Democrats Continue To Scale Back ‘Doc Fix’ in Substitute Amendment

On Wednesday, Senate Democrats unveiled a new substitute amendment to the "extenders" bill (HR 4213) after a procedural vote under budget rules blocked the legislation from advancing toward final approval, CQ Today reports (Rubin/Lesniewski, CQ Today, 6/17).

The Senate voted 45-52 to reject a Democratic motion to waive a budgetary point of order against an earlier version of the substitute amendment. Sixty votes were required to waive the point of order. According to CQ Today, the setback was widely expected. Democrats offered the further-scaled-back version with the hope of securing more support going forward (Lesniewski, CQ Today, 6/16).

The newly revised amendment package includes a six-month delay to a scheduled 21% cut to physicians' Medicare reimbursements. The House package -- which was approved last month -- includes a 19-month delay to the payment cuts. Senate Democrats were seeking a similar delay in their chamber (Hulse, "The Caucus," New York Times, 6/16).

Senate Democrats said that the change would reduce the legislation's cost by $16.4 billion, and combining the cut with other non-health-related alterations to the bill would make the legislation's final cost closer to that of the House-approved version (Cohn, CongressDaily, 6/17).

The revised version of the bill is projected to cost about $118 billion, and slightly more than 50% of the cost would be offset, CQ Today reports.

Despite the cuts, Senate Finance Committee Chair Max Baucus (D-Mont.), who offered both versions of the substitute amendment, did not eliminate a provision -- which the House omitted, but he restored in his first substitute amendment -- for about $24 billion in additional federal Medicaid assistance to states through June 2011.

Next Up for the Extenders Package, Payment Cut

Late Wednesday, Senate Democrats filed for cloture on the bill, which would allow the Senate to vote on Friday to end debate on the measure. However, the vote could come as early as Thursday if Republicans cooperate, according to CQ Today (CQ Today, 6/17).

Also on Thursday, a GOP package of alternative amendments offered by Sen. John Thune (R-S.D.) is poised to face a procedural vote under budget rules. However, it is unlikely that the package will draw the 60 votes needed to waive a budgetary point of order against it, CQ Today reports (CQ Today, 6/16).

Final passage in both chambers would block the 21% payment cut, which will take effect on Friday after CMS earlier this week announced that it would delay processing claims until then.