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Medicare payment bill fails Senate vote

The measure to overturn a scheduled 21% reduction in doctors' fees was blocked by a mixture of Republicans and centrist Democrats who objected that its $250-billion cost over 10 years was not offset.

October 22, 2009|Janet Hook and Noam N. Levey

WASHINGTON — With budget anxieties pervading the congressional healthcare debate, the Senate on Wednesday sidetracked popular legislation that would have increased Medicare payments to doctors by nearly $250 billion over the next decade.

Voicing concern about adding that much money to the federal deficit, a coalition of 12 centrist Democrats, one independent and all the Senate's Republicans voted to block consideration of the bill, at least for now.

The goal of the bill -- to overturn a scheduled 21% reduction in doctors' fees under Medicare -- enjoys broad bipartisan support. But opponents in both parties objected that the measure included no tax hikes or spending cuts to offset its price tag.

The vote was 53-47 against a motion to bring the bill to the floor, 13 short of the 60 needed under Senate rules. Senate Majority Leader Harry Reid (D-Nev.) promised to find another way to block the fee cut, scheduled to take effect next year.

But the setback for Reid represented a warning about the unpredictable road ahead for the far more controversial and expensive propositions at the core of President Obama's healthcare overhaul.

Even as the Senate voted on a simple and popular bill to help doctors, Democratic Party unity frayed; the once powerful American Medical Assn. did not get its way; and fiscal conservatism scored a rare triumph.

"With a record deficit and a ballooning national debt, the American people are saying enough is enough," said Senate Minority Leader Mitch McConnell (R-Ky.). "Today's vote shows that this message is finally starting to get through to Congress. Hopefully it's a sign of things to come in the healthcare debate ahead."

But with the vote, Senate Democrats delivered a clear and important message to the AMA that the organization's top priority cannot be included in the bill without jeopardizing an overhaul that many in the medical profession believe is crucial to preserving the nation's healthcare system.

After the vote, Dr. J. James Rohack, AMA president, called the measure a "victim of Senate politics."

"Congress needs to fulfill its obligation to seniors, baby boomers and military families," Rohack said in a statement.

But an AMA official said the medical group was not withdrawing its support for a healthcare overhaul, a key position that has helped sustain the Obama administration's campaign.

Congressional Democrats and the White House have been carefully courting the AMA for months, conscious of the group's work to derail previous healthcare overhaul efforts. The Senate vote may be a sign that the doctors group, although influential, is not the powerhouse it once was.

The bill before the Senate was an effort to fix a long-standing quirk in Medicare law that cuts doctors' fees when program spending outpaces economic growth. Congress has routinely intervened year after year to overturn the cuts at the behest of the AMA, in an attempt to keep doctors from dropping Medicare patients.

Despite wide agreement that the payment system should be fixed, Republicans and some conservative Democrats argue that the bill should be deficit neutral, in the spirit of Obama's promise that his healthcare initiative would add "not one dime" to the deficit.

The roll call vote was a field guide to the kind of Democrats who will have to be persuaded that the costs of the broader healthcare bill are fully offset, including Southerners like Sen. Jim Webb of Virginia and fiscal conservatives like Senate Budget Committee Chairman Kent Conrad of North Dakota.

Democrats may come under even more pressure to address healthcare spending as a result of a report released Wednesday by the Department of Health and Human Services. It cast doubt on the ability of healthcare overhaul to slow the growth in the nation's annual healthcare tab, which is set to surpass $2.5 trillion this year.

The report estimated that the original healthcare legislation proposed by House Democrats -- which is being revised by party leaders -- would accelerate the growth in healthcare spending over the next decade by 2.1 percentage points over what had been projected without an overhaul.

That is in large part because as more people get health insurance, more are likely to obtain medical care.

The Obama administration dismissed the report as out of date.

Also Wednesday, congressional Democrats stepped up pressure on another powerful interest group in the healthcare debate: insurers.

The House Judiciary Committee voted 20-9 to eliminate the insurance industry's decades-long exemption from antitrust law, and Senate Democratic leaders announced they would try to attach a similar amendment to their healthcare overhaul.


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