Senate Dems seek higher doctor payments

Maneuvering to boost prospects for sweeping health care legislation, Senate Democrats hope first to win quick approval for a bill that grants doctors a $247 billion increase in Medicare fees over a decade but raises federal deficits in the process, officials said Wednesday.

By creating a two-bill approach, Democrats intend to claim the more comprehensive health care measure meets President Barack Obama's conditions - that it will neither add to deficits nor exceed $900 billion in costs over 10 years.

If approved and signed into law, the legislation would avert a 21 percent reduction in Medicare fees paid to doctors that is scheduled to take effect in January as well as additional cuts in future years.

Lawmakers frequently draft budgets that assume payment rates for doctors treating Medicare patients will fall rather than rise, part of a sleight of hand set of assumptions to make deficits appear smaller than they actually are. They then convene the following year and restore the money.

The disclosure of Senate Democrats' plans came as senior lawmakers sat down with White House chief of staff Rahm Emanuel and other top administration officials for the first time to draft a health care bill expected to be voted on in the full Senate beginning in about two weeks.

Two Senate committees have approved different versions of the legislation, requiring the unusual set of negotiations.

The bill to restore planned Medicare cuts for doctors was introduced without fanfare in the Senate on Tuesday and set aside for swift floor action next week, rather than sent to the Senate Finance Committee for hearings as would normally be the case.

"This is a bill that would permanently change the payment system for physicians to a fairer system," Sen. Debbie Stabenow, D-Mich., said as she introduced the bill.

Jim Manley, spokesman for Senate Majority Leader Harry Reid, D-Nev., said the decision to move quickly and apart from the health care bill was made in consultation with the White House. House Democratic leaders were also involved in the discussions.

House Democrats, in particular, have grumbled about trying to adhere to Obama's price tag.

In the Senate, the immediate impact of a two-bill approach is to slice $10.7 billion from the cost of the health care bill that cleared the Finance Committee bill, money that could then be spent on other priorities.

A 60-vote Senate majority will be required to pass the measure, potentially placing Republican senators in a quandary.

If they oppose it, they may anger doctors who have made restoration of the planned payment cuts a top priority. If they support it, they may open themselves up to charges they helped raise deficits and facilitated passage of a health care bill that conservatives oppose vigorously.

Stabenow's office did not immediately return a call seeking additional information.

Dr. J. James Rohack, president of the American Medical Association, issued a statement welcoming the developments. "Without repeal, the current formula projects steep cuts of about 40 percent over the next five years. As we work to improve the health system, permanent repeal of the payment formula is an essential element of health reform to ensure the security and stability of Medicare," he said.

Manley said the measure does not need to be offset by spending cuts or higher taxes because "it does not increase spending. It simply restores a more honest picture of what future physician spending will actually be."

But Democrats saw the issue differently more than a year ago, the last time Congress acted to head off a cut in payment rates.

Then, they insisted on cutting payments to insurance companies providing private Medicare coverage in order to cover the $13.5 billion cost of the increase in doctor payments. The result was a showdown in which the legislation was passed over President George W. Bush's veto.