California Healthline Daily Edition

Summaries of health policy coverage from major news organizations

House Dems Make More Cuts to ‘Extenders’ Bill; Vote Planned for Friday

After failing to reach a compromise with members on the cost and provisions of the so-called "extenders" bill (HR 4213), House Democratic leaders on Thursday agreed to cut roughly $31 billion more from the $145 billion package in an attempt to secure enough votes for its passage before members leave for the Memorial Day recess on Friday, CQ Today reports.

The latest version of the bill would eliminate extensions of COBRA subsidies for unemployed workers and a renewal of additional state Medicaid funding outlined in the 2009 federal economic stimulus package (Rubin/Schatz, CQ Today, 5/27).

On Wednesday, the leadership released a scaled-back bill that includes abridged extensions to expiring jobless benefits, including subsidies to help unemployed residents obtain coverage through COBRA, and would delay until 2012 a 21% cut to physicians' Medicare payments. The changes cut the bill's cost from nearly $200 billion to $145 billion, according to Congressional Budget Office estimates (California Healthline, 5/27).

However, Wednesday's changes were not enough to garner enough votes for passage. Members of the fiscally conservative Blue Dog Coalition refused to sign on to the bill unless further cuts were made. Blue Dogs did not offer specific ideas on how to reduce the cost of the bill, according to CQ Today.

The COBRA subsidies are set to expire on June 1 and the 21% cut to Medicare physician payments will take effect June 2, unless Congress acts (Bolton, The Hill, 5/27).

House Vote Likely on Friday; To Be Held in Two Phases

House Democratic leaders plan to schedule a vote on the new version of the bill on Friday, even though prospects for Senate consideration of the bill before the Memorial Day recess have "vanished," CQ Today reports (CQ Today, 5/27). House sources say that members plan to hold the vote in two phases: First, a package that includes the unemployment benefits and tax extenders, and second, a 19-month delay to the pending cut to physicians' Medicare payments.

The two-phase approach would give lawmakers with concerns about approving spending that is not offset the chance to express their disapproval and also support the so-called "doc fix," which legislators agreed to exempt from pay/go rules earlier this year, CongressDaily reports.

The House would then send the combined package to the Senate, where the bill is expected to remain untouched until members return from the Memorial Day recess (Cohn, CongressDaily, 5/27).

Senate Majority Leader Harry Reid (D-Nev.) confirmed the chamber would consider after the recess whatever the House passes on Friday.

Challenges to Senate Passage Continue

CQ Today reports that some Senate Democrats could complicate matters for the bill's prospects. Some senators have proposed significant changes to a provision related to a tax increase on businesses and venture capitalists, which would force the House to hold a revote.

According to CQ Today, House Speaker Nancy Pelosi (D-Calif.) "seemed disinclined" to accept any Senate changes to the provision (CQ Today, 5/27).

Meanwhile, a senior Senate Democratic aide said that Senate Democrats are planning to offer a 14-day extension to the expiring unemployment benefits, COBRA coverage subsidies and freeze on the physician payment cut, The Hill reports.

However, Senate Republicans are expected to reject the proposal, as it would add $4 billion to the federal deficit. Republicans plan to make a counterproposal for a short-term solution that would be covered by surplus funds from the 2009 federal economic stimulus package.

However, the Democratic aide said that Democrats would reject the proposal because they contend those extra funds should be spent on job creation (The Hill, 5/27).

Lawmakers, Industry Groups Express Mixed Reactions to New Bill

Rep. Raul Grijalva (D-Ariz.), co-chair of the Congressional Progressive Caucus, on Thursday said that the bill had been scaled back to the point that he and other liberal House members might reconsider their support, CongressDaily reports.

Grijalva said he welcomed the extension of physician payments but called the proposed elimination of COBRA and Medicaid subsidies "embarrassing and short-sighted." He said, "We're Democrats. We're supposed to stand up for the little guy" (CongressDaily, 5/27).

Meanwhile, representatives for several physician and labor groups continued to lobby lawmakers on Capitol Hill for swift passage of the extenders bill. Some group officials said that further delay on approving the bill would impact hundreds of thousands of U.S. residents who depend on the unemployment subsidies and coverage.

Physicians faced with sharp cuts to Medicare reimbursement rates also could be forced to limit the number of Medicare patients they treat or stop accepting Medicare altogether, CQ Today reports (Ethridge, CQ Today, 5/27).

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