After the Senate failed to pass the Sustainable Growth Rate (SGR) patch to help doctors avert a 21% cut in Medicare reimbursements, Majority Leader Harry Reid (D-NV) accused Republicans of deliberately voting against the bill to undermine health care reform. The amendment, which was not paid for, failed 47-53, “13 short of the 60 needed to advance the measure” to a final vote. Thirteen Democrats joined all Republicans to oppose the measure.
“One of the sponsors of this legislation, one of the Republican leaders is not supporting this legislation,” Reid said referring to Sen. Jon Kyl (R-AZ). “How do you like that? This is another effort of the Republicans to slow down, divert, and stop what we’re trying to do with health care and basically everything else.” Reid suggested that Republicans were keeping the issue alive to divert broader health reform and and accused them of hypocrisy:
I want everyone here to know, we’re going to take care of Medicare. If the Republicans here in the Senate don’t want to do it the way we’ve done it in the past by doing this doctors’ fix, then we will, when we finish the health care legislation, we’ll come back and we’ll take care of a multiple-year fix for the doctors and senior citizens….but I think it’s really too bad that suddenly they’ve gotten religion. They never worried in the past about all these tax cuts being paid for. They never worried about the drug manufacturers getting all this free stuff they got. They never worried about any of this. They now are suddenly being very frugal, very frugal when they find it’s a way that they can slow down what we do here.
Watch it:
The vote underlines the GOP’s duplicitous strategy and also reveals the diminishing power of the American Medical Association (AMA). “We were told by the American Medical Association and others, that we would get help by the Republicans to take care of senior citizens so they could have doctors to take care of them,” Reid lamented. The vote is a defeat for the AMA, which spent some $2 million dollars lobbying for the SGR fix in the last 2 weeks.
Congress created the SGR in 1997 to check rising health care costs. According to the formula, “the amount Medicare pays doctors for an average Medicare patient can’t grow faster than the economy as a whole.” In 2002, medical inflation outpaced economic growth and Congress stepped in to avert the cuts. Between 1999 and 2008, Congress patched the SGR formula six different times.
This year, as Democrats attempted to patch the cut by offering a floor amendment outside of the major health care reform bills, Republicans and some conservative Democrats argued that “the $247 billion Medicare bill would violate Mr. Obama’s vow that health care legislation not add ‘one dime’ to the budget deficit. Senate Majority Leader Mitch McConnell (R-KY) accused Obama of breaking his campaign pledge:
And now the Democrats in Congress are proposing that we put another quarter of a trillion dollars on the government charge card in order to prevent a cut in the reimbursements for doctors who treat Medicare patients. All of us want to keep this cut from happening, but the American people do not want us to barrow another cent to pay for it. And they don’t want Democrats to pretend that this quarter of a trillion dollars isn’t part of the cost of health care reform. Because it is. It is also a clear violation of the President’s pledge that health care reform wouldn’t add a single dime to the deficit over the next decade.
Watch it:
But McConnell supported paying for the SGR patch with deficit spending before he opposed it. Since Congress began fixing the formula in 1999, he — and the majority of the Republican party — rarely objected to barrowing “another cent to pay for it.” McConnell has voted to patch the SGR five different times, three of his votes resulted in increased deficits:
Year
Name Of Bill
Provisions
Vote
Did It Add To Deficit?
1999
Incorporated into an omnibus bill
Eliminated Medicare reimbursement cuts for 2000 through 2002.
Senate: 74-24
House: 216-210
NO
2003
The Medicare Modernization Act of 2003
Eliminated Medicare reimbursement cuts for 2004 and 2005.
Ultimately, the SGR fix has little to do with health care reform. After all, the patch is not adjusting unsustainable growth in health care spending or some other system imbalance. It is fixing a failed complex formula that Congress created to control health care spending.
Congress should eliminate the scheduled pay cut and fix the formula, but physicians should not receive a blank check. Instead, they should be required to adopt efficiencies and delivery system reforms. After all, if the purpose of the SGR is to reduce health care spending, physicians should play their part.
The Hill reports that “Pelosi made it clear in a leadership meeting Tuesday night that she intends for the Medicare-based public option to be included in the final House bill. But she acknowledged in a meeting of the full caucus later that she doesn’t yet have the 218 votes among Democrats that she needs to guarantee its passage.”
Over at The Treatment, Jonathan Cohn asks (and answers) ‘What is Nancy Pelosi Doing?.” It’s a good question, but reformers should also ask, ‘What is Nancy Pelosi Getting?’ Blue Dogs and some moderate lawmakers believe (wrongly, in my opinion) that a public option that reimburses at Medicare rates for the first 2 to 3 years would devastate rural providers (they’ll all go down in three years, you see).
But if Blue Dogs reject the public plan, then Pelosi must ask them to offer policy solutions that can meet the objectives of a robust public option:
- If you reject the public option, how will they make up for its estimated $100 billion in savings?
- The public option will lower premiums by about 10%, so how should we make coverage more affordable within the Exchange?
- How will you hold insurers’ feet to the fire to ensure that they don’t game the new rules and your constituents?
Reformers don’t have $100 billion to waste. They don’t have the extra dollars to increase affordability subsidies. In other words, they don’t have the luxury to dispose of a policy that can help make coverage more affordable.
If the Blue Dogs want to gut the plan, they must propose reforms that achieve the same objectives: a compromise public option that triggers market rates if they devastate providers, increase affordability subsidies, institute new regulatory and accountability entities to hold insurers accountable, expand Medicaid even further. The list is long, and Blue Dogs should start pitching some ideas. They shouldn’t get something for nothing.
