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Medicare Maneuvers, Part 2: The Solution?

Capitol Building, D.C.As we wrote about yesterday, payment cuts for doctors who treat Medicare patients finally went into effect July 1. Unfortunately, the first legislative attempt to block the looming doctor payment cuts didn’t come until the end of 2007, and was part of the doomed legislation to improve public funding for children’s health care (see WhatIf’s piece on SCHIP). With the competing SCHIP bills finally all defeated this spring by Presidential vetoes and Republican opposition, there was little time left to deal with doctor payment cuts before the July deadline.

With a week to go, the House passed a landslide vote (355-59) on legislation to prevent the cuts. A few days later on June 26, the Senate fell one vote short of the 60 votes needed to close debate on the House bill (cloture) and move on to the final vote on it. (Cloture is a tactic that can help one party force a vote on a bill when they think they are closest to having the votes they need or are running out of time.)

The cloture vote went strictly on party lines: all Democrat Senators voted for it, all Republican Senators voted against it.

Had the legislation repealing the cuts passed both chambers of Congress, President Bush had promised he would veto it because of the legislation’s requirement that private Medicare insurers coordinate with local health care provider networks in order to increase health delivery quality and efficiency and reduce duplicated charges. Insurance companies had lobbied against the requirement, saying they were overly constraining.

Groups like the American Medical Association (AMA) are urging people to call their Senators to thank them for voting yes or scold them for voting no on the cloture vote, which would have allowed a full vote to go forward and the payment cuts to be blocked. To see how your senator voted, go here.

In theory, Majority Leader Harry Reid (D-NV) can present a new bill that would reverse the cuts retroactively when the Senate returns from recess after July 7. He is apparently hoping that Republican senators get enough pressure in the meantime to be willing to back the House bill that already passed. He may have momentum on his side: the Senate had tried to vote to end debate on a similar bill in order to pass it on June 12 but were short that time by 6 votes. Following the huge success of the House bill last week, the gap in the Senate vote became smaller. Maybe the third time is a charm.

Republicans contend that there was never any chance the Democrats’ bill would pass – that they were grandstanding and wasting precious time. GOP leadership claims they would rather vote on a recently created bipartisan compromise bill that would reduce Medicare Advantage payments without forcing them to coordinate with provider networks. The Democrat-backed bill was also 25% more expensive because it improved some Medicare benefits including mental health treatment and preventive care. It also cut payments to certain medical device suppliers.

An interesting note is that the one missing vote needed to pass the legislation and block the President’s veto would have come from Senator Edward Kennedy (D-MA), who has been absent while undergoing treatment for cancer. It also interesting that Republican Presidential Candidate John McCain did not vote.

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