HEALTH – The Fix Is Not In As Senate Moves Closer To Cloture Vote

by Anna Edney with Dan Friedman contributing

Senate Democratic leaders scheduled a vote on cloture today on a permanent Medicare physician payment fix after they failed to reach an agreement with Republicans on amendments.

Democrats worked several days to avoid a cloture vote after their own members opposed the fix because it is not offset and Republicans withheld expected support. Majority Leader Reid said he still hopes to work out a deal with GOP leaders on amendments prior to the vote.

The $245 billion bill, by Sen. Debbie Stabenow, D-Mich., would repeal the payment formula that results in annual cuts like the 21 percent payment reduction looming next year. Democrats brought the bill to the floor last week to give physician groups a shot at what they have clamored for as part of the healthcare overhaul. The price tag has kept a permanent fix out of the Senate overhaul bill.

Democratic leaders did not have the 60 votes to cut off debate as of Tuesday. If the cloture vote today fails, as many expect, Democrats will have to regroup to appease physicians as they take up the overhaul bill.

Budget Chairman Kent Conrad wants to amend the bill to transform it into a two-year patch that is offset. Conrad’s proposal would wipe out the 21 percent cut set for next year and replace it with two annual 0.5 percent raises in Medicare physician pay.

The two-year patch will cost $25 billion, Conrad said, and is offset, but the senator would not disclose how it is paid for. His proposal would create a commission to craft a permanent fix.

“There have been one-year, two-year, five-year, 10-year fixes proposed,” Majority Whip Durbin said. “How you pay for them and how many votes you put on the board is what it’s all about.”

The American Medical Association floated talking points Tuesday saying physicians would not support a short-term fix. The talking points argue the $245 billion is not new spending since lawmakers have averted the cuts every year for the last seven years.

“It is fiction to pretend that the Medicare physician payment baseline is operative,” the one-pager stated.

AMA also argued in the one-pager that the cost to repeal the physician payment formula will grow as time stretches out, just as it did between 2005, when the cost was $49 billion, and now.

American Medical Association President J. James Rohack To hide the Thumbnails, click on the white arrow on the right. —ed

“Temporary patches have increased the cost of repeal and increased the size of future Medicare physician payment cuts,” AMA President James Rohack said later Tuesday.

Though some in their own party opposed the fix because it was not offset, Democrats blamed Republicans for the possibility the permanent fix will not pass.

“We were told from the outset that this was going to be bipartisan as it has been historically,” Durbin said. “Turns out, Republicans believe that they can derail healthcare reform by defeating the doc fix. That’s what this is all about. This is another way to slow down the process and stop healthcare reform. That is what drives their caucus.”

U.S. Sen. Bob Corker (R-TN)

Republicans argued they do not want to add to the deficit.

Sen. Bob Corker, R-Tenn., called Stabenow’s bill “one of the most sinister, selfish and short-sighted solutions I have seen in my two years and 10 months in Washington.”

Stabenow said Democrats were surprised by uniform GOP opposition.

“There was a sense that we’d have more Republican support,” Stabenow said. “I think it’s part of the whole ‘just say no’ approach right now, since this is something that the president would like to do to solve this once and for all to solve this for physicians so that seniors would feel comfortable that their doctor is available. It is not taking on another dimension because if the president wants it, Republican leadership is going to just say no. And in the past, originally when I introduced the bill it was a bipartisan bill.”

House Democratic leaders also said Tuesday they would not pass the Senate’s version of the physician payment fix unless the upper chamber also passed statutory pay/go with exemptions for reducing the estate tax, cutting middle-class taxes, patching the alternative minimum tax and fixing physician payments.

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U.S. Sen. Bob Corker (R-TN)To hide the Thumbnails, click on the white arrow on the right. —ed