House Passes Temporary Medicare Fix After Senate Again Fails To Pass More Comprehensive Legislation

Nancy Pelosi’s misguided attempt to use Medicare as leverage to pass the unemployment and jobs measures in the tax-extenders bill failed. Fortunately Pelosi quickly realized there was no point in continuing this strategy when Senate Republicans again blocked passage. Forty Republicans and Ben Nelson voted against the measure, blocking the measure supported by 57 Democrats. Subsequently Pelosi backed down and the House passed the temporary Medicare fix.

While misguided, at least it can be said that Pelosi meant well, motivated by a desire to promote economic recovery, which certainly could not be said of the Republicans. After the Senate passed a Medicare fix as a separate measure, she was under the mistaken belief that she had some leverage over Senate Republicans by blocking a vote on the Senate measure.

I am surprised at how badly Pelosi misread the Republicans. Republicans were willing to vote for the Medicare “doc fix” but certainly would not be heartbroken if it failed and they could blame Democrats for destroying Medicare. Even if they were actually in support of the measure, their opposition to spending money on jobs or the unemployed certainly trumped any such feelings.

Senator Debbie Stabenow of Michigan (where we recently fell to the number two in unemployment, now surpassed by Nevada)  summed  up the Republican mind set here:

It is very clear that the Republicans in the Senate want this economy to fail. They see that things are beginning to turn around. You know the numbers. When this president took office, we were losing 750,000 jobs a month. … Now we are gaining jobs. … Unfortunately, and cynically [on their part], in cynical political terms, it doesn’t serve them in terms of their elections if things are beginning to turn around.

I believe when you look at this bill, which is all paid for — we raised revenues to pay for it — the one piece that is technically not paid for [is the federal unemployment benefit extensions and] that is done in a way that we have always done it, … [those are] always categorized as an emergency. And, frankly, if 15 million people without jobs is not an emergency, I don’t know what is.

Ezra Klein provided this political interpretation earlier in the day when he anticipated the loss on the jobs measures:

And still, it looks like Democrats might lose the vote today. And when I say “lose the vote,” I don’t mean that a majority of the Senate will vote against it. I mean that 58 senators, rather than 60, will support the legislation. All Republicans, and possibly Ben Nelson, appear to remain opposed. And why not? The less that Democrats appear to be doing on jobs — and the fewer jobs that Democrats actually create — the better Republicans will do in November. Substantial compromises on the bill haven’t brought any new votes, and that’s in part because Republicans see no political upside in passing the legislation.

While it made no sense for Pelosi to believe that the threat of not passing the Medicare fix would get Republicans to vote for unemployment benefits, at least she did quickly back down and get the Medicare fixed later the same day.

Getting this passed quickly was important for a number of reasons. After postponing the processing of payments since the beginning of June, Medicare began processing payments with the 21 percent cut. It will now be necessary to reissue these checks with the updated amount. Earlier in the week I saw estimates that this would cost $15 million, and this would increase with every batch of Medicare payments which must be reprocessed. The delay also increases expenses for physicians and undermines confidence in Medicare. This might lead more doctors, who now see Medicare patients at a considerable discount compared to commercial payers,  to decide against accepting Medicare patients.

Now that it is established that both parties agree that this needs to be fixed, hopefully we can also achieve a permanent fix to the Medicare payment formula before the end of the year. Attempts last year failed because the Republicans had wanted to include this cost in the cost of health care reform and use it as another bogus argument against reform. Now that health care reform has been passed hopefully the Republicans will not see further political gain in blocking a permanent fix.

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AARP Joins Physician Groups In Blasting Congress For Inaction On Medicare Payment Fix

The failure of Congress to act on the Medicare “doc fix” has led to protests from medical organizations and the American Association of Retired People who have pointed out the harm this will do to the Medicare program and people dependent upon Medicare for their health care. The American Academy of Family Practitioners has called on Congress to stop harming patients and do their job. The American College of Physicians has blasted Congress for causing “Irreparable damage to Medicare” as seniors and military families face loss of access to health care. AARP sent the following letter to every member of Congress urging action on Medicare, warning that their inaction “threatens access to physician services for millions of Medicare beneficiaries.”

On behalf of millions of AARP members, I urge you to immediately pass legislation that ensures seniors have access to their physicians, and provides much needed fiscal relief to the states and to unemployed individuals.

Regrettably, given Congress’s failure to reach timely agreement on a Medicare physician pay package, the Centers for Medicare and Medicaid Services has now been forced to implement a draconian 21.3 percent reduction in their reimbursements.  This cut threatens access to physician services for millions of Medicare beneficiaries – especially those living in rural and other underserved areas.

While Congress continues to debate temporary patchwork solutions, people on Medicare are growing increasingly anxious about whether they will be able to find a doctor when they need one.  Seniors, who have paid into Medicare their entire working lives, deserve the peace of mind of knowing they will be able to find a doctor who will treat them.

AARP urges Congress to act immediately to stabilize doctor reimbursement rates for as long as possible until a permanent solution can be found.   For nearly a decade, Medicare patients and the doctors who treat them have been held hostage by short-term patches to an unworkable Sustainable Growth Rate (SGR) formula.  In the months to come, we look forward to working with Members of Congress from both sides of the aisle to repeal the SGR formula and replace it with a permanent physician payment system for Medicare that rewards value and ends the uncertainty for patients and providers alike.

In addition, enhanced Medicaid funding to states to assist them with the added costs of providing health coverage to low income individuals and for home and community based services must be extended.

Finally, we urge the extension of unemployment benefits for those unable to find jobs during this economic downturn.

AARP members are counting on you to address these critical issues immediately to protect their health and economic security.

Congress Plays Chicken With Medicare

Medical blogs have been protesting the failure of Congress to resolve this problem. For example, Dr. Rob warns that Congress is playing “a great big game of chicken.”

  • The house is playing chicken with the senate.
  • The Democrats are playing chicken with the Republicans.
  • They aren’t in the cars themselves, we are.  Doctors and patients are careening toward destruction in the name of political gamesmanship.

Surely they will flinch.  Surely someone will understand the consequences of the crash.  But you know what?  Sometimes each side expects the others will be the ones who flinch.  Sometimes nobody flinches.  Sometimes the cars crash and people are killed.

There are two potential ways to resolve this deadlock. The quickest would be for Nancy Pelosi to go along with Senate Majority Leader Harry Reid, House Majority Leader Steny Hoyer, and Rep. Robert Andrews (D-N.J.), the Chair of the Education and Labor health panel, and allow the House to vote on the temporary fix passed in the Senate last week.

Nancy Pelosi has been insisting on a different course by attaching the Medicare “doc fix” to other unrelated legislation. The Senate is attempting to pass legislation which includes some of Pelosi’s goals, but it is questionable if the Senate could pass such legislation without watering it down to the point where Pelosi would not find it acceptable.

For Nancy Pelosi to be the one who, at present, is blocking passage of this legislation might be political suicide for the Democrats, risking turning over control of Congress to the Republicans in November. The Democrats are already on shaky ground with seniors. As Ezra Klein pointed out earlier today, health care reform has become more popular since passage–except with seniors. The Democrats cannot afford to further alienate the senior vote, which tends to turn out more heavily in off year elections than the younger voters who are more likely to stick with the Democrats.

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Democrats Split As Nancy Pelosi Betrays Seniors

Nancy Pelosi’s irrational behavior regarding the Medicare “doc fix” is creating rifts between Pelosi and other Democrats. For the past several months we’ve had a repeated pattern of the Democrats taking the lead in trying to fix the problem while the Republicans have blocked passage. Suddenly it is Nancy Pelosi who is jeopardizing Medicare.

The Senate passed a six month temporary fix last Friday which differed from the House proposal. While far from perfect, the Senate bill would have at least bought some time to again work on a long term solution. It was initially assumed that the House would quickly approve the Senate bill but instead Pelosi has insisted she will not act upon a Medicare fix which does not also include the jobs proposals in the House bill.

While fighting for the jobs proposals are admirable, this should not be done at the expense of passing the Medicare fix. Failure to pass the fix endangers the Medicare program and will cause seniors, the disabled, and military families to have difficulty getting access to health care. (Medicare directly covers seniors and the disabled while Tricare, which covers active members of the military and their families, bases its fee schedule on the Medicare fee schedule).

As Nancy Pelosi and Harry Reid took differing positions, Politco reported this morning that  Congress battles as Medicare burns. There even appears to be some disagreement with Pelosi among the House Democratic leadership, as reported by The Hill:

Rep. Robert Andrews (D-N.J.), the Chair of the Education and Labor health panel, tells The Hill that Congress should quickly pass a bill delaying cuts to Medicare physician payments. The comments seem at odds with House Speaker Nancy Pelosi’s (D-Calif.) statement Monday that the House should hold off on taking up the Senate’s Medicare doc fix until the Senate passes a tax extenders bill, which some House members fear might go nowhere if it’s uncoupled from the must-pass doc fix.

“Leverage is less important than ensuring seniors can see their doctors,” Andrews said as he was entering a meeting in the office of House Majority Leader Steny Hoyer (D-Md.). “So I think it’s important to pass it.”

As I said earlier as my Facebook status, also posted to Speaker Pelosi’s FB page (and on Twitter in an abreviated 140 character version):

Nancy Pelosi: We expect Democrats to fight to preserve Medicare, not give Republicans political cover to destroy it. So far it has been the Republicans who have been blocking the payment fix, but if you follow through with threats not to pass the latest temporary fix passed by the Senate the Democrats become responsible for endangering Medicare, and risk losing the senior vote.

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Fewer Doctors Accepting Medicare Patients Due To Payment Uncertainties

USA Today reports that “The number of doctors refusing new Medicare patients because of low government payment rates is setting a new high, just six months before millions of Baby Boomers begin enrolling in the government health care program.” There have always been doctors who do not accept Medicare due to lower payment rates compared to private insurance but the number is now increasing due to uncertainty about future payments due to the flawed physician payment formula:

Recent surveys by national and state medical societies have found more doctors limiting Medicare patients, partly because Congress has failed to stop an automatic 21% cut in payments that doctors already regard as too low. The cut went into effect Friday, even as the Senate approved a six-month reprieve. The House has approved a different bill.

• The American Academy of Family Physicians says 13% of respondents didn’t participate in Medicare last year, up from 8% in 2008 and 6% in 2004.

• The American Osteopathic Association says 15% of its members don’t participate in Medicare and 19% don’t accept new Medicare patients. If the cut is not reversed, it says, the numbers will double.

• The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%.

The federal health insurance program for seniors paid doctors on average 78% of what private insurers paid in 2008.

“Physicians are saying, ‘I can’t afford to keep losing money,’ ” says Lori Heim, president of the family doctors’ group.

In past years Congress has acted at the last minute to override steep cuts called for under the payment formula but this year there has been increased uncertainty as the Republicans have repeatedly played politics to prevent a long term fix. If the scheduled 21% cut is not reversed it is anticipated that far more doctors will stop accepting Medicare patients. This cut would place Medicare payment closer to the level of Medicaid, which already suffers from difficulties in access to care.

Medicare not only covers those over the age of 65. The program covers many who are disabled, and the Tricare program which covers U.S. military personnel and their families also pays based upon the Medicare fee schedule.

This year, after attempts at a permanent fix were blocked, the fee cuts have been blocked in temporary measures which have only been effective for one to two months. The Senate finally passed a six month fix last week but payments from June were already being sent out at the reduced rates. The fix would restore the cut fees retroactively but now Nancy Pelosi is threatening that the House will not pass this until the Senate also passes a jobs bill. While a jobs bill is also necessary, these are two separate issues and Medicare beneficiaries should not be forced to suffer while Congressional Democrats are fighting to pass a jobs bill.

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Nancy Pelosi Gambles With Future Of The Democratic Party By Rejecting Medicare “Doc Fix”

Harry Reid might be the leader of a House of Congress from Nevada but it is Nancy Pelosi who has turned into quite a gamble–a gamble which if she loses will probably turn the Democratic Party back into a minority party. On Friday the Senate passed a six month Medicare “doc fix” but regrettably could not also pass jobs legislation. Now Nancy Pelosi is threatening that the House will not pass the Senate bill until they also pass jobs legislation.

If her gamble works and the Senate passes the original House bill as opposed to the more limited Senate bill then Nancy Pelosi will come off as a legislative genius. However this is a very high stakes gamble. If she fails then it will be the Democrats who will receive much of the blame for the failure of passage of the Medicare fix.

Failure to pass the Medicare fix will lead to serious limitations on medical care for the elderly and disabled individuals now on Medicare. In addition, Tricare pays based upon the Medicare fee schedule so this will also adversely affect U.S. military personnel and their families.

Conservatives already are beginning to realize that Nancy Pelosi might have handed them a tremendous gift. Ed Morrissey writes:

In other words, Pelosi has handed the Senate Republicans the key to a filibuster not just in the Senate but also in the House, all to demand a massive expansion of the deficit on two separate fronts.  The GOP couldn’t have possibly asked for a better political position even if they had begged Pelosi not to throw them into that briar patch.  And if the “doctor fix” fails to get out of the House, it won’t be Republicans who get the blame, since Pelosi can call a vote on that any time she desires.

Let’s hope that Republicans manage to keep this advantage for as long as it takes Pelosi to realize that she’s blown it.

Morrissey is incorrect on an earlier point claiming, “the passage of the ObamaCare legislation whose financials were specifically predicated on keeping the Medicare reimbursement cuts in place.” A permanent fix was originally planned to be part of health care reform but Republicans made this politically impossible by counting the paper costs of this fix as part of the health care legislation.

Regardless of countless acts by the Republicans to play politics here and block a permanent fix, Morrissey is correct that the Democrats will pay the price politically if Nancy Pelosi is the one to prevent passage of the fix which has now passed the Senate. Loss of the senior vote will be devastating to the Democrats.

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American Osteopathic Association Endorses Health Care Reform Legislation

The AOA has joined the AMA in endorsing the health care reform legislation along with making recommendations for changes. The recommendations include eliminating the flawed physician payment formula and significantly modifying or abolishing the Independent Payment Advisory Board.

Following is the text of the item in today’s AOA Daily Report which includes their letter to President Obama, Speaker Pelosi, and Majority Leader Reid:

The full AOA Board of Trustees convened today to finalize the AOA’s official position on health system reform legislation as Congress nears a final vote after a year-long debate.  The Board examined how the bill aligns with AOA policies established by the AOA House of Delegates over the last 30 years and developed a letter to President Obama, Speaker of the House Nancy Pelosi, and Senate Majority Leader Harry Reid delineating our unanimous support of advancing the legislative process as well as our strong recommendations on how to ensure access to care, promote primary care, provide for fair physician payment, and reduce overall health care costs, especially by enacting federal PLI reform.  Read a copy of the letter here.

Earlier I posted a copy of a statement faxed and emailed to physicians in support of the legislation by the American Medical Association along with links to letters sent by the AMA with their suggestions for improvements in the legislation.

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AMA Supports Passage Of Health Care Reform With Recommendations For Improvements

The American Medical Association which previously endorsed passage of the House and Senate health care reform bills has sent out a fax to physicians supporting passage of the revised bill to be voted upon this Sunday. The fax states that “We worked hard and made significant progress toward resolving” problems with the original Senate bill. They also state there are issues “that cannot be addressed through the current reconciliation process and will need to be address by Congress and the administration.”

The AMA calls for changes including repealing the Medicare sustainable growth rate formula, making changes in the Independent Payment Advisory Board, the cost-quality value index, rules for data release, and enactment of effective medical liability reforms.

While they consider this bill “an imperfect product” and see problems in the bill which I agree with, the  AMA concludes that this bill “does, in fact, improve the ability of patients and their physicians to achieve better health outcomes.”

Update: The American Medical Association has also released a press release supporting the bill and a letter to Nancy Pelosi outlining their view. A more detailed explanation of these points was included in this  letter to Harry Reid and Nancy Pelosi in January.

Update 2: The fax has also been sent by email making it easier to post on line. The text is under the fold.

Update 3: The American Osteopathic Association supports health care reform legislation.

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Conservative News Network Hires Yet Another Conservative

While CNN began with a reputation for being a liberal network, it has increasingly become the Conservative News Network since being sold by Ted Turner. While certainly not as far right as Fox, and preserving some degree of journalistic integrity, CNN has hired far more Republicans than others in the past several years. There is yet another addition–Erick Erickson of Red State.

Steve Benen finds this pick to be far worse than all the other conservatives which CNN has hired in recent years:

This is easily the worst decision CNN has ever made. That the network probably reviewed Erickson’s work before hiring him, and offered him a job anyway, suggests CNN’s professional standards for what constitutes “an important voice” have all but disappeared.

The point here isn’t that it’s disappointing to see CNN hire yet another conservative voice, adding to its already-large stable of conservative voices. To be sure, it’s frustrating, but it’s nothing new.

The problem here is with Erickson himself.

For example, it wasn’t long ago when Erickson explained his belief on why the left has a stronger online presence than the right. He attributed it to an asymmetry in free time, since conservatives “have families because we don’t abort our kids, and we have jobs because we believe in capitalism.”

This is the same Erickson who recently called retiring Supreme Court Justice David Souter a “goat f–king child molester,” referred to two sitting U.S. senators as “healthcare suicide bombers,” praised protesters for “tell[ing] Nancy Pelosi and the Congress to send Obama to a death panel” (he later backpedaled on that one), and described President Obama’s Nobel Prize as “an affirmative action quota.”

And perhaps my personal favorite was the time, just last year, when Erickson was angry about new environmental regulations relating to dishwasher detergent. He told his readers, “At what point do the people tell the politicians to go to hell? At what point do they get off the couch, march down to their state legislator’s house, pull him outside, and beat him to a bloody pulp for being an idiot?”

There was a point when major professional outlets would look at a voice like this as an “extremist,” to be shut out of the mainstream of America’s civil discourse. CNN, however, considers this record of radical rhetoric, and concludes it should pay him to offer on-air political commentary.

CNN will no doubt hear about blog posts like this one, and assume that liberals are angry because the network hired a right-wing blogger. But that’s not it — there are thoughtful, intelligent conservative bloggers in the country, who occasionally have insightful things to say. The problem here is that Erick Erickson isn’t one of them.

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GOP Fundraising Documents Cost Them A Donor

The recent accidental release of a presentation for donors prepared by the Republican National Committee continues to create embarrassment. The presentation shows how the GOP, lacking any real policies, tries to fool donors with appeals based upon fear. Ben Smith reports on one former donor who has decided not to contribute to the party:

A prominent Evangelical figure and Republican donor says he will end his contributions to the organized Republican Party in reaction to the leaked fundraising presentation that advised using “fear” to solicit contributions and displayed an image of President Obama as the Joker from Batman.

Mark DeMoss, who heads a major Christian public relations firm in Atlanta and served as a liaison to the Evangelical community for Mitt Romney in 2008, wrote Chairman Michael Steele yesterday that he was “ashamed” of the presentation, calling depictions of Obama, Speaker Nancy Pelosi, and Majority Leader Harry Reid “shameful, immature and uncivil, at best.”

“I’m afraid the presentation is representative of a culture and mindset within the Republican National Committee,” DeMoss, a past member of the RNC’s “Eagle” program for top donors who gave the party $15,000 in 2008, wrote in the letter to Steele, which he shared with POLITICO. “Consequently, I will no longer contribute to any fundraising entity of our Party—but will contribute only to individual candidates I choose to support.”

Personally I think people should have become wise to the minset of the Republican National Committee when they sent out fund raising letters in 2004 trying to scare people by saying John Kerry would take away their bibles. Better late than never. The full text of the letter is under the fold:

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Republican Documents Show Plan For Fund Raising Based Upon Appealing To Fear

The Republican Party is doing better at present than most would have expected last year but they still have the same fundamental problem: they are wrong on all the issues. Their arguments continue to be based by making multiple claims which are counter to fact. That’s the hand they have, and they are going all out with it.

Politico has obtained a copy of a presentation from the Republican National Committee outlining their strategy of conning donors they denigrate into contributing money by raising false fears about Obama and socialism:

In neat PowerPoint pages, it lifts the curtain on the often-cynical terms of political marketing, displaying an air of disdain for the party’s donors that is usually confined to the barroom conversations of political operatives.

The presentation explains the Republican fundraising in simple terms.

“What can you sell when you do not have the White House, the House, or the Senate…?” it asks.

The answer: “Save the country from trending toward Socialism!”

Manipulating donors with crude caricatures and playing on their fears is hardly unique to Republicans or to the RNC – Democrats raised millions off George W. Bush in similar terms – but rarely is it practiced in such cartoonish terms.

One page, headed “The Evil Empire,” pictures Obama as the Joker from Batman, while House Speaker Nancy Pelosi and Senate Majority Leaders Harry Reid are depicted as Cruella DeVille and Scooby Doo, respectively.

The documents also discusses how to approach different groups of donors:

The most unusual section of the presentation is a set of six slides headed “RNC Marketing 101.” The presentation divides fundraising into two traditional categories, direct marketing and major donors, and lays out the details of how to approach each group.

The small donors who are the targets of direct marketing are described under the heading “Visceral Giving.” Their motivations are listed as “fear;” “Extreme negative feelings toward existing Administration;” and “Reactionary.”

Major donors, by contrast, are treated in a column headed “Calculated Giving.”

Their motivations include: “Peer to Peer Pressure”; “access”; and “Ego-Driven.”

The slide also allows that donors may have more honorable motives, including “Patriotic Duty.”

A major Republican donor described the state of the RNC’s relationship with major donors as “disastrous,” with veteran givers beginning to abandon the committee, which is becoming increasingly reliant on small donors.

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