Reporting from Washington — Doctors in 14 California counties have been poised to receive a boost in what Medicare pays for their services under legislation being debated on Capitol Hill to expand tax breaks and federal aid to unemployed workers.
But the proposed raise, which would correct a perceived imbalance in the way the federal insurance program reimburses physicians in some metropolitan areas, is emerging as a new target for Republican lawmakers fighting the legislation.
FOR THE RECORD:
Medicare bill: An article in Saturday's Business section about a Medicare measure that would boost payments to doctors in some urban areas said Alpine County in California is near Oregon. It is near the Nevada border. —
Sen. Tom Coburn (R-Okla.) is trying to strip out the $400-million raise, contending that California is getting a special deal.
"We need a doc fix for the entire country, not a partial fix for one state," Coburn said in a statement. "The American people are tired of special deals that pick winners and losers on the basis of politics rather the country's best interest."
Supporters of the raise, which was originally in the House version of the healthcare overhaul, point to independent studies by the Government Accountability Office and others that show the formula has depressed Medicare payments in parts of many states, but most prominently in California.
The low reimbursement rates are forcing doctors in some urban areas to stop seeing new Medicare patients, said Rep. Sam Farr (D-Carmel), who has been pushing for a change in the Medicare formula for more than a decade. "This is denying access to seniors."
The root of this debate is one of the most arcane parts of the 45-year-old Medicare program: the complex system the federal government uses to calculate what it pays physicians depending on where they work.
In many states, Medicare pays doctors in urban areas more than those in rural areas to reflect the higher cost of practicing in cities. But many counties in California and in other states have been classified as rural in part because they were less developed when Medicare devised the payment formula.
As a result, Medicare pays doctors in San Diego and Sacramento counties $66.78 for a typical office visit, the rate that physicians are paid in undeveloped areas such as Alpine County, Calif., on the border with Oregon.
Meanwhile, doctors in Los Angeles and Orange counties are paid more than $73 a visit; those in parts of the San Francisco Bay Area are paid close to $80. Eight California counties are currently paid at the higher rate, according to the U.S. Department of Health and Human Services' fee schedule.
The legislation being debated in Washington would allow Medicare to expand the number of counties in metropolitan areas beginning in 2012.
That would effectively boost the payment rates in 14 additional counties with high costs, including San Diego, Riverside, San Bernardino, Sacramento, Yolo, Santa Barbara, Santa Cruz and Sonoma.
To prevent Medicare rates from falling in the remaining rural counties, the federal government would have to spend $400 million over the next five years, according to the nonpartisan Congressional Budget Office.
Unlike doctors in some other states, California physicians have also agreed on a long-term way to offset the cost of raising reimbursements in some areas.
"We tried for years to get together with doctors in other states," said Elizabeth McNeil, vice president for government relations at the California Medical Assn.
McNeil said that if the new system works, it could be extended to other states with similar issues.
But the payment formula remains a political flashpoint.
Traditionally, GOP lawmakers from California have backed the change. Reps. Darrell Issa of Vista, Duncan Hunter of Alpine, Mary Bono Mack of Palm Springs and Brian P. Bilbray of Carlsbad cosponsored a bill by Farr last year to change the Medicare funding formula for California.
Now, representatives for Issa and Hunter say they oppose adding the change to the current legislation. An official in Bilbray's office said the congressman was still reviewing it. Bono Mack's office did not respond to an inquiry.
Tom Hamburger of the Washington bureau contributed to this report.