Senators return to work Monday facing an immediate deadline for a bill to avert major pay cuts for doctors who treat Medicare patients, but grumbling among conservative fiscal hawks and some liberals could force the Senate to miss the cutoff.
A two-week spring vacation didn’t seem to break the gridlock: Senate leaders who had banked on swift passage after the bill breezed through the House late last month now face the prospect of a drawn-out floor debate with myriad amendments from conservatives, who say the legislation is saturated in red ink, and liberals, who say the bill should provide more funding for a children’s insurance program.
“The challenge for the Senate, that I hope will be addressed next week, is getting the best possible health policy,” said Sen. Ron Wyden of Oregon, the ranking Democrat on the Senate Committee on Finance, who wants to force a vote on funding children’s insurance. “I will be doing everything I can to ensure that that happens.”
The bill that leaders are pushing would permanently nix cuts to doctor’s payments, thus heading off an annual headache for lawmakers who have always temporarily papered over the cuts but have never found the money to pay for a permanent repeal. The legislation would pay for a partial repeal by requiring some wealthy seniors to pay more for Medicare — but it still would leave a $141 billion deficit.
Without a deal, the Obama administration says it will have to start processing applications Wednesday under a formula that will amount to a 21 percent pay cut for doctors.
Congress could make retroactive any changes it enacts, but the cuts would still put a temporary dent in medical practices’ cash flow.
As the clock ticks, Senate leaders will have to decide whether to entertain a growing queue of amendments.
Sen. Mike Lee, Utah Republican, wants Congress to eventually pay for the whole bill by forcing it to abide by a 2010 budget law, known on Capitol Hill as “PAYGO,” which requires new spending to be offset by spending cuts or tax increases.
That would force Congress to find $7 billion in savings later this year, and $14 billion a year for the next decade.
“My amendment would not change or delay anything else in the bill — doctors and seniors won’t notice any difference. It would just require Congress to budget for the costs like we promised we would,” Mr. Lee said Sunday in an op-ed for the Deseret News in Salt Lake City.
A spokesman for Senate Majority Leader Mitch McConnell, Kentucky Republican, declined to comment on the proposal Friday, saying that “members are discussing the path forward” on the bill.
House Speaker John A. Boehner, who hammered out the deal with Minority Leader Nancy Pelosi, is urging the Senate to act. Despite the legislation’s costs in the near term, he says Congress is on the cusp of a milestone that will pay off in the long run.
“This bill represents the first real entitlement reform in nearly two decades, and [the Congressional Budget Office] and other experts have confirmed that it will save taxpayer dollars over the long term,” the Ohio Republican said. “Overall, that’s a big, conservative win for the American people.”
Some Democrats, though, want to fund the Children’s Health Insurance Program for four more years instead of the two-year extension included in the bill. They also want to remove language that extends a ban on federal funds for abortion.
“There are a number of senators who want to be heard on this issue and there ought to be an opportunity for them to weigh in,” he told reporters late Thursday.
Doctors hope they talk fast.
“A 21 percent cut in reimbursements is not something to be taken lightly, especially in an environment where there is already a huge gap between practice costs and Medicare reimbursement,” American Medical Association President Robert M. Wah said last week. “It is of the utmost importance that [the House bill] passes and quickly.”
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