Opinion: More anger over Kentucky Sen. Bunning’s delay of spending bill


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Add doctors and satellite TV viewers to the list of people who will be angered by Sen. Jim Bunning’s foot-stomping over a package of spending extensions pending in the Senate.

The Kentucky Republican is blocking a vote on the bill, which would also extend unemployment benefits and the COBRA subsidies that help laid-off workers keep their health insurance. This unusual turn of events (the bill in question has been in the works for some time and was considered a sure thing for passage) has brought to fruition a looming — but widely considered unlikely — pay cut that doctors have been screaming about for years.


That cut had been scheduled to take effect Jan. 1, but it was postponed by Congress late last year under the assumption that a longer-term, or even permanent, solution would be passed before the end of this month.

The American Medical Assn. is not happy. In a statement, AMA President J. James Rohack called on the Senate to “stop playing games” and making patients “the collateral damage of their procedural games.”

Under an arcane formula that dates to 1998, physician payments under Medicare are automatically reduced when spending outpaces GDP growth in a given year. Since 2003, Congress has legislatively intervened to prevent the cuts — as happened in December when House Speaker Nancy Pelosi (D-San Francisco) stuck a temporary two-month fix into an unrelated spending bill. The practice of ignoring the cuts (nicknamed the “doc fix”) has become commonplace – but also a source of controversy over the AMA’s role in the healthcare debate.

The issue came to a head in October, when Senate Majority Leader Harry Reid (D-Nev.) attempted to push through a bill that would...

...put a permanent end to those cuts — which at a few percentage points per year had compounded to a whopping 21%.

That was an embarrassing moment for Reid and the AMA. The bill was blocked by Republicans and some Democrats, who objected to its nearly $250-billion price tag. Reid implied that the AMA had wrongly assured him there were enough GOP votes for passage.

Ultimately, the issue was left unsolved. But nobody thought the cuts would ever materialize. Thanks to Bunning, the unthinkable has happened.


And a resolution could be many days away. Perhaps more unthinkable to those outside Washington is what the Bunning stunt could mean for some rural satellite TV viewers. As of Monday, those customers could find their TV screens blank because the program that allows delivery of their pictures will also lapse.

Sadly for both constituencies, there was nothing that could be done late last week. It takes just one objecting senator to stall a vote on a bill. Such an action can be overcome through cloture. But that parliamentary procedure spans multiple days and requires senators to be present, not en route to their home states, as many were Friday.

The bill is now essentially dead. And the AMA, a powerful Washington force that had thrown its support behind the Democrats’ healthcare agenda, is angry. In his statement, Rohack said the cut could force “many physicians to limit the number of Medicare and TRICARE patients they see in order to keep their practice doors open.’

On Monday, Reid will bring up a new bill to provide longer-term extensions, and some extra spending like Medicaid help for states. Depending on how that process goes, the doc cuts — and the TV snow — could go unsolved for some time.

— Kim Geiger

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