Democrats Seek Support From Moderate Republicans on Sen. Baucus’ Medicare Package

Proponents of a Democratic Medicare package being written by Senate Finance Committee Chair Max Baucus (D-Mont.) are trying to garner support for the legislation from moderate Republicans, CQ HealthBeat reports (Armstrong, CQ HealthBeat, 6/3). Baucus' bill would halt a scheduled 10.6% cut to Medicare physician payments and institute a 0.5% increase in the payments for next year, among several other provisions. On Thursday, Baucus is scheduled to meet with physician groups to discuss the legislation. Baucus is hoping to bring the package to the floor next week (Kaiser Daily Health Policy Report, 6/3).

According to CQ HealthBeat, supporters of the package are "trying to pry loose some Republicans" to gain 60 votes needed in the Senate to limit debate on the bill and hold a vote. Committee ranking member Chuck Grassley (R-Iowa) said that a whip count has not been conducted yet to see if Republicans have the 40 votes to prevent cloture. Democrats have "several ways" to try to gain Republican support, including adding "sweeteners" to the legislation such as higher payments for physicians in rural areas and for hospitals that treat the uninsured in certain states, according to CQ HealthBeat. In addition, some Republicans likely "face tough re-election campaigns," and "[v]oting against the bill could irk physician groups and other health care professionals," who are "valuable fundraising sources for Republican candidates," CQ HealthBeat reports (CQ HealthBeat, 6/3).

According to CongressDaily, the "split is mainly over how to pay for the package." Democrats are targeting extra payments to Medicare Advantage plans, and Republicans prefer focusing MA plan cuts on indirect medical education payments, CongressDaily reports (Edney, CongressDaily, 6/4). The White House has threatened to veto the legislation (CQ HealthBeat, 6/3).

Supporting Republicans
So far, Senate Special Committee on Aging ranking member Gordon Smith (R-Ore.), who also is a member of the Finance Committee, has voiced his support for the package. Smith has been working to add provisions to the bill, including increasing low-income beneficiary assistance, copayment parity for mental health services, and more drug coverage for beneficiaries with HIV/AIDS, cancer and other serious conditions, according to a Smith spokesperson. Sen. Olympia Snowe (R-Maine) also supports Baucus' bill, which is "not a surprise" because she has "supported broad Medicare Advantage cuts," CongressDaily reports (CongressDaily, 6/4).

E-Prescribing
Although Baucus' bill "isn't likely to pass in" its current form, "lobbyists say [electronic] prescribing is one piece that may survive in the final package," the Wall Street Journal "Health Blog" reports. The e-prescribing provision is the "most significant" of the bill's "intriguing ingredients," and it "has considerable support from both parties, as well as a powerful array of interests packing it," according to the "Health Blog" (Wilde Mathews, "Health Blog," Wall Street Journal, 6/3). The provision would increase physician pay by 2% beginning in 2009. By 2011, any payments for any physician not using the technology would be cut by 1%, which would increase to 2% by 2013, according to the AP/Boston Globe.

Tony Clapsis, an analyst for Lehman Brothers, in a recent note to investors wrote, "E-prescribing remains the only health IT proposal that can generate short-term savings for the federal government, and as a result is the only one we think can get passed for the foreseeable future." Mark Merritt, president of the Pharmaceutical Care Management Association, said that the penalties outlined in the provision for not adopting e-prescribing will be more important than the rewards (AP/Boston Globe, 6/4).