Legislation To Change Medicare Physician-Pay Formula Stalls in Senate

Efforts to pass a bill (S 1776) that would permanently change the way physicians are paid under Medicare have been stalled in the Senate after several Democrats on Tuesday said that they would not support the legislation unless its 10-year, $247 billion cost was fully offset, The Hill reports (Bolton, The Hill, 10/20).

The bill -- introduced last week by Sen. Debbie Stabenow (D-Mich.) -- is designed to avert a 21% Medicare payment reduction scheduled to go into effect on Jan. 1, 2010. The bill also would repeal the current sustainable growth rate formula used to determine Medicare physician payments (American Health Line, 10/20).

Democratic Sens. Evan Bayh (Ind.), Tom Carper (Del.), Kent Conrad (N.D.), Russ Feingold (Wis.) and Claire McCaskill (Mo.) called for spending cuts or tax increases to offset the legislation's cost. They joined Republican senators, who also criticized the bill's lack of funding, in opposition to the legislation (The Hill, 10/20).

Sen. Joseph Lieberman (I-Conn.), who caucuses with the Democrats, also said he does not support the measure (Edney/House, CongressDaily, 10/20).

Durbin, Stabenow Admit To Shortage of Votes

Senate Majority Whip Richard Durbin (D-Ill.) acknowledged on Tuesday that "we don't have 60 votes on our side of the aisle" to overcome a Republican filibuster (Pear, New York Times, 10/20).

Stabenow said that although her measure has the support of "the majority" of Democrats, it would need Republican support to pass. "We're still working on it, we've got work to do on that," she said (Reichard, CQ HealthBeat, 10/20).

Senate Democratic leaders have scheduled a cloture vote for Wednesday after failing to garner the 60 votes necessary for cloture on Tuesday.

Many observers expect that Wednesday's cloture vote also will fail (Edney, CongressDaily, 10/21).

Stabenow Refuses To Include Offsets

On Tuesday, Stabenow refused to cave to bipartisan demands that she include funding mechanisms to cover the entire cost of her payment fix bill, Roll Call reports (Stanton, Roll Call, 10/20).

At a press conference, Stabenow argued that the bill would be paid for by readjusting "the baseline" of federal spending. However, CQ HealthBeat reports that would "simply place the cost of the measure on the federal deficit" (CQ HealthBeat, 10/20).

Alternative Legislation in the Works

Conrad currently is holding private meetings with Sen. Chuck Grassley (R-Iowa) on an alternative to Stabenow's bill that would cost $25 billion over two years and be fully offset, the AP/Boston Globe reports (AP/Boston Globe, 10/21).

Conrad did not indicate the funding mechanisms of the proposal but said that a commission would eventually be established to create a permanent fix to the Medicare physician payment system (CongressDaily, 10/21).

Hoyer Says Pay-Go Must Come First

On Tuesday, House Majority Leader Steny Hoyer (D-Md.) said that he and House Speaker Nancy Pelosi (D-Calif.) are demanding that the Senate pass statutory pay-as-you-go legislation before taking up the Medicare physician-payment change, Roll Call reports (Dennis, Roll Call, 10/20).