KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Democrats’ Infighting Threatens Bill That Includes Medicare Payments To Doctors

Democratic infighting on a tax "extenders" and jobs bill, which includes a subsidy for COBRA health insurance benefits for newly laid-off workers and halts a scheduled cut in Medicare reimbursements for physicians, is casting doubt on the likelihood of a vote this week.

The Associated Press: "Democrats are struggling to extend unemployment benefits before they go on vacation next week as they work to ease concerns among jittery lawmakers being hammered over deficit spending. House leaders hope to vote Thursday on a bill that would extend the benefits through November, but they are running into opposition from Republicans and some Democrats concerned about the cost of the overall bill. Democratic members of the conservative Blue Dog coalition are unhappy the bill would add $84 billion to the federal budget deficit. Several Blue Dogs were still noncommittal after meeting with House Majority Leader Steny Hoyer Thursday morning. 'We have serious reservations,' said Rep. Dennis A. Cardoza, D-Calif. 'There are many small sticking points.'"

Democratic leaders had already agreed to scale back a fix to the Medicare doctor reimbursement rate and end the unemployment benefits a month earlier than originally proposed. That would save $40 billion (Ohlemacher, 5/27).

CongressDaily: "The Blue Dog Coalition wants to see unemployment insurance and health subsidies for laid-off workers pared further before agreeing to vote for a huge package of tax breaks, benefit extensions, physician reimbursements and other items. That could put the bill in danger of being shelved until after the Memorial Day recess, although Speaker [Nancy] Pelosi pledged the problems would be resolved before then."

"Members of the moderate faction of House Democrats made it clear to leadership this morning they would not support the $143 billion bill in its current form." According to Rep. Stephanie Herseth Sandlin, D-S.D., many members of the Blue Dog coalition still consider the bill's price tag, even with the trims, too high (Cohn, 5/27).

Politico: Pelosi "may decide there is no backing away from a floor vote. But even if she were to prevail, a narrow House victory could make it harder for Senate Democrats to come up with the 60 votes to overcome Republican opposition there. ... [T]he retreat on the Medicare 'doc fix' is painful for [Pelosi] and many in the party after promises made in the course of the health care debate. ... Medicare has been long plagued by an erratic reimbursement formula that threatens a 21% cut for doctors next month. The goal had been to have a patch big enough to restore some stability and also allow enough time to initiate reforms to encourage physicians to provide primary and preventive care and band together in more cost-efficient accountable care organizations. Instead, under the political pressure of the deficit, there has been a steady retreat in the past two weeks. A five-year $88.5 billion plan was reduced to $65 billion over 3½ years, and now the latest version will end December 2011 with no real reforms" (Rogers, 5/27).

Roll Call: "Senate Democrats are eyeing a late Thursday evening exit for the Memorial Day recess, as they face the very real possibility that neither the House nor the Senate will be able to pass a major tax extenders bill that includes a six-month extension of jobless benefits. Senate Majority Leader Harry Reid (D-Nev.) had said the Senate would work into the weekend if needed to complete action on the extenders legislation, given the current extension of unemployment benefits expires next week. Without a bill from the House, Democrats said they would take a run at passing a temporary extension Thursday night" (Pierce, 5/27).

The New York Times: "House Democratic leaders spent much of Wednesday trying to figure out ways to pare back the measure to attract enough votes for a bill that is chock-full of provisions Democrats would typically embrace - extended jobless pay, health insurance subsidies for the unemployed, a summer jobs program and a tax increase on wealthy investors. ... Aides said the changes would result in about $90 billion of the measure's overall costs of around $150 billion being branded as emergency spending and added to the deficit - a level they hoped a majority could swallow" (Hulse, 5/26).

The Washington Post: If the House and Senate don't pass the bill and send it to the president by June 1, "millions of people could cease to be eligible for up to 99 weeks of jobless benefits and doctors' Medicare payments could fall by [21] percent." Republicans say any added deficit spending is irresponsible (Montgomery, 5/27).

Bloomberg Businessweek: "The decision [to scale the 'doc fix' back] came after the AARP, the American College of Physicians and the American Osteopathic Association urged lawmakers yesterday to stick to their plans for a 3½-year postponement. [AMA] President J. James Rohack said in a statement, 'It is disappointing that Congress is considering an even shorter temporary action at the 11th hour. Everyone agrees that the current payment system is fatally flawed and delaying solving the problem will make the problem bigger'" (Faler and Donmoyer, 5/27).

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