WASHINGTON In a matter of days the federal government is scheduled to start paying doctors 10.6 percent less when they treat Medicare patients.
With that in mind, the House overwhelmingly passed legislation Tuesday that would void the cut and pay for it by trimming payments to private health insurers.
The legislation passed 355-59 despite a veto threat by President Bush and protests from the insurance industry. It had broad support from doctors, hospitals and pharmacists. A vote against the measure would have risked alienating those important constituencies just as lawmakers get ready to break for the July 4th recess.
Now, the job of avoiding a pay cut for doctors falls to the Senate, where lawmakers were working behind the scenes Tuesday to craft a compromise that would gain the administration's support or generate enough votes to overcome a veto.
Some 600,000 doctors care for Medicare patients. Payment rates are set to drop by 10.6 percent on July 1 as a result of a formula that calls for cuts when spending exceeds established goals. Avoiding the cuts has become an annual event for Congress, but finding the money invariably requires trimming payments to other health-care providers.
Democrats this year have focused on taking the money from the Medicare Advantage program, which lets the elderly and disabled get their health benefits through a private insurer rather than through traditional Medicare.
Democratic lawmakers say the government's payments to the insurers are overly generous, but the administration and supporters in Congress say the payments translate into lower monthly premiums for Medicare Advantage participants or extra services such as vision and dental care. Under the bill passed Tuesday, insurers would lose nearly $14 billion over five years.
"The administration has repeatedly communicated that legislative proposals that result in loss of beneficiary access to additional benefits or choices in the MA program are unacceptable," the Office of Management and Budget said in a statement of administration policy.
Democratic lawmakers, however, dared Republicans to vote against the measure. They added an array of measures that were popular with health-care providers and patients. For example, insurers would be required to pay pharmacies within 14 days of billing. Another measure would lower the co-payment from 50 percent to 20 percent when Medicare participants get treatment for mental health problems.
"Vote against the bill and talk to your local pharmacist, my Republican friends," warned Rep. Pete Stark, D-Calif.
The biggest threat, however, was the loss of access to a physician that many lawmakers warned would occur because doctors would be reluctant to see Medicare patients.
"If we fail to enact this legislation, physicians will face a 10 percent pay cut that jeopardizes access to care for seniors and the disabled," said Rep. John Dingell, D-Mich., and chairman of the House Energy and Commerce Committee.
Republicans supported the measure, 129-59. Democratic lawmakers supported it unanimously with 226 votes.
Many of those who spoke against the bill criticized Democratic leadership for not holding hearings on the measure and for presenting them with a bill on the same day a vote was scheduled.
"The majority seems to be under the mistaken impression that the less input and the less Republicans know about major bills, the more likely we are to vote for them," said Rep. Joe Barton, R-Texas. "Well, I have a news flash. We were not part of the process when we don't have any input into the policy."
A similar bill failed last week to gain enough support in the Senate to proceed to a vote. Senate Majority Leader Harry Reid, D-Nev., plans to try again by Friday.
"As evidenced by the overwhelming House vote, the bill they are sending us enjoys significant bipartisan support. Senator Reid intends to bring this bill to the floor as quickly as possible," said Reid's spokesman, Jim Manley.