WASHINGTON -- Doctors' Medicare fees would be cut 21 percent next year unless some change is approved, and quickly, but Senators sent a strong signal Wednesday that they're reluctant to spend billions on a long-term solution.
Despite a strong effort by the American Medical Association, the Senate rejected a bid to continue debate on a 10-year plan by 13 votes because of concerns it isn't paid for.
James Rohack, the AMA president, said he's "deeply disappointed," and Senate Majority Leader Harry Reid, D-Nev., vowed he'd pursue a "multi-year fix" after dealing with health care legislation.
Before the end of the year, the change is expected to pass -- because Congress is highly unlikely to put doctors and seniors in a precarious position.
First, however, there's going to be a lot of political turmoil as lawmakers sort out all sorts of tough questions.
Should the change be part of the big health care overhaul? Should Congress pass a long-term fix, or simply one that applies for a year or two? Also, how will this be paid for -- since the federal deficit last year hit $1.4 trillion and a lot of lawmakers are reluctant to make it bigger?
Advocates of a strong fix have warned that if the currently scheduled payment system goes into effect, patients would have a harder time finding doctors willing to treat them. "These cuts threaten to disrupt the relationships between people with Medicare and the doctors who care for them," according to Joe Baker, the president of the Medicare Rights Center, a nonprofit, nonpartisan consumer advocacy group based in New York.
Members of Congress agree on this much. "The one thing we have to understand is we are going to make sure that senior citizens have the ability to go to a doctor when they're sick," Reid said. "That's the key. We want to make sure that more doctors take Medicare patients, not less."
Beyond that, solutions to this problem are proving elusive.
Part of the problem involves disagreements over how long a fix is necessary. The Senate Finance Committee, as part of its $829 billion comprehensive health care plan, agreed to increase doctors' payments 0.5 percent next year, at a cost of $10.9 billion.
Sen. Debbie Stabenow, D-Mich., and others want a 10-year, $246.9 billion plan that would freeze rates during that period, a plan that's been widely praised by the doctors' group and AARP, which represents seniors.
"While short-term fixes have temporarily averted widespread access problems, they have also grown the size of the problem -- and the cost of reform," Rohack said at a Washington news conference. "This bill does away with past budget gimmicks and instead lays the foundation for fiscally honest and responsible repeal of the broken formula."
Skeptics countered that the 10-year fix dramatically adds to the deficit, and that argument doomed the bill Wednesday.
"It just adds almost $250 billion to the deficit, to the debt for the coming years. And I just don't think we can do that anymore," said Sen. Joseph Lieberman, a Connecticut independent who caucuses with the Democrats.
Supporters of the 10-year plan, however, argue that the Finance Committee fix, while less expensive, pushes the problem off for another year, and estimates are that doctors fees would drop 25 percent in 2011.
One solution is to adopt a compromise fix separately from the big health care overhaul, which presumably would make the Medicare change easier to pass. Discussions are under way to do that.
The system Congress is trying to fix comes from a complex formula called the "Sustainable Growth Rate," which is supposed to set the Medicare fees each year. Year after year, though, it falls short of what physicians say is a reasonable payment. In each of the past seven years, Congress has had to enact higher fee schedules.
The problem is expected to grow more acute in the next decade, as more baby boomers retire. Those are the reasons, congressional leaders say, that something will be done.
"It can be one year, two years, four years, 10 years, I don't know. That's got to be worked out," said Senate Finance Committee Chairman Max Baucus, D-Mont., "The main point is there will not be a reduction in doctors' reimbursement."
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