By protecting doctors' Medicare pay, lawmakers look to keep health reform tab low

The Los Angeles Times reports on a Democratic plan to cancel scheduled cuts to physician pay under the Medicare program with a bill separate from their sweeping health reform proposal. It would allow lawmakers to "reconcile a nearly $250-billion difference between the House and Senate" while at the same time keeping the American Medical Association on board with their plans. The plan, however, is not paid for and would add to the deficit.

The current formula for paying doctors requires automatic cuts whenever Medicare grows faster than the economy. The Senate Finance Committee health bill did not include blocking the cuts, while the House version did, adding the to its price tag. "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" (Geiger, 10/20).

In fact, Senate Majority Leader Harry Reid, D-Nev., "scrapped a planned Monday vote to take up the [physician payment legislation] in the face of stiff opposition from Republicans and Democrats who don't want to move the massive bill without offsets," Roll Call reports. Meanwhile, Sens. Kent Conrad, D-N.D., and Chuck Grassley, R-Iowa, are working together on a proposal to pay for the cuts. Republican leaders, meanwhile, have offered their own ideas, such as applying unused stimulus money to physician payments (Stanton, 10/20).

Minority Leader Mitch McConnell said the decision by Senate Democrats to separate the physician bill from the broader reform proposal was "so transparent," Politico reports. "They're taking this issue out of health care, suggesting that we spend a quarter of a trillion dollars, not pay for it, so that they can then argue — the very next week potentially — that this trillion-dollar health care bill is paid for," McConnell said. Steve Ellis of Taxpayers for Common Sense said the tactic was equivalent to a dieter saying, "I can meet my weight-loss goals if I ignore my butt" (Frates, 10/20).

The AMA, meanwhile, is "firmly in favor of higher pay for doctors, [and] began airing ads last week saying the increase would 'protect seniors' access to quality care,'" the Associated Press reports. However, the group has resisted requests from top Democrats to pledge its support for Democratic health reform proposals in exchange for the payment change (Espo, 10/20).

This isn't the first time Congress has taken up the physician payment problem, NPR reports. "It seems just about every fall in Washington, the leaves turn, the weather cools and Congress looks for a way to avert cuts in payments to doctors in the Medicare program." In some of those past years, the inevitable actions to avoid the pay cuts were not always paid for when Republicans ran Congress (Rovner, 10/20).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.