Doctor payment cuts are debated

In an effort to reconcile a nearly $250-billion difference between the House and Senate approaches to overhauling healthcare, Senate Majority Leader Harry Reid (D-Nev.) is pushing a bill to halt scheduled reductions in Medicare payments to physicians.

The measure, introduced last week by Sen. Debbie Stabenow (D-Mich.), would end the cuts and set Medicare payment rates at current levels. Doing so would allow Democrats to maintain the American Medical Assn.'s support for an overhaul without having to absorb the cost of higher doctor payments in the final healthcare bill.

The current formula imposes cuts to doctors when Medicare spending outpaces growth in the gross domestic product. Each year, Congress intervenes to ignore the cuts -- it sometimes has even increased payment rates -- at the behest of the AMA and other physician groups. The result has been an accumulation of rate cuts totaling 21% next year.

While there is consensus in Congress that the payment system should be fixed, Republicans and some conservative Senate Democrats have said they won’t support a bill that adds to the nation’s red ink. The proposed change would cost about $245 billion.


“They’re doing it so they can say their healthcare plan doesn’t add to the deficit,” Senate Minority Leader Mitch McConnell (R-Ky.) said Monday. “It’s a gimmick, and a transparent one at that.”

The House healthcare bills included the fix, which explains in part its $1.042-trillion price tag over 10 years. The bill that passed last week in the Senate Finance Committee instead assumed that the rate cuts would take place in future years, resulting in its $829-billion tab.

Republicans blasted the finance committee bill as disingenuous, and House Majority Leader Steny H. Hoyer (D-Md.) called it a “facade.”

To solve the doctor payment issue separately would put the House and Senate healthcare bills on a fairly even footing when it comes to estimating their effect on the deficit.


But the Stabenow approach would simply halt the cuts without any way to offset the cost. Passing such a bill would require 60 votes, which is considered unlikely. Some Democrats, such as budget committee Chairman Kent Conrad (D-N.D.), have said they would withhold their support until Stabenow and Reid can show how they’ll pay for it.

On Monday, Reid was negotiating with Senate Republicans to allow some amendments to the Medicare payment bill before bringing it to a vote on the floor. Republicans plan to offer amendments that would help pay for the bill, but could result in another short-term, rather than permanent, fix.

The AMA, which has spent millions of dollars lobbying to eliminate or at least postpone the cuts, has argued that they would force many doctors out of business and would cause others to turn away Medicare patients.

“It’s something we’ve been working for the last seven years,” said Dr. J. James Rohack, who heads the AMA. “And Congress has only put temporary Band-Aids on it.”