Partisan fight over Medicare could render seniors victims

By Lisa Mascaro (contact)

Wednesday, July 9, 2008 | 2 a.m.

Washington — Doctors across Nevada are weighing whether to continue accepting new Medicare patients if Congress fails to stop a 10 percent pay cut to Medicare providers scheduled to take hold next week.

Usually, Congress has been able to prevent the annual pay cut, an unintended consequence of new Medicare reimbursement formulas since 2001.

But this year, with a fiercely divided Congress facing the biggest physician pay cut to date, the expected fix is coming down to the wire in a partisan standoff.

The Senate could vote again as soon as today on the bill that has passed the House but failed by one vote last month in the Senate.

Even if the bill were to pass, President Bush has threatened a veto.

Doctors say the cut could severely threaten their ability to care for seniors in a state with a growing retiree population.

“It’s probably the most critical time I’ve seen in Medicare,” said Larry Matheis, executive director of the Nevada State Medical Association.

Last month, the House surprised many when it overwhelmingly passed the fix with a veto-proof majority despite the objections of Republican leadership and the Bush administration.

Nevada’s three lawmakers, Democratic Rep. Shelley Berkley and Republican Reps. Jon Porter and Dean Heller, all voted yes. Nevada has more than 320,000 Medicare recipients.

But in the Senate the bill was blocked by one vote, drawing an angry rebuke from the floor last month by Senate Majority Leader Harry Reid.

The Republican leader, Sen. Mitch McConnell of Kentucky, said Democrats were engaging in a partisan stunt by holding a vote on a bill they know Bush has pledged to veto.

But Reid virtually taunted Republican senators who voted against the bill, asking them why they were afraid of Bush when the president’s approval ratings were so low. (Congress’ own ratings are lower than Bush’s.)

The next day Berkley dashed off a release criticizing Republicans for putting Nevada’s seniors in harm’s way.

“With the Valley’s rapidly growing senior population, Las Vegas will be especially hard hit if this drastic cut in reimbursement rates is not reversed,” Berkley said.

Reid said if the bill fails again, “Republicans are going to have to live with that.”

Both Republicans and Democrats want to stop the pay cut, but the sticking point is how to raise the funds needed to do so.

Democrats want to trim Medicare Advantage, the private insurance-run program some on Medicare choose.

Democrats say Medicare Advantage costs more to run than traditional Medicare. But twice in June, bills to cut one to pay for the other have been blocked by Senate Republicans.

Republicans and the Bush administration worry that trimming Medicare Advantage will harm the privately run programs they are trying to foster.

Republicans complain that Reid refused to allow a vote on a temporary extension. They were working with Democrats in committee to develop a fix both parties could accept when Reid pushed the Democratic bill to a vote last month.

Doctors groups from Nevada said they were now targeting Republican Sen. John Ensign, who voted against the bill.

Ensign said more than 8 million seniors nationwide rely on Medicare Advantage. Matheis said 30 percent of the Medicare recipients in Nevada use the private plan. Ensign co-authored a bill with other Republican leaders in June to halt the doctors’ pay cuts without cutting the private program.

“The Democrats forced a vote on a partisan measure knowing that it faced a veto threat,” Ensign said in a statement after the first Democratic bill was shot down in mid-June. “We cannot afford to wait any longer to pass a physician payment fix.”

Dr. Edward Kingsley, a co-founder of Comprehensive Cancer Centers of Nevada in Las Vegas, said he left a voice mail at Ensign’s office on the issue.

Kingsley said his medical group will continue taking Medicare patients, but he knows other doctors are worried about how they will cover costs.

“Some physicians are not going to be able to afford that or it’s not worth it to them,” Kingsley said. “That’s ultimately what we all fear — these patients are not going to have access to the care they need.”