Senate Democrats Scale Back Medicare Payment Fix in ‘Extenders’ Bill
On Wednesday, Senate Democratic leaders began scaling back the "extenders" bill (HR 4213), after strong opposition from moderate Democrats and Republicans over the bill's cost, projected effect on the federal deficit and lack of offsets, the Washington Post reports (Montgomery, Washington Post, 6/16).
The unrevised version of bill, which the Congressional Budget Office estimated would cost about $140 billion and raise the deficit by nearly $78 billion over 10 years, was set to face a series of scheduled test votes on Wednesday morning. However, Democrats said it had become clear that they did not have enough votes to advance the bill, necessitating the changes (Rubin , CQ Today, 6/15).
Although a final draft of the scaled-back bill had not been released by Tuesday night, the AP/Chicago Tribune reports that it would delay for seven months -- rather than 19 months -- a scheduled 21% cut to physicians' Medicare reimbursements. The payment cut will take effect Friday, after CMS earlier this week announced that it would delay processing claims until then (Taylor, AP/Chicago Tribune, 6/16).
Democratic sources said the change -- along with one other non-health-related alteration -- would cut the bill's cost by $22 billion, bringing its final cost closer to the House-approved version of the bill, which CBO projected would add about $54 billion to the deficit (Cohn, CongressDaily, 6/15).
Vote Hurdles Loom; Fate of 'Doc Fix' and COBRA Provisions Unclear
It is not yet clear whether the changes to the bill will be enough for it to advance on Wednesday. In addition to securing the votes of all 59 in the Democratic caucus, the leadership must draw the support of at least one Republican to meet congressional budget rules (AP/Chicago Tribune, 6/16).
Sen. Olympia Snowe (R-Maine), one possible swing vote, said that there "obviously" needed to be major revisions to the bill. According to CQ Today, Snowe has suggested addressing the cut to physicians' Medicare payments in a separate bill, which she said could offset the provision's estimated $22.9 billion cost with excess funds from the 2009 federal economic stimulus package.
CQ Today also reports that an attempt by Sen. Bob Casey (D-Pa.) to restore about $8 billion for the extension of COBRA subsidies for unemployed workers, which the House omitted, is not likely to survive the procedural votes (Rubin , CQ Today, 6/15).
Cloture Vote on Medicaid Aid Package Averted
Senate Majority Leader Harry Reid (D-Nev.) announced that he had reached an agreement with Senate Republicans to waive a cloture vote to end debate on a substitute amendment to the bill, in exchange for allowing the GOP to offer a point of order against the proposal. The substitute amendment -- which would restore about $24 billion in state Medicaid aid that the House also omitted -- still would require 60 votes for approval, which is unlikely, CongressDaily reports (Cohn, CongressDaily, 6/16).
Senate Finance Committee Chair Max Baucus (D-Mont.), who offered the substitute amendment, said Wednesday that it is not "locked down" and could be subject to "modifications" (Rubin , CQ Today, 6/15).
GOP Amendment Analysis Revised, To Proceed to Floor Vote
As part of the Reid-GOP deal, the Senate will hold a vote on a package of alternative amendments to the "extenders" bill, which the GOP introduced last week, according to CongressDaily (CongressDaily, 6/16).
Among other proposals, the GOP package would delay the cut to physicians' Medicare payments through 2012, one year longer than House and Senate Democratic versions of the bill propose, and eliminate the federal state Medicaid aid package (California Healthline, 6/11).On Tuesday, CBO issued an updated analysis of the GOP package, estimating that it would eliminate $68 billion from the federal deficit, $13 billion more than it originally estimated. However, it is unlikely the package will be approved (CongressDaily, 6/15). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.