Congress Wrestles With Yearly Medicare Fee Cuts
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.
As doctors are quick to remind lawmakers, it's not just the healers who could be hurt if the cuts take effect as scheduled Jan. 1. This year's anticipated cut of more than 20 percent is so large that many doctors say they may have to stop seeing Medicare patients altogether.
"Congress cannot continue to put Band-Aids on the problem, and it's time for a permanent fix," said Rebecca Patchin, chairman of the American Medical Association board. "We need permanent action from Congress to stabilize the security of Medicare for seniors."
And since nothing scares politicians more than angry senior citizens, who are traditionally among the largest bloc of voters in midterm elections, the real issue facing Congress isn't whether to stop the doctor pay cuts — which are the result of a 1997 Medicare formula gone awry — but how. More specifically, lawmakers must find a way to offset the estimated $245 billion cost over 10 years.
An Annual Debate
Democrats say they will — reluctantly — add the cost to the deficit rather than cut other spending or raise taxes. "The slate should be wiped clean," Senate Majority Leader Harry Reid said last week. "Everyone understands we addressed these physician payment cuts every year. This is nothing different than we've done before."
Despite the fact that they didn't always offset the cost of eliminating previous scheduled cuts, Republicans nonetheless attacked the Democrats' plans.
"It is perfectly obvious why Democrats want to resolve this issue outside the larger issue over health care," Senate Minority Leader Mitch McConnell said Monday on the Senate floor. "They're doing it so they can say their larger health care plan doesn't add to the deficit. It's a gimmick — and a transparent one at that."
A Temporary Fix
Indeed, separating out the physician pay issue from the rest of the health overhaul bill does solve a thorny problem for lawmakers in both chambers. In the House, the 10-year cancellation of doctor payment reductions was included in the broader overhaul bill after Democratic leaders cut a deal with the fiscally conservative "Blue Dog" Democrats. The deal was that that portion of the bill wouldn't have to be paid for as long as the House passed a separate bill to ensure that no future spending would be passed without offsetting spending cuts or increased taxes.
In the Senate, however, the Finance Committee, which oversees Medicare, included only a one-year cancellation of the payment cut, because the committee couldn't find enough money to pay for any more.
Adding To The Deficit
"Neither side has anything to be proud of when it comes to health care," says health care consultant Robert Laszewski. "The Republicans, for example, created the [Medicare] Part D drug program and added the whole thing to the deficit. But this was the year we were finally supposed to face up to our problems. Are we going to deal with America's health care costs or are we just going to keep playing the games we've played over the years?"
Meanwhile, not all lawmakers are going along with the idea of just adding another quarter of a trillion dollars to the burgeoning national debt, including, most notably, Senate Budget Committee Chairman Kent Conrad of North Dakota, a Democrat.
But Democrats badly want the backing of the AMA for their health overhaul effort, and both Democrats and Republicans are loath to cross politically powerful seniors. The bill up this week pits those interests against those of deficit control.
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RENEE MONTAGNE, host:
As Congress works and works on plans to overhaul the health care system, lawmakers do intend to vote this week on one small part. It's a permanent fix for a flawed formula that keeps threatening to cut Medicare pay for doctors. NPR's Julie Rovner reports.
JULIE ROVNER: Back in 1997, Congress set up a system that was supposed to help control what Medicare pays doctors. It worked for a while, then it started working a little too well, threatening to bit into doctors' pay a little more each year.
Starting in 2003, Congress began canceling the cuts, usually a year at a time -but now the problem has gotten really out of hand.
Ms. REBECCA PATCHIN (American Medical Association): If Congress does not act in January of 2010, there will be a whopping 21 percent cut in physician pay.
ROVNER: Rebecca Patchin chairs the board of the American Medical Association. Doctors say a cut that big will affect more than just the medical profession; it will also force them to stop seeing Medicare patients. And seniors are a powerful political force. So powerful, in fact, the AMA is running ads for the bill, reminding lawmakers just what's at stake.
(Soundbite of advertisement)
Unidentified Woman: For seniors, a doctor can mean everything: independence, hope, security - and Medicare makes it possible. But every year, Congress must make a temporary fix to the Medicare payment plan so seniors can keep their doctor and the care they depend on.
ROVNER: The last time this issue was before Congress, in 2008, lawmakers overrode President Bush's veto to put off a cut, and that cut was only half as big as the one now looming. So speaking on the Senate floor yesterday, Senate Majority Leader Harry Reid said Congress is now ready to fix the problem once and for all.
Senator HARRY REID (Democrat, Nevada): One of the seniors' biggest fears is doctors will simply drop them, which is why we're proposing this bill to make sure doctors will continue to see Medicare patients.
ROVNER: Only taking care of the problem costs a lot - about $245 billion over the next decade. And unlike the rest of the health care overhaul bill, which will have its funding offset by tax increases and other spending cuts, the Medicare doctor fix - as it's known inside the Beltway - won't. Here's how House Majority Leader Steny Hoyer put it…
Representative STENY HOYER (Democrat, Maryland): This happens to involve health care, but it's not part of health care reform.
ROVNER: Democrats say it's actually Republicans' fault that fixing the problem has gotten so expensive. That's because every time Republicans deferred the doctor pay cuts and didn't pay for them when they were in charge of Congress, it just added to the total price tag. But that hasn't stopped those same Republicans from lashing out at the Democrats for trying to pass the physician fee bill without paying for it. Here's Senate Republican Leader Mitch McConnell on the floor yesterday.
Senator MITCH MCCONNELL (Republican, Kentucky): It is perfectly obvious why Democrats want to resolve this issue outside the larger debate over health care. They're doing it so they can say their health care plan doesn't add to the deficit. It's a gimmick, and a transparent one at that.
ROVNER: Health industry consultant Bob Laszewski said Democrats may be right that Republicans were fiscally irresponsible when they were in charge, but that doesn't give Democrats a pass now.
Mr. BOB LASZEWSKI (Health Industry Consultant): Neither side has anything to be proud of when it comes to health care. The Republicans, for example, created the Part B drug benefit and added the whole thing to the deficit. But this was the year we were finally supposed to face up to our problem.
ROVNER: And Laszewski says he thinks Democrats are doing this Physician Pay Bill, at least in part, to cement the support of the still-powerful AMA on the health overhaul bill.
Mr. LASZEWSKI: If they come out against it, there's a real problem. So the doctors are being given a $245 billion pay fix in October, and then we'll all be shocked, simply shocked, when in November the American Medical Association comes out and supports Democratic health care reform.
ROVNER: And it's not just the AMA. The powerful senior group AARP is supporting the bill to fix the doctor pay problem too. The question will be whether the power of doctors and seniors will be enough to trump those lawmaker worried about adding still another $245 billion to the deficit.
Julie Rovner, NPR News, Washington. Transcript provided by NPR, Copyright National Public Radio.
