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Senior Citizen Politics
Republicans, Insurance Lobby Slam Shut Effort to
Stop Medicare’s 10% Pay Cut for Physicians
Sen. McCain could have stopped the pay cut but failed
to show for the vote; AMA says docs will limit Medicare patients
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One
Doc Says Enough's Enough - Leaving Practice
Says Medicare already
only reimburses about 30% of his fees...insurance companies not
paying enough either. A lot of doctors are retiring, he said,
because they can't meet their overhead. Read more below news
story.
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June 27, 2008 – The insurance industry lobby, with
a lot of help from Republican senators, appears to have managed to cut
Medicare’s pay to physicians by more than 10 percent by the end of June.
Although approved by a majority of the Senators present, the legislation
failed by one vote to reach the 60 needed to close debate and call for
the final vote. President Bush had promised to veto the bill that
earlier passed the House by a gigantic margin of 355-59, as many
Republicans defied the President’s threat.
Sen. John McCain, the almost certain Republican
nominee for president, could have made up the one-vote difference in the
Senate but he was absent for the vote. He has also refused comment. Sen.
Barack Obama, the presumed Democratic nominee, voted for closing the
debate.
Daily Report: Senate Fails to Take Up
Legislation to Delay Medicare Physician Fee Cut
A House-passed bill (HR
6331) that would delay a 10.6% reduction to Medicare physician fees
failed by one vote to receive the 60 votes in the Senate required to
gain cloture on Thursday, CongressDaily reports. The House had
passed the measure by a veto-proof margin earlier this week.
The bill is similar to a measure (S
3101) proposed by
Senate Finance Committee Chair Max Baucus (D-Mont.) that also
failed to receive enough votes to invoke cloture (Edney,
CongressDaily, 6/27). The final vote on Thursday was 58-40; however,
Senate Majority Leader Harry Reid (D-Nev.) changed his vote to no to
ensure he could reintroduce the bill under procedural rules (Armstrong
[1], CQ Today, 6/26).
Sen. Judd Gregg (R-N.H.) offered a 30-day extension
of the current pay level, but Reid objected (Edney, CongressDaily,
6/26).
According to CongressDaily, "Democrats hoped the
impending deadline and unexpected overwhelming support in the House
would put enough heat on GOP senators to support cutting off debate" (CongressDaily,
6/27).
Missing Votes
 Presumptive
Republican presidential nominee Sen.
John McCain (Ariz.) and Sen. Edward Kennedy (D-Mass.) were not
present for the vote. Presumptive Democratic presidential nominee Sen.
Barack Obama (Ill.) voted for cloture on the measure.
McCain was in Ohio campaigning during the vote and
Kennedy is undergoing cancer treatments after recently having a brain
tumor removed. According to the
New York Times, "McCain's absence made it likely that Democrats
would seek to hold him at least partly responsible for the outcome." The
Times reports that a McCain spokesperson said he had no immediate
comment (Herszenhorn, "The Caucus," New York Times, 6/26).
Session Extension
Reid on Thursday told senators to clear their
calendars for the weekend and prepare for another cloture vote on
Sunday, according to a spokesperson for the lawmaker. According to
CongressDaily, Senate Republicans have objected to bringing the
legislation to the floor on Friday.
Meanwhile, Reid said that he cannot file for
cloture until midnight due to other legislative efforts (CongressDaily,
6/26). A Sunday vote could push final action on the bill into next week
(Armstrong [2], CQ Today, 6/26).
Baucus said that the House measure is the Senate's
only option to avert the fee cut before the Fourth of July recess
because the House has already left for recess. "There is no
alternative," Baucus said, adding, "This is the only train in the
station" (Armstrong [1], CQ Today, 6/26). Reid said that the Senate is
"going to finish Medicare" before it adjourns for the recess (Armstrong
[2], CQ Today, 6/26).
White House Reiterates Veto Threat
The White House on Thursday again threatened to
veto the measure because it makes cuts to indirect medical education
payments and imposes limitations on so-called private fee-for-service
plans under Medicare Advantage.
The Bush administration said that the bill would
"reduce access, benefits and choices for many of the approximately 2.25
million beneficiaries who have chosen to enroll in" the plans (Armstrong
[1], CQ Today, 6/26). The measure would cut about $14 billion over five
years from payments to some plans under MA (Lueck, Wall Street Journal,
6/27).
Although Finance Committee ranking member Chuck
Grassley (R-Iowa) voted against cloture, he said, "I personally think
the White House has drawn lines in the sand that are unreasonable."
Compromise Bill
Baucus and Grassley reached a tentative agreement
on a compromise bill earlier this week, but it was abandoned in the
Senate after the House approved its measure by a veto-proof margin.
According to CongressDaily, "The compromise would have avoided a
promised veto of the House-passed measure" (CongressDaily, 6/27).
Republicans "were upset" that they did not have the
option to vote on the compromise legislation, according to CQ Today
(Armstrong [1], CQ Today, 6/26). However, CQ Today reports that "there
may not be enough time" for the bill to pass the Senate and the House
before the recess. CQ Today reports that Reid "could ultimately ...
accept Gregg's plan for a 30-day extension of the current doctor payment
rates" (Armstrong [2], CQ Today, 6/26).
Retroactive Patch
Congress also has the option of returning after the
recess and passing a bill that would retroactively restore the physician
payment levels and block the cut. However, such a move "will likely
create an administrative headache" and "ha[s] long been seen as an
undesirable outcome," according to CQ Today (Armstrong [1], CQ Today,
6/26).
On Radio: NPR's "Day
to Day" on Thursday reported on the Medicare physician fee cut (Rovner,
"Day to Day," NPR, 6/26).
AMA outraged at Senators who put
health insurers before Medicare patients
"The physicians of America are outraged that a
group of Republican senators followed the direction of the Bush
Administration and voted to protect health insurance companies at the
expense of America’s seniors, disabled and military families,” said
Nancy H. Nielsen, MD, President, American Medical Association.
"These senators leave for their 4th of July picnics
knowing that the most vulnerable Americans are at risk because of the
Senate's inability to act to stop drastic payment cuts for health care
services that are needed by our Medicare and TRICARE patients.
"The House voted to preserve access to care for
Medicare patients in a bipartisan landslide vote to pass H.R. 6331 by an
overwhelming margin of 355 to 59. The House made seniors, the disabled
and military families a top priority. The AMA appreciates the courage of
the 59 Senators, including 9 Republicans, who voted to put patients
ahead of partisan politics and vote for H.R. 6331.
"Today, thanks to some senators, we stand at the
brink of a Medicare meltdown. On July 1 – just four days from now – the
government will slash Medicare physician payments by 10.6 percent,
forcing many physicians to make the difficult choice to limit the number
of Medicare patients in their practices.
"The Senate must return from their recess and make
seniors’ health care their top priority. For doctors, this is not a
partisan issue - it's a patient access issue."
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One Doc Says Enough's Enough - Leaving
Practice
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One of an increasingly small number of primary care
physicians, Dr. David Haldorsen, shown here with
patient Carol Ceballos on Friday, is closing his
practice after 15 years.Times Herald-Record/CHET
GORDON |
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June 27, 2008 –
“A longtime Monroe physician is retiring, taking with him
his mantle as one of the last doctors in the area to make
house calls, and a view of a health care system driving
doctors out of the profession,” according to a report by
Christian Livermore in The Times Herald-Record of
Middletown, New York
Dr. David
Haldorsen will close his practice after almost 15 years. He
will continue his Spring Valley practice for the time being,
but will probably close that when he sells the house from
which he operates it, said medical manager Joan Thiel.
Inadequate
reimbursement rates and rising costs made it too difficult
for him to support the practice.
"I see lots of
patients, but between all the expenses, I'm losing money,"
he said, "and I don't have time to increase my hours to grow
the practice."
The gulf
between what it costs him to treat a patient and what
insurance companies actually pay has become too wide —
Medicare reimburses about 30 percent of his fee, he said. A
lot of doctors are retiring, he said, because they can't
meet their overhead.
"There's this
thing about doctors all being rich," he said. "Some of them
are, the specialists probably, but the others are just
getting by."
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