http://prescriptions.blogs.nytimes.com/2009/10/21/senate-rejects-doc-fix-spending-bill-as-some-democrats-side-with-republicans/?8au&emc=au
Some Democrats Side With Republicans
By David M. Herszenhorn AND Robert Pear
In a vote that was a highly symbolic proxy for the larger partisan fight over health care policy, the Senate on Wednesday rejected a bill that would have averted steep cuts in Medicare payments to doctors.
Senate Democratic leaders had pushed the bill, which would have cost $247 billion over 10 years, as a standalone measure separate from the broader health care legislation that is President Obama’s top domestic priority.
The bill was meant to fix a longstanding payment formula that calls for annual cuts in Medicare payments to doctors — cuts that for years Congress has avoided with yearly stop-gap measures that have come to be known on Capitol Hill as the “doc fix.”
The Senate majority leader, Harry Reid of Nevada, had argued that flawed doctor payment formula was a longstanding problem and that the cost of fixing it should not count in the price tag of the big health care bill.
The American Medical Association had also lobbied heavily in favor of a permanent correction of the formula, which calls for a 21.5 percent cut in Medicare fees in 2010 and cuts of about 5 percent in each of the next few years.
But Republicans seized on the proposal to suggest that Democrats were not being fully forthcoming about the cost of the broader health care overhaul, which Mr. Obama has said should be about $900 billion and not add to the federal deficits.
And in the end, a dozen Democrats and one independent joined all 40 Senate Republicans in opposing the measure, which failed on a procedural vote by 53 to 47. Under Senate rules, the measure needed 60 votes to advance.
Because Democrats did not propose offsetting the cost of fixing the doctor-payment formula, the bill would have added the full cost of $247 billion to future deficits.
The Senate Republican leader, Mitch McConnell of Kentucky, said that Wednesday’s vote represented a first signal of bipartisan opposition to the Democrats’ larger health care proposals.
“In the Senate’s first vote on health care spending this year, a bipartisan majority rejected the Democrat leadership’s attempt to add another quarter trillion dollars to the national credit card without any plan to pay for it,” Mr. McConnell said in a statement. “With a record deficit and a ballooning national debt, the American people are saying enough is enough. Today’s vote shows that this message is finally starting to get through to Congress. Hopefully it’s a sign of things to come in the health care debate ahead.”
Mr. Reid and other Democrats criticized the Republicans for opposing an adjustment to the doctor-payment formula and accused them of playing politics and simply seeking to obstruct Mr. Obama’s agenda.
The Senate Finance Committee had proposed a one-year fix for the doctor-payment formula as part of the broad health care legislation it approved last week — a proposal that is still being melded with a health care bill passed last summer by the Senate health committee.
And Senator Kent Conrad, Democrat of North Dakota and chairman of the Budget Committee, who was a leading architect of the Senate Finance Committee bill, had proposed a commission to come up with a long-term solution to the Medicare doctor-payment formula and several other recurring budgetary problems.
Mr. Conrad was among the Democrats who voted against the party leadership. Others were Evan Bayh of Indiana, Russ Feingold of Wisconsin, Claire McCaskill of Missouri and Ron Wyden of Oregon.
House Democrats included a permanent adjustment of the doctor payment formula in their health care legislation, at a cost of $228.5 billion over 10 years. But they, too, have said the cost should not count in judging whether the broader health legislation meets Mr. Obama’s requirement of not adding to the deficit.
Since 2003, Congress has stepped in to postpone cuts under the payment formula, in legislation but has usually found ways to offset the cost to the government.
Aides to Mr. Reid said they had no choice but to try to fix the doctor payment formula ahead of debate on the larger health care legislation. Otherwise, they said, an amendment would be offered on the Senate floor to add the formula adjustment to the bill, pushing the overall price-tag of the legislation above $1 trillion and seriously imperiling its chances.
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For more on "doc fix", see this editorial in today's Wall Street Journal, "The Doctor Fix Is In":
http://online.wsj.com/article/SB10001424052748704500604574483531025733584.html
