trying to do with health care and everything else."

Several Republicans said they would support some type of payment fix to spare doctors a scheduled 21 percent cut in their Medicare payments next year, but not without any offsets.

Republicans want to offer amendments to any payment bill that makes it to the floor, including an attempt to limit medical malpractice litigation—a longtime GOP objective. Republicans want to cap punitive and non-economic damage awards, encourage settlements and take other steps to limit malpractice lawsuits. Too many doctors, they say, practice defensive medicine, ordering unnecessary tests and procedures to protect themselves against lawsuits.

Another proposal Republicans would like a vote on would divert funds from the Troubled Assets Relief Program to help offset part of the cost of stopping cuts in Medicare payments.

But Reid and Senate GOP Leader Mitch McConnell of Kentucky failed to reach any agreement on amendments that could be offered to the payment fix legislation.
"I'm going to vote against this deficit-expanding bill because enough is enough," McConnell declared.

Moderate Democrats said they would support a shorter payment fix that was fully offset.

Joseph I. Lieberman, I-Conn., who caucuses with the Democrats, warned against simply adding to the national debt by hundreds of billions of dollars.

"The road to an unsustainable national debt is paved with good programs with good intentions," he said. "We can't have, no matter how good or how worthwhile, programs that we are not prepared to pay for."

Lieberman advocated another temporary one-year patch for the doctor payments, as included in the Senate Finance Committee's version of the health care overhaul (S 1796). "I just think one year is enough—one year paid for," he said.

"All of us want to keep this cut from happening," McConnell said. "But the American people don't want us to borrow another cent to pay for it. And they don't want Democrats in Congress to pretend that this quarter of a trillion dollars isn't part of the cost of health care reform—because it is."

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