Senate Approves a Bill on Changes to Medicare
By ROBERT PEAR
APRIL 14, 2015 - New York Times
WASHINGTON — The Senate on Tuesday
overwhelmingly approved sweeping changes in the way Medicare
pays doctors, clearing the bill for President Obama and resolving an issue that
has bedeviled Congress and the Medicare program for more than a decade.
The 92-to-8 vote in the Senate,
following passage
in the House last month by a vote of 392 to 37, was a major success for
Republicans, who devised a solution to a complex policy problem that had
frustrated lawmakers of both parties. Mr. Obama has endorsed the bill, saying it
gcould help slow health care cost growth.h
The bill, drafted in the House in
negotiations between Speaker John A. Boehner and Representative Nancy Pelosi,
the Democratic leader, also extends the Childrenfs Health Insurance Program for
two years, through 2017.
Without action by Congress,
doctors would have faced a 21 percent cut in Medicare fees on Wednesday or
Thursday. Senate leaders cleared the way for final passage by allowing votes on
several amendments sought by liberal Democrats and conservative Republicans.
Medicare spent $70 billion last
year under the fee schedule used to pay doctors and some other health care
professionals. That accounts for about 12 percent of all Medicare spending.
Ninety-eight percent of people enrolled in the traditional fee-for-service
Medicare program receive at least one physician service during the year.
The legislation moves Medicare in
a direction espoused by Mr. Obama and many health policy experts, toward payment
based on the quality and value of care, rather than just the volume of services.
Organized medicine now accepts that change in principle, and the American
Medical Association lobbied strongly for the bill, demanding that Congress gfix
Medicare now.h
Congress has passed 17 short-term
bills since 2003 to block cuts in Medicare doctorsf fees that were called for
under the existing law. Such cuts would most likely prompt some doctors to
accept fewer Medicare patients.
The Senate majority leader, Mitch
McConnell, Republican of Kentucky, said the bill taken up Tuesday was gdesigned
to ensure that seniors on Medicare donft lose access to their
doctors.h
gItfs a solution to a broken
Medicare payment system that has vexed congressional leaders of both parties for
years,h he said. gIt would mean an end to the annual exercise of Congress
passing a temporary fix to the problem one year and then coming right up to the
very same cliff the next year, without actually solving the underlying
problem.h
Senator Ron Wyden of Oregon, the
senior Democrat on the Finance Committee, called the bill ga milestone for
Medicare.h But he and other Democrats said it would have been better to extend
the childrenfs insurance program for four years, rather than two.
Mr. Wyden said the current formula
for paying doctors was ghorrendously flawedh but had gdominated much of the
discussionh in the last 18 years.
Before passing the bill, the
Senate rejected a half-dozen proposed amendments on Tuesday night. Democrats,
for example, wanted to provide more money for womenfs health care. Republicans
wanted to repeal a provision of the Affordable Care Act that requires most
Americans to have health
insurance, and they tried to force Congress to pay for the Medicare bill so
it would not increase budget deficits.
The current payment formula, set
by Congress in 1997, links Medicare spending on doctorsf services to growth of
the overall economy. Medicare spending has regularly exceeded the targets. Under
the law, the excess is supposed to be recouped in subsequent years through cuts
in payment rates for doctors.
The bill would repeal that
formula. Fiscal conservatives object because only one-third of the cost would be
offset. The rest, $141 billion from 2015 to 2025, would add to federal
budget deficits.
gThis bill is not paid for,h said
Senator Jeff Sessions, Republican of Alabama.
New spending would total $211
billion over 10 years, the Congressional Budget Office estimated. Higher-income
Medicare beneficiaries would pay additional premiums totaling nearly $35
billion, and Medicare would save a similar amount by trimming payments to
hospitals, nursing
homes and home health agencies.
Senator Mike Lee, Republican of
Utah, said the bill gdoubles down on Medicarefs broken price control modelh and
ginflates the administrationfs power as regulator and compliance officer.h
gThe principal change proposed in
this bill is to move from a Medicare payment system based on volume to one based
on bureaucratic measures of quality and value,h Mr. Lee said.
The votes against the bill came
from Republicans: Mr. Sessions and Mr. Lee, along with Senators Ted Cruz of
Texas, David Perdue of Georgia, Marco Rubio of Florida, Ben Sasse of Nebraska,
Tim Scott of South Carolina and Richard C. Shelby of Alabama.
For a few hours on Tuesday, it
seemed senators might also be close to an agreement to vote on Mr. Obamafs
nomination of Loretta E. Lynch to be attorney general, but the prospect
evaporated.
Senator John Cornyn of Texas, the
No. 2 Senate Republican, offered a plan to overcome an impasse over abortion
restrictions in a sex-trafficking bill, but Democrats quickly rejected it.
Republican leaders have held up a vote on Ms. Lynch until the Senate finishes
work on the trafficking bill.
Democrats on Tuesday repeated
their opposition to the abortion restrictions and denounced the delay of Ms.
Lynchfs nomination. gThey can stall her for 157 days; she is going to be
attorney general of the United States,h said Senator Harry Reid of Nevada, the
Democratic leader.
Commenting on the Medicare bill,
federal officials welcomed its emphasis on the quality of care but said it would
probably not provide a permanent solution.
Paul Spitalnic, the chief actuary
of the Medicare program, said the bill could lead to ga payment reduction for
most physiciansh after 2025. gIf not addressed by subsequent legislation,h he
said, gwe expect that access to and quality of physiciansf services would
deteriorate over time for beneficiaries.h