HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Friday, July 11, 2008

With Nudge by Kennedy, Medicare Bill Passes

The Washington Post reports on the recent approval of the Medicare Bill due in part to Senator Kennedy's encouragement.  Paul Kane writes,

MedicareSen. Edward M. Kennedy (D-Mass.) made a dramatic return to the Capitol yesterday to help the Senate pass legislation that would rescind a sharp cut in Medicare payments to physicians…

The legislation was approved by a veto-proof margin, 69 to 30, after falling one vote shy of passage less than two weeks ago. Kennedy cited that close vote, and his potential to make a difference, as the reason for his reappearance…

Kennedy cast his vote to prevent a 10.6 percent cut in payments to doctors who treat Medicare patients. On June 26, just 59 senators voted in favor of the legislation, which needed 60 votes to overcome Republican objections to the bill. Kennedy was not present for that vote.

The White House has threatened to veto the measure because of provisions written by Democrats that would instead reduce payments to private insurers who participate in an alternative program, Medicare Advantage.

The cuts in that program, which supporters say benefits elderly patients in rural communities, would allow Democrats to postpone the pay cut to doctors for 18 months but would cost the insurers $14 billion over five years.

The House approved the bill June 24 by a 355 to 59 vote. That veto-proof majority prompted Senate Majority Leader Harry M. Reid (D-Nev.) to continue pushing the bill for a vote, even after it fell the vote short 11 days ago.

Yesterday, Vice President Cheney attended a luncheon of Senate Republicans just hours before the vote, speaking against the Medicare legislation and assuring senators that Bush would veto the bill, according to sources familiar with the meeting.

Despite Cheney's lobbying, 18 Republicans supported the measure -- twice as many as last time. All 49 Democrats and both independents voted for it.

Democrats credited Kennedy's vote as the moment when some Republicans realized the bill would be approved, offering them a last chance to side with physicians. "Once we hit 60, it became a lot more," said Senate Majority Whip Richard J. Durbin (D-Ill.)…

Since the initial vote, Republicans had come under intense pressure from the American Medical Association, which aired advertisements in states where such Republicans as Sen. John Cornyn (Tex.), who opposed the provision, were facing reelection.  The Texas chapter of the AMA withdrew its endorsement of Cornyn after his first vote.  Yesterday, he switched sides. 

The Medicare fee reductions are based on a funding formula more than a decade old that requires payment cuts to doctors whenever the growth rate in Medicare costs climbs above the growth in the gross domestic product.

Soaring health-care costs have caused regular payment cuts, but Congress has postponed them. The current reduction took effect July 1, but the government has said it would delay processing claims until early next week.

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