Medicare payment cuts to doctors loom as Republicans reject slimmed-down 'extenders' package

Republicans were successful in blocking a "slimmed-down package of jobless benefits and state aid late Thursday" as Sens. Ben Nelson, D-Neb., and Joseph Lieberman, I-Conn., voted with them, The Washington Post reports. The approximately $120 billion measure "needed 60 votes to advance, but garnered only 56." Democrats hoped a package that included a shorter-term fix for Medicare doctor payments rates could attract the votes of the two lawmakers and one or two Republicans. "Though the sprawling package contains a number of must-pass provisions, Republicans have been steadfast in their opposition, insisting that the full cost of the measure be covered by cutting existing government programs. … The measure would protect doctors from a steep cut in Medicare rates scheduled to take effect Friday and extend emergency unemployment benefits that support more than 5 million people" (Montgomery and Dennis, 6/18).

Politico: Senate Majority Leader Harry Reid "is clearly near 60 votes but closing a deal with two Maine Republicans — Sens. Olympia Snowe and Susan Collins — is elusive both because of their political fears and his own reluctance to trim back a $24 billion package of Medicaid assistance important to cash-strapped Nevada" (Rogers, 6/18).

Snowe "said she was worried about the impact of a provision in the bill that would expose certain small business owners to Social Security and Medicare payroll taxes. Ms. Collins said she had concerns about the overall impact of the bill on the deficit. 'I'd like to see more of the bill paid for,' she said," The Wall Street Journal reports (Boles and Vaughan, 6/17).

The Associated Press: "There was some urgency to pass the jobless measure since by the end of the week, more than 900,000 people out of work for more than six months will have been ineligible to apply for continued benefits, according to the latest Labor Department estimates. And doctors face a scheduled 21 percent cut in Medicare reimbursements effective Friday. 'Tonight, every single Republican voted to give doctors a 21 percent pay cut,' Reid said. In fact, efforts to pass a stand-alone measure to forestall the Medicare cuts could be revived as early as Friday. Senate Minority Leader Mitch McConnell, R-Ky., appeared amenable to a compromise floated late Thursday that would give doctors six months of relief from the Medicare cuts, accompanied by measures to ensure the payments wouldn't add to the deficit" (Taylor and Ohlemacher, 6/17).

And, according to The Hill, Sens. Max Baucus, D-Mont., and Chuck Grassley, R-Iowa, reached an agreement on a six-month fix of the Medicare payment rate for doctors that could allow the Senate to pass the extenders bill today. "The agreement is to offset the 2.2 percent pay bump for doctors with pension provisions included in the substitute amendment filed by Sen. John Thune (R-S.D.) and a hospital payment provision that was included in the version the House passed right before the Memorial Day recess" (Pecquet, 6/17).

Roll Call: Reid has vowed not to give up. "One senior Senate Democratic aide said Reid would likely move off the bill and attempt to put political pressure on Republicans before returning to the measure later. …Though the tax extenders and unemployment insurance are popular programs, Republicans and some Democrats have insisted that the entire measure be offset with spending reductions elsewhere, while Democrats have argued the bulk of the bill is paid for. Before it was trimmed, the bill would have added nearly $78 billion to the already ballooning federal deficit. The bill that was rejected Thursday night would have added $55 billion to the deficit" (Pierce, 6/17).

The New York Times: "The spending and tax measure has become caught up in intensifying politics around deficit spending as members of both parties, reacting to rising public concern, have grown reluctant to vote for measures that add to federal red ink" (Hulse, 6/17).

CongressDaily: The House has recessed for the weekend, meaning passage of the bill will slip at least into early next week. The Senate, in the meantime, will continue its consideration Friday. "Reid said he was negotiating with Senate Republicans to set up votes on final passage, but Republicans including Sen. Tom Coburn of Oklahoma were still pressing their amendments" (Cohn, 6/18).

Another provision that had been stripped out could get new life, though concerns about its cost persist. "Sens. Bob Casey Jr. (D-Pa.) and Sherrod Brown (D-Ohio) on Thursday scaled back their proposal to extend COBRA health benefits for the nation's millions of unemployed workers," The Hill's Healthwatch Blog reports, in a separate post (Lillis, 6/17).

---

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.