A measure to zero-out the physician payment formula was crushed in the Senate last week, failing to garner 13 members of the Democratic Caucus who could have advanced the bill and nary a single Republican.
The $250 billion bill, written by Sen. Debbie Stabenow (D-Mich.) and rushed to the floor by Senate Majority Leader Harry Reid (D-Nev.), fell 13 votes short of the 60 needed to overcome a legislative block, 53-47.
Under the measure, the Sustainable Growth Rate—roundly seen as a flawed part of the Medicare payment formula—would have been wiped clean and physician payments would be frozen for 10 years.
While few would argue that the SGR doesn't need fixing, the policy behind the legislation met headfirst with the political realities on Capitol Hill on its way to one of Reid's most embarrassing losses.
Prior to the vote, the Senate's top Democrat sent mixed signals as to the bill's chances.
In one breath, Reid told reporters that he wouldn't bring the bill to the floor for a vote unless he thought he had the votes to pass it. In the other, however, he was already making contingency plans, saying that a physician pay patch would have to pass after the broader health reform package goes through.
Republicans and some Democrats, however, opposed the legislation because it would have added to the overall national debt.
The American Medical Association, which championed the bill, said it was “deeply disappointed” in the vote.
“While short-term fixes have temporarily averted widespread access problems, they have also grown the size of the problem—and the cost of reform,” AMA President J. James Rohack, M.D., says in a written statement.
Others, however, said the expected the measure to fail—though admitted to being surprised by the double-digit loss. “I don't read too much into the vote,” said one healthcare lobbyist who spoke on the condition of anonymity because of his involvement with the measure.
Stabenow says that they had expected some Republicans to vote in favor of the bill. Once it became clear that they weren't going to do so, then other lawmakers also bailed.
“We were missing all Republicans,” she says. “So that really stopped others from coming onboard.”
Still, lawmakers have a number of options still available. For starters, a provision in the Senate's much broader health reform package would give doctors a 0.5% update for 2010.
“We're trying to develop a healthcare system for the future that works,” Baucus says. “Doctors' payment is a relic. It's something from the past. We're trying to clear the decks and get rid of this relic and focus on payment reforms.”
Further, Sen. Kent Conrad (D-N.D.), along with Sen. Chuck Grassley (R-Iowa), is weighing a measure that would give doctors back to back 0.5% updates in 2010 and 2011.
Sen. Richard Durbin (D-Ill.), the No. 2 Democrat in the Senate, acknowledges that a number of amendments have been filed that would fix the physician payment formula, but declines to say which ones are the front-runners.
“How you pay for them and how many votes you put on the board is what it's all about,” he says.
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