CQ TODAY PRINT EDITION
June 26, 2008 – 10:05 p.m.
Medicare Cloture Narrowly Fails
By Drew Armstrong, CQ Staff
It now looks certain that doctors will take a deep cut to their Medicare payment rates next week, after the Senate failed to move forward on a take-it-or-leave-it Medicare bill offered up by Democrats.
A cloture vote that would have led to passage of the bill (
Feelings were raw following the vote, and predictions dire.
“The doctors are going to survive with a 10 percent pay cut, but they’re going to drop out of the system,” said Majority Leader Harry Reid , D-Nev.
But it’s likely the issue will be revisited shortly after the July Fourth recess. The vote had been 59-39, but Reid changed his vote from “aye” to be on the winning side so that, under procedural rules, the bill could be brought back up later.
“We’ll be back, and you’ll have another opportunity to vote for this,” Reid said.
The bill would have stopped a 10.6 percent cut to Medicare’s physician payment rates, scheduled to take effect July 1.
After the bill’s failure, Senate Minority Leader Mitch McConnell , R‑Ky., offered a motion to extend Medicare’s current physician payment rates for 30 days. Reid objected.
With the House going into recess for the Fourth of July, Senate Finance Chairman Max Baucus , D-Mont., who had shepherded the Medicare effort there, made clear that the bill was the only shot the Senate would get. With the House gone, there is no way lawmakers can stop the cuts.
“There is no alternative,” Baucus said. “This is the only train in the station.”
Republicans were upset at having only one option to vote on the legislation — in the form of a bill passed by the House — instead of getting a chance to support a tentative compromise between Baucus and Sen. Charles E. Grassley , R-Iowa, worked out earlier in the week.
“This is a terrible way for Congress to do business,” said Sen. John Cornyn , R-Texas. He called the bill “a partisan proposal here that we’re being asked to take or leave.”
Grassley, often a close partner with Baucus on Medicare legislation, agreed and urged Republicans to vote against the bill.
Medicare Cloture Narrowly Fails
“For years, the Finance Committee has been the model for how a committee can work on a bipartisan ... basis,” Grassley said. “For some reason this year, that doesn’t seem to be the case,” he continued, but he made a point of not blaming Baucus.
McConnell said that Grassley would lead negotiations to produce a new Senate bill that more Republicans would support.
With the cuts to physician rates now scheduled to go through, Congress will have the option of returning after the recess and passing a retroactive bill that will restore payment rates and make up for the cuts. That will likely create an administrative headache, however, and had long been seen as an undesirable outcome.
The White House reiterated its veto threat against the bill on Thursday, likely making moot the narrow victory that seemed possible for Democrats. The administration opposes a provision that would partially offset the cost of the bill by cutting some bonus payments to private Medicare Advantage plans in areas with teaching hospitals. It also disagreed with a provision to limit a subset of the plans known as “private fee for service,” saying the bill would “reduce access, benefits, and choices for many of the approximately 2.25 million beneficiaries who have chosen to enroll in” those plans.
The administration’s demands have put Grassley in an uncomfortable position. “The White House has drawn lines in the sand that I think are unreasonable,” Grassley said.
The Medicare Advantage plans are paid at a higher rate than traditional Medicare, and Democrats have long argued that the private plans’ rates should be cut.
The Bush administration and many Republicans argue that the plans inject private competition into the market and will eventually lower costs.
The House passed the measure two days ago, 355-59, in a vote comfortably more than the two-thirds majority that would be needed to override a presidential veto.
The Senate on June 12 fell six votes short of the 60 votes needed to limit debate on a similar measure (
Comments
This vote will certainly lower costs. We doctors will simply stop seeing Medicare patients. Will the last one out please turn out the lights.
As a group, we MUST stop seeing medicare patients. Only an uprising by the folks most directly affected, the elderly patients, will affect a positive change. Patients must be instructed to contact their representatives immediately.
This bill contained more than just "cuts for docs". It provided the federal government and medicare an opportunity to postpone and reevaluate enactment other laws that have placed an extraordinary financial and administrative burden on over 10,000 small providers. Many of these "small businesses" are being forced out of business because of mismananged regulations that "appear to save money" or office "a good sound bite for the press". These laws governing competitive acquisition and the DMEPOS industry are mismanaged and misunderstood. In their current state will reduce services and quality to thousands of medicare beneficiaries. It may be time to truly rethink the "great concept of cheaper healthcare".
Access to primary care physicians is already difficult to impossible in my area for folks on medicare. The payment formulas are way too low and the whole situation is ridiculous. They have been holding this 10% cut over our head for years only to reverse it at the last minute and maybe throw a .5% at us and hope we are happy. It's time for the senate to aprove a realistic fee schedule that matches the increases we have all experienced in overhead and cost of living and that keeps pace with it on a yearly basis.
May I say NO ONE has mentioned whether the private payors will ALSO cut us 10.6% ??!! And this fiasco of a bill ,unless it's fixed, will continue to cut us until we are down 40% ???
This bill is important to healthcare and important to seniors. It got down again to petty politics and a $1 billion a day war habit. Very disappointing and the Senate should be embarrassed. Doctors and other providers wnat to be treated fairly - this bill took steps in that direction. Enjoy your holiday Senators, those of us in patient care endeavors will be working!!
I am equally outraged by this bill. I have had it with the Government compeling us to continue to accept these cuts. I believe it is time for Physicians to finally say enough is enough, mobilize and protest these actions. In voice to our legislator's offices, in writing to our elected officials and in action by refusing to see patients in the Medicare system. Only in this way can we send a clear and indelible message to Washington that the Physicians of America have had enough.
In order to maintain a financialy viable practice I have had to limit the number of new appointments for medicare patients to not more than 50% of all new patient visits. With a 10% payment reduction I'll be scheduling even fewer medicare patients. I won't be quite as busy, but I am overworked as it is and I'll be able to reduce my office staff.
Folks, follow the money. Our first problem is corrupt politicians whose campaigns are funded by the insurance and pharmaceutical industries. We need a complete elimination of the politicians who are owned by the industry (ANY industry). That means virtually all of them. Jack Lohman http://moneyedpoliticians.net
As a physician and managing partner of a large medical group practice, I have additional concerns. It is already difficult to attract the best and the brightest to medical practice. What message does this reduction send to those who might consider a career in medicine? In combination with the professional liability fiasco, declining reimbursement from government programs sends a message to would-be physicians that will not soon be forgotten. Our "leaders" are setting the stage for ever less availability of quality health care providers and services.
Unless something quickly changes this latest vote, I am going to stop seeing Medicare patients and close my doors. I somply cann not work woth these low rates. I am already treatning patients at a ridulusly low rate of reimbursment, that it doesn't pay to be in private practice. With all the costs of everything else escalting expontentially, we are the only industry where our rates are being cut and we can not raise them....there fore we must close!. No more choice for the patients, no more quality care, I close my practice and put 12 people out of work because they couldn't come up with 2 more lousy votes......Great job Senate!
I am a geriatrician. I am in practice in Florida and have been for many years. I am a participating physician for medicare for as long as it was possible to be one. The senate has just put the death nail into the specialty of geriatric medicine. There is a significant shortage of geriatricians and all primary care physicians. Young doctors are no longer choosing these specialities. They are the back bone of our medical system. They are on the front lines and gate keepers of all of US medicine. There is no interest in continuing to care for patients that actually cost the physician not only time to treat but actual dollars. My expenses have soared in the last years and before this travisty I was getting about 41% of charges now it will be 10% less. I can not continue to see and treat patients at a financial loss. I know that many primary care physicians in Florida feel the same way. Many older physcians are leaving medicine because of this as well. I am closing my medicare panel . I will limit my medicare patient visits. I wll stop taking medicare assignment. The medical system as we know it will now have to save itself and that means no more medicare patients.
Stop seeing Medicare patients.... opt out? Not if you are a Hospital Based Group, (Anesthesiology, Radiology, Pathology, Ed) These groups have NO options but to take the cuts. Anesthesiology takes the biggest hit of them all. Cutting CRNA Staff and/or wages is not an option or you will lose staff and then the contracts of the facilities that they staff.
If this is the Democrats idea of saving money. It just became clear that I should vote Republican!
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