WASHINGTON — At 75 years old, Billie Cox has fallen and broken her ankle, had an elbow replacement and suffers the same aches and pains of many her age.
But Cox, a retired real estate agent who lives in Lacey, has a new medical problem -- her regular doctor says he will no longer see her or other Medicare patients if a 10.6 percent cut in physician reimbursement rates takes affect July 1 as scheduled.
And with less than two weeks to go, it remains uncertain whether Congress will act in time to reverse the rate reduction.
"It would be devastating, especially in a state like ours," said Rep. Adam Smith, D-Wash. Medicare reimbursement rates in Washington state for doctors are already among the lowest in the nation, he noted.
The cuts in reimbursement rates could affect not only Washington state's more than 700,000 seniors, but also another 300,000 or so in the military-related TRICARE health care system. TRICARE's reimbursement rates for doctors are tied to Medicare's.
"That's a sizable number," said Brian Wicks, president of the Washington State Medical Association, which represents most of the state's 11,000 practicing doctors.
A December survey by the association found 60 percent of the doctors questioned would either restrict the number of Medicare patients they see or not see any at all if the cuts aren't reversed.
"Right now Medicare barely covers our costs," said Wicks, an orthopedic surgeon in Silverdale. "If you take another 10 percent off, it won't cover our costs. I see some dramatic changes coming in Medicare."
Wicks and others say Washington has been penalized since 1965, when the Medicare program was adopted and doctor reimbursement rates were based on a state's medical costs. The costs have traditionally been low in Washington because of cost-conscious doctors and a generally healthy population that doesn't seek medical care for every sneeze and sniffle.
By some estimates, doctors can make twice as much practicing in Miami as they do in Seattle. Medicare reimbursement rates can be $2,500 per patient higher in Florida and New York than in Washington.
By some accounts, it's been hard to attract new doctors to Washington state because they can make more money elsewhere. The impact has been felt especially in rural areas.
The looming cuts in reimbursement rates will only make the situation worse.
Several weeks ago, Billie Cox said she received a letter from her doctor explaining he no longer would be taking Medicare patients if the cuts take effect.
"I don't blame him, but if he drops me I don't know where I will go," said Cox. "He can't refer me to another doctor who takes new Medicare patients because he doesn't know any. I feel frustrated."
Cox's doctor, Daniel Dugaw, who has practiced in Olympia for 20 years, said he regrets having to drop Cox and his other Medicare patients. But he feels he has no choice.
"They are the most costly and time consuming and have more medical problems than any of my other patients," Dugaw said. "I will opt out."
The problem stems from a program that runs on auto-pilot adopted in 1998 by Congress. Using a formula called the "sustainable growth rate," the program was designed to limit Medicare spending by automatically adjusting Medicare reimbursement rates for doctors every year.
Facing dire warnings from doctors and an outcry from seniors, Congress has delayed the cuts year after year. But in doing so, the amount that has to be sliced the next year goes higher and higher.
"We've given some aspirin to lower the fever, but we are only dealing with the symptoms, not the root cause," said Rep. Brian Baird, D-Wash. "Controlling costs is a good thing, but this is not the way to do it."
Baird said he thinks Congress will again delay the cuts, but "it always comes down to a game of chicken. The politics are ugly. Eventually we are all going to have to grab hands and jump off the cliff together if we are going to solve the health care problems."
Smith is a little less certain.
"I don't know if we will act, no one knows," he said. "At the moment, there is not a clear plan to prevent them (the cuts)."
The dispute is tied up in the broader Senate vs. House fight over how to pay for things that will add to the federal deficit. House members have insisted that if the Medicare rate cuts are delayed, the cost needs to be paid for. Senate Democrats have tried to find off-setting savings, but Senate Republicans have blocked their efforts.
Two weeks ago, the Senate refused to cut off debate on a measure that would have delayed the cuts for 18 months. The chairman of the Senate Finance Committee, Sen. Max Baucus, D-Mont., and the committee's top Republican, Iowa Sen. Charles Grassley, have been meeting to try to broker a compromise.
"This impending cut means Washington state doctors will have little incentive to continue serving Medicare patients," said Sen. Patty Murray, D-Wash. "It means decreased access for seniors at a time when more and more baby boomers are becoming eligible for Medicare and it means underserved rural seniors will have more barriers to care."
Washington state's other senator, Democrat Maria Cantwell, said the cuts need to be postponed.
"This should give us the time to implement real changes to Medicare," Cantwell said.
Murray has introduced legislation in the Senate and Smith in the House that would make the rates more equitable between states. The measure would ensure no state receives less than the national average of per patient spending.
"To be honest, it's going nowhere," said Smith. "I will keep pushing it, but we don't have the money. It needs to be part of a broader reform package. Comprehensive reform is expensive and includes hard choices. Few want to acknowledge it, let alone face up to it."