Democrats Seek One More Republican Vote To Delay Medicare Physician Fee Reduction, Target McCain

Democrats are attempting to convince one additional Republican senator to vote to invoke cloture on a House-passed bill (HR 6331) that would delay a 10.6% reduction to Medicare physician fees that was scheduled to take effect last week, CQ Today reports (Armstrong, CQ Today, 7/8). CMS provided Congress with more time to act on blocking the fee reduction, freezing physician fee rates until July 15 through an administrative measure. A spokesperson for Senate Majority Leader Harry Reid (D-Nev.) said that the Senate will again vote to invoke cloture on the measure as early as Wednesday. The measure failed to receive cloture in the Senate by one vote on June 26. The House last month passed the measure by a veto-proof margin. The bill is similar to a measure (S 3101) proposed by Senate Finance Committee Chair Max Baucus (D-Mont.), which also failed to receive enough votes for cloture (Kaiser Daily Health Policy Report, 7/8).

Senate Majority Whip Richard Durbin (D-Ill.) said that Democrats are looking to presumptive Republican presidential nominee Sen. John McCain (Ariz.) -- who did not participate in the last vote -- for the additional vote. A McCain spokesperson said he again will not be present to vote. Sen. Edward Kennedy (D-Mass.) also will miss the vote for a second time because of his cancer treatment. Presumptive Democratic presidential nominee Sen. Barack Obama (Ill.) voted for cloture on June 26, and a spokesperson said that Obama's vote would remain unchanged (CQ Today, 7/8).

Medicare Vote Complicated for McCain
McCain has yet to disclose his position on the Medicare bill, The Hill reports. However, should he vote no on the measure, "Democratic leaders are poised to blame [him] for the chamber's failure to advance" the bill. According to The Hill, "McCain could find himself in a tough spot" because if he votes for the bill, "he would please physicians' groups but anger insurance companies, many of his Senate Republican colleagues and the White House." If he does not vote or votes against the measure, "he would open himself up to attacks of supporting a cut in doctors' payments and stiff-arming elderly and military veterans' access to Medicare," The Hill reports. Durbin said, "There's nothing to stop (the cut) unless the Republican senators give us one more vote, and we'd like to know where John McCain is on the issue." According to The Hill, "Any one of the 39 Republicans who voted no could rescue McCain from a politically damaging situation" (Raju/Young, The Hill, 7/8).

Tricare Affected by Cut
In related news, Durbin on Saturday during a Democratic radio address said that the physician fee cut also could affect Tricare, the U.S. military health care program, CongressDaily reports. Payment rates under Tricare by law are linked to Medicare rates. However, Tricare is granted more flexibility to implement the rate cut than Medicare, retired Col. Steve Stobridge, director of government relations for the Military Officers Association of America, said. He added that the rate cut would not take effect until later in the summer.

MOAA on Tuesday sent a special alert to its members asking that they e-mail senators about the cut to Tricare, which yielded about 14,000 e-mails to legislators, according to Stobridge. Baucus on Tuesday said, "Further delay could endanger health care for military retirees and even for those on active duty." According to CongressDaily, a Baucus spokesperson said his comments were not intended to elicit Republican votes on the physician fee measure. "I think as the cut takes effect, its implications across the board -- including this one outside Medicare -- are becoming more apparent," the spokesperson said (Edney, CongressDaily, 7/9).

No Amendments, Reid Says
Reid on Tuesday said that if the measure gains cloture and moves to the floor, he would not allow any amendments, CQ HealthBeat reports (CQ HealthBeat, 7/8). Some Republican senators, especially Sen. Arlen Specter (Pa.), said they voted against cloture because they were not allowed to offer amendments, according to CQ Today (CQ Today, 7/8). Reid said that "75% of the Republicans in the House voted for" the bill, adding that "it seems a little unusual to me that this bill, they want to change it now, send it back to the House, and every day that it's not passed, seniors are being affected, doctors are being affected and veterans are being affected" (Raju, The Hill, 7/8).

Reid on Tuesday also responded to a 31-day extension of payment rates that was offered by some Republicans. Reid in a letter to Republican leaders wrote that the "suggestion of a 31-day extension is as disingenuous as it is ineffective," adding, "It will only offer patients and doctors uncertainty and administrative headaches" (CongressDaily, 7/9). If the measure receives enough votes to invoke cloture, it is expected to pass, CQ Today reports. However, the Bush administration has vowed to veto it because of cuts to Medicare Advantage. White House spokesperson Tony Fratto on Tuesday said, "There's been no change in our position" on the measure (CQ Today, 7/8).

Opinion
Several newspapers on Wednesday published opinion pieces related to the Medicare bill and the reduction to physician fees. Summaries appear below.

• Mike Leavitt, Wall Street Journal: Congress this week "will demonstrate if it is serious or not about reining in entitlement spending" with its vote on the House bill because it contains a provision that would stall a competitive bidding program for durable medical equipment, HHS Secretary Leavitt writes in a Journal opinion piece. Leavitt continues, "Right now the government is paying insane rental prices for medical equipment -- prices far higher than it would cost to purchase the equipment outright." He writes, "Make no mistake: 'Delay' means 'kill,'" adding, "Killing this competitive bidding program would cost taxpayers about $1 billion annually, while unjustly overcharging senior citizens." Leavitt concludes, "If Congress fails to uphold even this modest effort at entitlement reform, there is little reason to believe its members will muster the political courage for the unspeakably harder choices that await them" (Leavitt, Wall Street Journal, 7/9).
  
  
• Nancy Nielsen, Philadelphia Inquirer: "It's time to put politics aside and do what is right for patients" by passing the House bill and stopping the physician fee cut, American Medical Association President Nielsen writes in an Inquirer opinion piece. Nielsen continues, "There's long been bipartisan support to stop the cuts, and the bill ... should be considered and passed by the Senate." According to Nielsen, "Only the health insurers appear content with the status quo" because "private Medicare plans are making money hand over fist for insurance executives and Wall Street." She continues, "Without Senate action to stop the cuts, the promise of Medicare -- that it will be a viable insurer for our nation's seniors -- will be broken," and "[b]reaking that promise is the last thing physicians want." Nielsen concludes, "The bill will come up for a second vote," and "America's physicians call on Senator Specter to vote yes" on the bill (Nielsen, Philadelphia Inquirer, 7/9).
  
  
• "Viewsday," Long Island Newsday: The Medicare argument "centers on payments to doctors," but it is "more about leveling costs between special private plans and their traditional Medicare cousins," according to Newsday's opinion blog "Viewsday." A recent audit by the Government Accountability Office "indicates that although Medicare Advantage was originally sold as a way to rein in medical costs, it has generally increased spending -- perhaps not the soundest way to salve a growing health care crisis," Newsday writes ("Viewsday," Long Island Newsday, 7/9).
  

Broadcast Coverage

• American Public Media's "Marketplace Morning Report" on Wednesday reported on the Medicare bill. The segment includes comments from Joseph Antos of the American Enterprise Institute and Richard Brown of the University of California-Los Angeles School of Public Health (Marshall Genzer, "Marketplace Morning Report," American Public Media, 7/9).
  
  
• WAMU's "The Diane Rehm Show" on Wednesday also reported on the Medicare bill. The segment includes comments from Ron Pollack, executive director of Families USA; Stephen Moore, a member of the Journal's editorial board and former president of the Club for Growth; and Julie Rovner, NPR's health policy correspondent ("The Diane Rehm Show," WAMU, 7/9).