Cut in Medicare fees to doctors is blocked

The Arkansas Democrat-Gazette

Congress unites to override Bush veto

WASHINGTON — WASHINGTON - Congress on Tuesday blocked a cut in Medicare payments to doctors, overriding a veto by President Bush.

The Senate voted 70-26 on Tuesday, more than the twothirds needed, to override Bush’s veto of the Medicare legislation. The House voted 383-41 hours earlier to thwart the veto.

Democratic Sens. Blanche Lincoln and Mark Pryor of Arkansas voted to override the veto. In the House, the entire delegation - three Democrats and one Republican - alsovoted for the override.

The legislation averts a 10.6 percent reduction in fees paid to doctors by Medicare, the U.S. health program for the elderly and the disabled. It cuts reimbursement instead to insurance companies that provide care through plans called Medicare Advantage.

Reducing insurers’ funding will hurt senior citizens enrolled in the plans, Bush said when he vetoed the measure Tuesday.

Arkansas officials said the override spared the state a devastating blow. The cuts would have meant doctors throughoutthe state could no longer afford to serve Medicare patients, said David Wroten, executive vice president of the Arkansas Medical Society.

“There will be a sigh of relief across the state of Arkansas and the rest of the country, for that matter, with seniors and their doctors knowing they’re not going to have to endure this 10.6 percent cut,” Wroten said.

Arkansas already has the country’s lowest Medicare reimbursement rates - estimated at 15 percent to 18 percent below the national average - because the Centers for Medicare and Medicaid Services factor in a “geographic adjustment” when they calculate Medicare reimbursement rates.

Lower reimbursements would have meant decreased access to care, particularly in rural parts of the state that already struggle to attract doctors, Wroten said.

“It’s not every day that a president gets overridden, but the president is just out of touch,” said Sen. Barbara Boxer, D-Calif., after the vote. “I truly think we’ve saved Medicare, and that’s a good feeling.”

Twenty-one Republicans in the Senate joined Democrats to override Bush’s veto, including four Republicans who opposed the measure when it passed the Senate last Wednesday.

“I’m strongly disappointed that the Senate was blocked from a bipartisan solution and that seniors will suffer,” said Sen. Jon Kyl, RAriz., who sided with Bush, in a floor speech before the vote.

The cut in doctors’ fees was required under a formula Congress approved a decade ago to hold down Medicare spending. It has been set aside repeatedly in recent years, leaving physicians facing the 10.6 percent reduction that officially took effect on July 1. Health groups such as the American Medical Association warned that senior citizens would have a harder time finding physicians if the cut wasn’t reversed.

BUSH OBJECTION

About one in five of Medicare’s 44 million enrollees is enrolled in Medicare Advantage plans, which usually offer extra benefits such as vision care and lower co-payments. The federal health program is expected to pay $86 billion this year for the plans, which are paid on average 13 percent more than it costs Medicare to provide services directly.

Bush’s opposition to the legislation focused on changes in insurers’ private fee-for-service plans, which a congressional advisory board has estimated are paid on average 17 percent more than Medicare spends to provide benefits itself.

The legislation will require this type of Medicare Advantage plan to form provider networks, instead of assuming that all doctors and hospitals that take Medicare are part of the plan. The change may cause some plans to close and beneficiaries to choose other Medicare options, according to a report by the Congressional Budget Office.

“I support the primary objective of this legislation, to forestall reductions in physician payments,” Bush said in his veto message Tuesday. “Yet taking choices away from seniors to pay physicians is wrong.”

Medicare also will stop paying private plans extra for patients treated at teaching hospitals. These facilities already receive extra payments to cover their higher cost. Overall, the legislation would reduce payments to private plans by about $12.5 billion over five years.

Democrats said insurers in Medicare Advantage are overpaid.

“Stop giving them a break to provide services that in many cases are second-rate,” said Rep. Pete Stark, D-Calif., during House debate Tuesday. “There is no reason to overpay the charlatans who provide second-rate care.”

But Rep. Mike Rogers, R-Mich., said, “We don’t have to punish the patients to help the doctors.”

A provision of the law suspends Medicare’s new bidding process for medical equipment such as wheelchairs and walkers. The procedure, intended to save money, requires suppliers to compete on price instead of being paid according to a fee schedule. Some suppliers who lost the initial bidding, covering 10 metropolitan areas, said they were treated unfairly and that Medicare beneficiaries might not get supplies they needed.

The delay of bidding will “perpetuate wasteful overpayments to medical equipment suppliers,” Bush said in his statement.

‘VERY GOOD NEWS’

In an interview after the vote, Pryor called the override “very good news” for Arkansans enrolled in the federal health insurance program for the disabled and people age 65 and older.

“Medicare is very, very important to our state,” Pryor said.

Arkansans make up 499,571 of the 44.2 million Medicare beneficiaries nationwide. The cuts would also have affected TriCare, the federal health-care program for active duty and retired military members and their families. A total of 99,997 Arkansans are enrolled in TriCare.

Lincoln issued a statement criticizing Bush for vetoing the bill and praising Congress for putting aside partisan politics for the benefit of senior citizens, military families and health-care providers.

“It is unfortunate the President chose to veto a bipartisan bill that improves care and access for Arkansas’s Medicarebeneficiaries, provides critical support for our health care providers, and makes much-needed reforms to Medicare Advantage programs,” Lincoln said.

Wroten, of the Arkansas Medical Society, said the state was lucky to have the full support of its congressional delegation but added that the veto override was only a temporary victory.

The Medicare Improvements for Patients and Providers Act of 2008 only carries the program through the end of 2009. Medicare’s funding formula ties health-care costs to the economy and the overall inflation rate. That means the formula calls for cuts every year health-care costs rise faster than inflation, which has been the case each year for the last several years.

Congress will have to address the issue again next year for 2010, Wroten said.

“Until we correct the flawed formula, we will have to go through this every year or two for the foreseeable future,” Wroten said.

Pryor said making positive changes to Medicare has been difficult under Bush.

“The president has not been a friend of Medicare,” Pryor said. “He’s just out of step with America, and certainly Arkansas, on this issue.”

Pryor said he hopes to work next year with the new president to “make sure that Medicare is secure.”

“Hopefully we’ll have more support coming out of the White House than we have the last eight years,” Pryor said.

Information for this article was contributed by Aliza Marcus and Roger Runningen of Bloomberg News, Carolyne Park of the Arkansas Democrat-Gazette and Kevin Freking of The Associated Press.

Front Section, Pages 1, 10 on 07/16/2008

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