Friday, October 16, 2009

URGENT ACTION NEEDED to repeal SGR and protect seniors' access to care

10/16/09 - Liability and Health News ALERT
URGENT ACTION NEEDED to repeal SGR, protect seniors' access to care

by Donna Baver Rovito, Editor, "Liability and Health News Update"
Author, "Pennsylvania's Disappearing Doctors"

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((I received this alert from PA physician and health care advocate extraordinaire, Dr. Marilyn Heine BEFORE anything from the AMA, the American College of Surgeons or any news stories about the issue showed up in my email box. As always, Dr. Heine is ahead of the curve on any and all issues which impact quality health care - thanks, Marilyn!))

** URGENT ACTION NEEDED: Protect Seniors' Access to Care

US Senate scheduled to vote on physician Medicare payment bill beginning Monday, October 19.

** The ISSUE:

Medicare payment to physicians is set to be slashed 21.5% in January 1, 2010, with a cumulative total of 40% reduction in reimbursements planned over the next few years. This is due to the flawed Medicare physician payment formula put in place in 1999.

Fair payment is critically important to ensure access to care for our senior citizens and the disabled. Plus, Tricare has been using Medicare rates so the issue impacts our military as well.

Medicare cuts can prevent doctors from seeing new Medicare patients, discourage them from investing in health technology, and make many consider closing their practices altogether!

The formula must be repealed and replaced with a fair, stable system that better matches the cost of providing care. S 1776 is critical to help get us toward that goal.


Please call TODAY. Take one minute to let your voice be heard. Your efforts could help preserve senior citizens' continued access to quality doctors.

Please phone:

* Senator Specter: (202) 224-4254 Web Form:
* Senator Casey: (202) 224-6324 Web Form:

Or use the AMA Physicians' Grassroots Hotline at (800) 833-6354


Please vote to advance and pass S 1776 to protect seniors' access to medical care.



Just to be clear on this - the flawed SGR formula on which Medicare reimbursements to physicians is based has called for a significant reduction in reimbursements to physicians across the board since 2003. EACH YEAR SINCE THEN, Congress, which has been aware of the flaw in the formula all along, has acted to POSTPONE the reduction. At the current time, a 21% decrease is scheduled for January 2010.

If implemented as passed in 1999, physicians across the nation would eventually suffer a cumulative decrease of 40%i n Medicare reimbursements! Of course, practicing physicians know that Medicare reimbursements have already dropped nearly that much in the past 10-15 years, dragging commercial insurance reimbursements down with them. Health care costs might be rising - but it's not because doctors are getting paid more.

None of those SGR decreases has yet actually occurred largely due to the advocacy efforts of America's physicians on behalf of their senior citizen patients, whom they could no longer afford to treat if the decreases went into effect. But Congress has so far refused to take action to permanently fix what they clearly know is a flawed formula - hospital and long term care reimbursements are based on a different formula, allowing for small increases in reimbursements each year. FIXING the Clinton administration's flawed formula should NEVER HAVE BEEN a part of the broader health care reforms currently being debated - it should have been fixed long ago.

Each year, the AMA, the American College of Surgeons, and other physician advocacy organizations, along with their senior citizen patients, have been forced to beg Congress not to impose the draconian cuts which could make it impossible for many doctors to treat Medicare patients at all. Commercial insurance already subsidizes Medicare reimbursements to an extent - but there's no way physicians can "cost shift" to make up such double digit losses in reimbursement. The bottom line is that this flawed formula MUST BE FIXED, before any talk of health care reform can continue.

Please weigh in on this issue today - America's doctors WANT to take care of their senior citizen patients, and have continued to do so even though it isn't financially sustainable. Senior citizens want their doctors to be able to continue to care for them. I think it's a no-brainer that we shouldn't still be talking about, but we are, and right now, we have the best opportunity we've ever had to get this problem fixed permanently.

Contact information and other details follow, along with an invitation to a political event and an appeal for physicians to get involved in a nationwide demonstration. Further details about the Baucus Bill and the continuing process to merge all of the health care reform bills will follow in another Update.

PLEASE make calls to your US Senators today and ask them to support S 1776 and permanently repeal the flawed SGR formula to make sure that America's doctors can continue to take care of one of America's most beloved assets - our senior citizens.

And THANK YOU for all the kind words about this newsletter and the MANY subscription requests. It's immensely gratifying to see how many people value my efforts - please know that it's MY honor to fight alongside America's dedicated doctors and other health care providers, and I'm happy to offer this small effort on behalf of quality medicine.



From the AMA Physicians Grassroots Network

We appreciate all that you've done on behalf of the Physicians' Grassroots Network. All of your hard work has paid off, because the Senate is about to consider a bill that would eliminate Medicare's sustainable growth rate (SGR) formula!

S. 1776, the "Medicare Physicians Fairness Act of 2009," was just introduced in the Senate this week. Senate leadership announced that the bill will serve as the Senate legislative vehicle for eliminating the SGR and laying the foundation for establishing a new Medicare physician payment update system. The bill would repeal the SGR permanently and set future payment updates at zero.

Importantly, the Senate leadership made it very clear that Congress does not intend to implement a permanent physician payment freeze and call it Medicare payment reform-and the AMA would not support such a proposal. Rather, by passing a separate bill that repeals the SGR and eliminates the accumulated spending target debt, budget constraints that have stopped permanent Medicare reform in the past would be lifted, allowing a new physician payment update system to be incorporated into a broader health system reform bill.

The first step to passing this bill will come quickly-as soon as Monday afternoon, in fact! On Monday, Oct. 19, there will be a "motion to invoke cloture." That means there will be a vote to allow formal consideration of the bill.

The key thing to remember is that we need 60 senators to vote with physicians and vote YES on cloture.A vote on final passage is expected to occur next Thursday (Oct. 22) or Friday (Oct. 23). We're going to need your help three times in the next few days:

Call or e-mail Sen. Arlen Specter and Sen. Robert P. Casey, Jr. NOW and urge them to SUPPORT S.1776.

This bill would not only stop the Jan. 1, 2010, Medicare cuts of more than 20 percent, it also would repeal the flawed SGR payment formula and start us down the path toward ensuring that physicians can continue caring for Medicare patients. Use our hotline at (800) 833-6354.

Next week, there will be a second procedural vote on "waiving the budget act" for S. 1776. When the time comes, we will need you to contact your senators again and ask them to vote YES (don't worry, we'll remind you!).

When the bill itself is up for a vote, we will need one final phone call to both Sen. Arlen Specter and Sen. Robert P. Casey, Jr. asking them to vote YES on S. 1776.

Each of these steps is critical to passing this bill, and Sen. Arlen Specter and Sen. Robert P. Casey, Jr. need to hear from you at each point.

Thank you for your continued involvement in the Physicians' Grassroots Network. Together we are stronger! Email your senator

For more information,please visit:


((This letter about the SGR fix was submitted to the Philadelphia Inquirer by Dr. Marilyn Heine - I think it's a masterful synopsis of the issue and I hope they print it. FYI, I've recently learned that Dr. Heine, who has served with distinction both on the PAMPAC and AMPAC Boards to further physician involvement in politics and improve the quality of health care, and whom I consider a good friend, is a candidate for Vice President of the Pennsylvania Medical Society. Members will chose their vice president, who will eventually become PMS President, next weekend at the combined medical society and medical society alliance annual convention in Hershey, PA. Were Alliance members able to cast votes for medical society officers - which we're not - I would be delighted to cast mine for Marilyn. She's a tireless advocate, both brilliant and articulate, and is an ideal choice to represent PA's physicians. I wish I could VOTE for her! Ah, well, perhaps I'll be able to talk her into running for public office somewhere down the road....I think SENATOR Heine has a nice ring to it....))


Sent: Thu, Oct 15, 2009 12:54 pm

Subject: Letter to the editor

The recent editorial (It’s not soup yet), points out the need for Americans to have health insurance. Yet, having insurance does not guarantee access to care. ((Excellent point, which most people who are debating health care reform have NOT acknowledged...))

Medicare, the program designed to safeguard care for our seniors and disabled, is in jeopardy. Medicare falls short of covering the cost of care physicians provide to patients.

Looming drastic cuts will make it harder for patients to see their doctor. Medicare payments to physicians are scheduled to drop by over 20 percent in January, and more cuts for years after that.

Medicare cuts often prevent doctors from seeing new Medicare patients, discourage them from investing in health technology, and make many consider closing their practices altogether!

In a poll the American Medical Association conducted last June, 70 percent of likely voters said they believe Medicare's reimbursement system needs a permanent solution.

In an AARP survey this September, 87 percent said it is important for doctors to be reimbursed adequately so they can continue to accept Medicare patients.

The Senate proposes building its health system reform plans on Medicare; but its foundation is crumbling due to an archaic payment system. For health system reform to succeed, Congress must eliminate the flawed Medicare physician payment formula.

Using a Band-Aid is not the answer, and in the past has made the problem worse. Now is the time for a permanent solution.

Congress should provide a stable, fair way for Medicare to pay physicians. Failure to do so threatens the security of the Medicare program and patients’ access to care.

Marilyn J. Heine, MD

((Well done, Marilyn - hope they have the good sense to print it!))


from the AMA Health System Reform Bulletin

Oct. 15, 2009

Here's your regular update on efforts by the American Medical Association (AMA) to work with lawmakers in reforming the nation's health care system in a way that provides quality, affordable health care for all.

Senate to vote on SGR Monday

On Oct. 13, Sen. Debbie Stabenow (D-Mich.) introduced S. 1776, the "Medicare Physicians Fairness Act of 2009," which the Senate leadership announced yesterday will serve as the Senate legislative vehicle for eliminating Medicare's sustainable growth rate (SGR) formula and laying the foundation for establishing a new Medicare physician payment update system.

S. 1776 will be the subject of a cloture vote on Monday, Oct 19. The Senate needs 60 votes to invoke cloture to allow formal consideration of the bill. A vote on final passage is expected to occur late next week, either on Oct. 22 or 23. Senate Majority Leader Harry Reid (D-Nev.), Senate Finance Committee chairman Max Baucus (D-Mont.), and Sen. Chris Dodd (D-Conn.), along with President Barack Obama, are all strongly supporting passage of S. 1776.

Sen. Stabenow's 18-line bill repeals the SGR formula and eliminates all debt that has been accumulated under the current payment system, setting future physician payment updates at zero. Importantly, the Senate leadership made it very clear yesterday that Congress does not intend to implement a permanent physician payment freeze and call it Medicare payment reform.

Rather, by passing a separate bill that repeals the SGR and eliminates the accumulated spending target debt, budget constraints will be eased, allowing a new physician payment update system to be incorporated into a broader health system reform bill. The details of that future update system have not yet been worked out, although certainly the two spending targets that would be created by the U.S. House of Representatives health system reform legislation, H.R. 3200, could be viewed as a starting point.

The procedural path for passing S. 1776 will be complicated, requiring the support of 60 senators on several procedural motions over the next few days. Furthermore, because the legislation is not offset by other spending cuts or revenue increases it will add to the federal budget deficit, raising its controversy and making supporting votes difficult for some senators.

Repealing the SGR is one policy objective that is a common goal for all physicians. Sen. Stabenow's bill creates the pathway the AMA has been seeking to finally achieve that goal. Grassroots activism will be absolutely critical to the success of this strategy.

The AMA has activated its physician and patient grassroots networks, and will be running television advertisements in key states. A unified and concentrated effort by the entire house of medicine will be essential to the AMA's success.

Visit the AMA's grassroots action center to send an e-mail to your senator. Also, the AMA grassroots hotline at (800) 833-6354 can connect you directly to your senator's office.


From the American College of Surgeons
Permanent Repeal of SGR: Your Action Needed Soon

We would like to take this opportunity to share breaking news regarding congressional action on the Sustainable Growth Rate (SGR). Yesterday afternoon, the College, along with a small group of other leading physician organizations, met with Senate Majority Leader Harry Reid (NV), Chairman of the Senate Finance Committee Max Baucus (MT), Senator Chris Dodd (CT), and key White House officials to discuss a separate strategy - apart from comprehensive health care reform legislation - for permanently fixing the SGR.

((This is a VERY SMART move on the part of physician advocacy groups. Linking the SGR formula to broader health care reform measures had the chilling effect of almost forcing some advocacy groups to support measures they might not otherwise have supported in a larger bill.))

With the support of Senate leadership, the strategy centers around legislation introduced by Senator Debbie Stabenow (MI). The "Medicare Physician Fairness Act" (S.1776) would eliminate the SGR by wiping out the SGR deficit, create a new baseline and set future payment updates at zero.

The "Medicare Physician Fairness Act" (S. 1776) is NOT the "America's Healthy Future Act" that was passed out of the Senate Finance Committee earlier this week and does not change our position on the provisions of the Senate Finance Committee bill. The details of comprehensive health care reform legislation, including what a future payment update system might look like, have not been determined.

We strongly support S. 1776 as it accomplishes a long-standing goal of the ACS.The College expects S. 1776 to be on the Senate floor on Monday, October 19th. Because of Senate procedure, there will be a series of votes on S. 1776 before final passage of the bill can occur. The first vote on Monday will be a cloture vote (a vote to limit debate and move to a vote for passage), followed by a vote to waive the budget act (so the Senate doesn't have to find an offset for S. 1776), another cloture vote to proceed to final passage on the bill, and then a vote on the bill. The first three votes will require 60 votes to proceed.

Tomorrow ((that's today, Friday)), we will be asking every Fellow, their families and their staffs to call their Senators and urge them to vote "yes" on every procedural motion for S. 1776 and ultimately on final passage of the legislation. The College will be emailing a 1-800 number that will connect you directly with your two Senators' offices in Washington, DC. We strongly urge every Fellow to participate in this grassroots effort to pass S. 1776.

Sincerely,Brent Eastman, M.D, FACS, Chair of the ACS Board of Regents

Lamar McGinnis, M.D., FACS, President of the American College of Surgeons

Andrew Warshaw, M.D., FACS, Chair of the ACS Health Policy and Advocacy Group

Christian Shalgian, ACS Director, Division of Advocacy and Health Policy


from National Journal
Both Chambers Look To Move Medicare Physician Fix Soon
Thursday, Oct. 15, 2009

In a surprise move, physicians will get a Senate vote as early as next week on a Medicare payment fix that helps them avoid massive cuts as House Democratic leaders work to set up that chamber's own separate vote on a payment solution.

The Senate move will appease physicians who have leaned on senators to use the overhaul to permanently fix a payment structure that leaves physicians facing annual cuts in Medicare reimbursement, including a 21 percent reduction looming next year. Physicians argue other payment reforms that focus reimbursement on quality rather than quantity are not as effective if the medical community continues to face cuts.

Physician lobbyists met Wednesday evening with White House healthcare czar Nancy-Ann DeParle, Senate Majority Leader Reid, Senate Finance Chairman Max Baucus and Sen. Christopher Dodd, D-Conn. Senate Democratic leaders made a procedural move Tuesday night that allows the chamber to bypass the usual committee process and take the $245 billion fix, proposed by Sen. Debbie Stabenow, D-Mich., straight to the floor.

Reid, Baucus and Dodd also met Wednesday with White House officials, including DeParle, White House Chief of Staff Emanuel and HHS Secretary Sebelius, to discuss merging the Finance and Senate Health, Education, Labor and Pensions committees' overhaul bills. The senators are expected to meet again today with administration officials, a spokesman for Reid said.

Leadership has indicated the merger will be swift. Baucus indicated Wednesday that might not be the case for the rest of the road ahead. When asked whether the panel can take up climate legislation before Thanksgiving, Baucus said, "I just don't know. Frankly, I think healthcare reform is going to take a little longer than people think."

The Senate could vote on the physician fix as early as next week. The fix faces three tough procedural hurdles that each will require 60 votes: a cloture vote, a budget point of order because the measure is not offset and a motion to proceed to the bill, a lobbyist source said.
Sources expect Reid to file cloture today, setting up a Monday vote to limit debate.

Stabenow's bill will repeal the formula, known as the sustainable growth rate, that determines Medicare physician payment. "SGR is one part of the physician reimbursement formula, and the Finance mark contains a new system based on quality that will move physician reimbursement away from rewarding for quantity to rewarding for quality. We have to eliminate the SGR in order to move toward the new system," Nkenge Harmon, Stabenow's communications director, said.

The Finance proposal gives physicians a 0.5 percent payment increase next year and leaves open the possibility of future increases.

Across the Capitol, Rep. Chris Van Hollen, D-Md., the assistant to the speaker, said the House will split the physician payment fix from the House overhaul bill as its own separate legislation to be voted on "in the same time period" as the overhaul.

House Majority Leader Hoyer said earlier Wednesday the decision had not been made to separate the physician fix. "But my view is that whatever we do with the doc fix we would do with or without healthcare reform, and healthcare reform really needs to be considered on its own merit and the SGR fix on its own merit," Hoyer said.

A House Democratic aide said the discussions are ongoing.

The House already voted as part of its budget resolution to exempt the $245 billion fix from pay-go requirements, but extracting it from the overhaul bill will help bring down the overall cost of the measure. The House has been searching for a way to get its overhaul bill closer to $900 billion, as President Obama has indicated he prefers, rather than the approximately $1 trillion it is at now.
The House legislation would eliminate future cuts and create a new payment formula to encourage efficiency like Finance's proposal.

A lobbyist source said the physician fix could end up back in the overhaul proposal through a House maneuver known as a "self-executing rule," that, according to the Congressional Research Service, "may stipulate that a discrete policy proposal is deemed to have passed the House and been incorporated in the bill to be taken up" once the House passes the rule governing floor time for the larger piece of legislation under consideration. This would allow the House to claim its bill is deficit-neutral even when the fix is attached and not offset.

by Anna Edney and Dan Friedman, with Kasie Hunt, Billy House and Darren Goode contributing


from The Hill
Senate may raise physicians’ Medicare payment fees
((It's not really a RAISE - it's a fix - of an error Congress made 10 years ago...))
By Jeffrey Young - 10/14/09 07:28 PM ET

The Senate is poised to take action on a costly bill to hike Medicare payments to physicians just weeks before bringing a sweeping healthcare overhaul to the floor.Majority Leader Harry Reid (D-Nev.) on Wednesday morning quietly set in motion legislation that could cost more than $200 billion over 10 years – without cuts or revenue to offset the spending -- on a separate track from a larger healthcare bill that President Barack Obama and Senate Democratic leaders have vowed would not add to the budget deficit.

“This is a bill that would permanently change the payment system for physicians to a fairer system,” Sen. Debbie Stabenow (D-Mich.) said on the Senate floor as she introduced the bill Tuesday evening. “It does have a cost to it,” she acknowledged.

Next year, without congressional intervention, Medicare’s fees to physicians would drop by 21 percent. In addition to their desire to prevent those cuts, Democrats are eager to win the support of physicians for healthcare reform. The American Medical Association (AMA) has already endorsed the House healthcare reform bill, which contains a $245 billion payment fix.

But doing so would also open Democrats to charges they were skirting the budget rules they established for themselves and were underestimating the cost of healthcare reform by moving a related bill separately.“As we go into the health care reform debate, I think it is important we get this done right first so every physician understands we are not going to put them in this position year after year after year,” Stabenow said.

With Reid’s procedural move Wednesday, the Senate is prepped to hold a cloture vote as soon as next week. That vote would require 60 senators to pass, as would a vote to override any senator’s objection to the bill’s cost not being offset under pay-as-you-go budget rules.Obama and Democratic leaders in Congress has been adamant that “paygo” would reign when it comes to new spending or tax cuts. The healthcare reform bill, with a cost ranging from just over $800 billion to just over $1 trillion, would also be subject to that standard.But lawmakers and the White House have sought a means to exempt the physician payments from paygo requirements. Congress has acted time and again to protect doctors from pay cuts and would inevitably to so again. Because of that, many Democrats argue, the fact that the budgetary baseline assumes those cuts and characterizes as a fix as new spending does not reflect reality.

((That makes perfect sense - the scheduled decreases HAVE never occurred, Congress has acted to postpone them every year for VERY good reasons, and even though some flawed formula in a 1999 bill calls for them, they were likely to never happen because of the dire consequences that would have followed. Frankly, for government accountants to even have CONSIDERED the cumulative value of those cuts as income was...well, silly.))

The White House and the House support enacting paygo into law – but leaving Medicare physician payments and a few other items out of its scope. The paygo bill would “rebase” the physician payment formula to assume that Medicare spending over the next 10 years would include the new policy and the hundreds of billions of dollars in additional spending.

The congressional budget resolution contains provisions that originated in the House allowing Congress to pass a physician payment fix without paying for it.

The Senate Finance Committee would block the cuts for two years as part of its $829 billion, which the Congressional Budget Office says would reduce the deficit by $81 billion.Reid, Senate Finance Committee Chairman Max Baucus (D-Mont.), Sen. Chris Dodd (D-Conn.) of the Health, Education, Labor and Pensions Committee and White House Office of Health Reform Director Nancy-Ann DeParle met with lobbyists from the AMA and other physician lobbying groups to explain their plan.

The gathering took place immediately after the senators met with DeParle and other White House aides on healthcare reform.Stabenow may have just introduced the bill but the problem it seeks to solve traces back nearly a decade. Under existing law, the formula that calculates what Medicare pays doctors has called for cuts every year, leading Congress to enact short-term fixes. A permanent solution has eluded Congress, largely because of the cost.House Democrats are also considering moving a physician-payments bill in a separate, non-offset vehicle from healthcare reform. Speaker Nancy Pelosi (D-Calif.) and Majority Leader Steny Hoyer (D-Md.) are continuing to back the House's approach, which is a permanent fix at a cost of roughly $240 billion, rather than an offset, one- or two-year fix.

But Hoyer on Wednesday expressed a new openness to consider either the permanent or the temporary fix independently of healthcare reform. "My view is that whatever we do with the doc fix, we would do with or without healthcare reform," Hoyer said. "And healthcare reform really needs to be considered on its own merit and the SGR fix on its own merit."

He stressed no final decsions have been made, but reiterated that the doc fix could occur as a separate vote.

-- Jared Allen contributed to this article.
-- This article was updated at 7:49 p.m.


US Senate Dems Readying Physician Payment-Fix For Next Week
Oct 15, 2009 2:18PM
By Patrick Yoest

WASHINGTON -(Dow Jones)- The U.S. Senate is set to take up a bill as soon as next week that would provide a 10-year, $247 billion fix to pay physicians under Medicare, in a move that would keep the costly changes from adding to the price tag of broader health care-overhaul legislation.

A spokesman for Senate Majority Leader Harry Reid, D-Nev., said that Reid hopes to bring up a bill next week that would avoid steep drops scheduled in future years for physician payments in the program. Medicare rates for physicians are projected to drop by 21% in January.

Sen. Debbie Stabenow, D-Mich., introduced the bill Tuesday, with Reid employing Senate rules that allow the bill to bypass the committee process and come directly to the Senate floor.

"This is a bill that would permanently change the payment system for physicians to a fairer system," Stabenow said in a little-noticed speech Tuesday. "It's important that we get this right, that we fix what has been a very flawed system."

In a bid to rein in federal spending on Medicare, Congress amended the program in 1997 so that payments to doctors were linked to a complicated formula of anticipated future growth in costs. But over time that funding formula hasn't kept pace with doctors' costs, resulting in annual shortfalls.

Lawmakers have avoided the shortfall by passing measures to ensure that doctors don't see a drop in the rates. The bill sponsored by Stabenow would repeal the current formula and thus assuage concerns of doctors' groups, such as the American Medical Association, that future cuts could occur.

House health care-overhaul legislation includes a similar fix, which makes their legislation significantly more expensive than the Senate version of the legislation. By considering a separate bill to change the physician payment formula, congressional Democrats can more easily keep the cost of legislation under $900 billion over 10 years - and meet the stated goal of President Barack Obama.

Doctors' groups met with Reid, Senate Finance Chairman Max Baucus, D-Mont., and Senate Health, Education, Labor and Pensions Committee to discuss the Medicare physician payment bill on Wednesday.

-By Patrick Yoest, Dow Jones Newswires; 202-862-3554; patrick.yoest@ (END) Dow Jones Newswires
Copyright (c) 2009 Dow Jones & Company, Inc


Senate Dems seek higher doctor payments
By DAVID ESPO (AP) – 17 hours ago

WASHINGTON — 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.

((Eliminating a scheduled DECREASE is not the same as an INCREASE - yes, the bill calls for a .5% increase in payments in 2010 - but that doesn't come close to $247 billion. Counting scheduled decreases as income is an accounting gimmick, especially since Congress was never going to really let them go into effect, and making them go away isn't a real spending INCREASE....))

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.
Copyright © 2009 The Associated Press. All rights reserved.


from The Hill
Senate Dems face obstacles in upping Medicare payments
By Jeffrey Young - 10/15/09 10:39 PM ET

The Senate Democratic leadership faces significant obstacles in passing a $240 billion bill next week that would increase Medicare payments to physicians.

((Once again - the proposed decreases SHOULD NEVER have been counted as "income." This isn't a real increase...))

Senate Majority Leader Harry Reid (D-Nev.) and Sen. Debbie Stabenow (D-Mich.) set the ball in motion earlier this week, but the more senators learn about their plan to move a standalone bill that is not paid for, and on the eve of the healthcare reform bill, the more doubt has been cast on its prospects.

Despite its cost, Reid characterized the bill as mere housekeeping to prevent a cut in physicians’ payment rates. “We address these physician payment cuts every year,” Reid said. “All we’re doing is wiping the slate clean by adjusting the baseline for what is current policy. It’s not new policy.” ((OK, now I'm a bit frightened....I actually AGREE with Sen. Reid....))

Fixing the physician payments could boost Democrats’ health reform efforts by providing physicians with a win on their foremost priority. The American Medical Association launched a national television advertising campaign Thursday supporting the Medicare bill, and lobbyists representing doctors will be out in full force next week.

Republicans countered that the Democrats’ plan to use deficit spending to pass the physician payments bill underscored the GOP’s contention that the majority party does not intend to fully pay for its healthcare legislation this year. The Congressional Budget Office estimated the bill costs $246.9 billion over 10 years.

Moreover, Senate Budget Committee Chairman Kent Conrad (D-N.D.) offered a full-throated objection to the bill increasing the deficit.The bill is likely to be subject to three separate votes requiring 60 senators to support it before the Senate can consider final passage. Winning over centrists will be crucial, since Republicans are likely to line up against it. ((And yet, many Republican legislators fought to POSTPONE the decreases each year....please make calls today to remind your legislators that this ERROR needs to be fixed...))

The first vote, which will be a cloture vote on the motion to proceed, is scheduled for Monday at 5:30 p.m.One of those votes would be to override any senator’s objection to the deficit spending. Asked whether he would raise such an objection, Senate Budget Committee ranking member Judd Gregg (R-N.H.) said: “I would presume, since we’ve heard so much chest-pounding about pay-go from the other side of the aisle and how important it is for fiscal discipline, that the majority leader would raise that point.”

Centrist Democratic Sens. Ben Nelson (Neb.) and Tom Carper (Del.) each expressed misgivings about passing a permanent new Medicare payment system for physicians without finding savings elsewhere in the budget.

“It could be offset, it should be offset, absolutely,” said Nelson, who nevertheless agreed it is appropriate to handle the Medicare bill separately from the healthcare reform bill. Congress has acted nearly every year in the 2000s to block Medicare pay cuts for doctors that are the result of a flawed formula on the books. Next year, in the absence of congressional intervention, physicians would see their pay rates slashed by 21 percent.

But paying for a long-term fix has always proven too big a burden for Congress under Republican and Democratic control, leading to a series of short-term solutions that actually made a permanent fix more expensive.The Senate Finance Committee’s healthcare reform bill would replace the 21 percent cut for 2010 with a 0.5 percent increase. The House’s healthcare reform bill would create a new payment formula. The House does not pay for the higher physician payments, either. It has, however, passed a bill that would incorporate the new spending into the Congressional Budget Office’s baseline, an approach the Senate has rejected.

Engaging in deficit spending to address one healthcare issue does not seem to jibe with President Barack Obama’s promise that healthcare reform would not add to the budget deficit. But Democrats argued the two things should not be viewed through the same lens.

Centrist Democrats expressed skepticism, or outright opposition, to the move.Conrad categorically rejected passing the Medicare bill without finding budgetary offsets. “I’m trying to work out something else but it’s, right now, on a course to come to the floor,” Conrad said. “I don’t agree with just adding that amount to the debt. I think it should be paid for.” ((It was never real income in the first place.....))

Conrad said that Reid consulted with him before deciding to move ahead. “I was asked for my recommendation and I gave the recommendation that I just said here,” Conrad said. “Obviously, that advice wasn’t followed.”

Republican Sen. John Thune (S.D.) said the Medicare bill is a “quid pro quo” to get physicians to support healthcare reform and to disguise the full cost of healthcare legislation.“Obviously, they’re doing it to alleviate having to deal with that issue in healthcare reform because they know it will blow a big hole in this whole idea that it’s deficit-neutral. So I think it’s a very cynical ploy,” Thune said.

Democrats argue that the assumption under current law that physician payments would get smaller every year does not reflect a reality in which Congress would never let that happen.“What we’re trying to do is to repeal a very outdated, unfair payment process and get a new baseline. This needs to be in the baseline,” Stabenow said.

But as far as Conrad sees it, deficit spending is deficit spending. “People can say, well, it’s not because they’ve changed the baseline. That is not the way a baseline can have any credibility. You can’t just alter the baseline and say, all of a sudden, you don’t have to pay for things,” he said.

The Medicare bill will be subject to amendments on the floor. Republicans are considering offering an amendment that would pay for the measure using unspent funds from the economic stimulus bill. Carper suggested that the doctor-payment fix could extend beyond the one year in the healthcare reform bill but should be paid for.

— J. Taylor Rushing contributed to this article

((Let's try not to get caught in the middle of the wider health care debate here - legislators from BOTH parties have supported postponing the scheduled decreases and repealing the flawed formula which created them. The broader health care reform debate is so contentious that we're in danger of legislators refusing to come to an agreement on something THEY AGREE ON, simply because it is supported by the other side. MAKE THE CALLS and send the emails today, to remind them that we can ALL agree that it's a terrible idea to reduce physician reimbursement to the point that doctors can't afford to take care of Medicare patients any longer - and that the "income" or "cost" of this fix is only on paper....))


from Bloomberg News
Senate Finance Panel Passes $829 Billion Health Plan
By Laura Litvan and Nicole Gaouette

Oct. 13 (Bloomberg) -- The Senate Finance Committee approved an $829 billion plan to overhaul U.S. health care, clearing the way for a full Senate debate over the broadest expansion of the government’s role in the medical system since the creation of Medicare in 1965.

Just one Republican on the panel, Senator Olympia Snowe of Maine, voted for the measure in an otherwise party-line 14-9 tally. That marked the first time a Republican in either the Democratic-controlled Senate or House has supported the revamp legislation, President Barack Obama’s top domestic priority.

“Ours is a balanced plan that can pass the Senate,” said panel Chairman Max Baucus, a Montana Democrat.

Baucus had spent months courting Snowe and other Republicans, making his committee the last of five congressional panels to complete its version of the legislation. Senate and House Democratic leaders must now merge the bills and schedule floor debates. After each chamber votes, they’ll have to reconcile their measures.

Senate Majority Leader Harry Reid will meld the finance panel bill with one approved by the Senate health committee in July, forcing him to resolve differences over a host of issues that divide both political parties and risk rupturing Democratic unity. Reid spokesman Jim Manley said the health- care bill should be on the floor the week of Oct. 26.

“There are many miles to go in this legislative journey,” Snowe said. “My vote today is my vote today. It doesn’t forecast what my vote will be tomorrow.”

Stocks Fall

The Standard & Poor’s index of 13 health insurance stocks lost 2.4 percent. UnitedHealth Group Inc., the largest insurer by sales, led the decline, with the shares of the Minnetonka, Minnesota, company dropping 94 cents, or 3.7 percent, to $24.29 at 4:01 p.m. in New York Stock Exchange composite trading. Health Net Inc. followed, with the Woodland Hills, California, company falling 61 cents, or 3.6 percent, to $16.27.

“We cannot support this legislation in its current structure,” Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, an industry trade group, said in an e- mail.

Senator Jon Kyl, an Arizona Republican, criticized Baucus for saying he was proud of the bill. “That sets the bar pretty low,” Kyl said in an interview after the vote. “All you have to do is raise taxes, but that hits the American people pretty hard.”

Premiums Seen Rising

Kyl said critics were unfair to dismiss a study released two days ago by the insurance industry group charging that the finance panel plan would more than double premium costs. Kyl said the Congressional Budget Office and health policy firms “all agree that premiums will go up.”

The White House criticized the report, and doctors, medical-device makers and one of two hospital groups reiterated their support for the overhaul.

Unlike other versions, the finance bill includes a new tax on the most-expensive insurance plans, doesn’t require employers to provide coverage to workers, and omits a provision creating a new government insurance program, the so-called public option, which most Republicans oppose.

Nonprofit co-operatives would instead provide competition to an insurance industry that stands to gain millions of new customers because the bill requires Americans to obtain insurance. The measure also imposes new restrictions on insurers’ ability to deny people coverage.

‘Extraordinarily Complicated’

The legislation seeks to curb health costs and provide coverage to almost all Americans who lack insurance. Democrats want to expand the Medicaid program for the poor and provide subsidies for millions of Americans to obtain policies.

The Congressional Budget Office gave the bill a boost last week when it estimated the measure would cut the federal budget deficit by $81 billion over 10 years. Obama has vowed not to sign any bill that adds “one dime” to the deficit. The agency also said the proposal would provide insurance for 94 percent of all legal residents of the U.S., up from 83 percent now.

Obama today praised Baucus’s panel for “plowing forward on what we all acknowledge is an extraordinarily complicated issue.”

‘Slippery Slope’

Senator Charles Grassley, the ranking Republican on the panel, echoed the view of many members of his party by saying the legislation will strengthen the federal government’s management of the health-care system.

“This bill is already moving on a slippery slope toward more government control of health care,” Grassley said. He said it’s likely to continue a “march leftward” as the legislation is merged in Congress.

The finance committee has sole jurisdiction in the Senate over how to pay for the overhaul, making its tax and spending- cut provisions almost certain to remain in the final bill the chamber considers.
They include a new 40 percent excise tax, beginning in 2013, on insurers of employer-sponsored health plans with benefits exceeding $8,000 for individual coverage and $21,000 for families.

Thresholds are increased by $1,850 and $5,000 for retirees 55 and older and for employees in the coal mining and other union-heavy industries.

Biggest Tax Increase

That provision would raise $201 billion over 10 years, the CBO said, making it the biggest tax increase in the measure.

Another tax provision would increase the threshold for itemized deductions for unreimbursed medical expenses from 7.5 percent of adjusted gross income to 10 percent. The measure also imposes $13 billion in new annual fees on drugmakers, medical device manufacturers and health insurers.

The legislation is also offset by $404 billion in cost savings over a decade in both the Medicare and Medicaid programs. That includes $117 billion in cuts to Medicare Advantage, a program in which private insurers offer 10 million senior-citizen enrollees benefits such as dental or vision coverage not offered by the government program.

To expand health-insurance coverage, the legislation requires all U.S. citizens or legal residents to have coverage, or pay a penalty of $750 per year, with the fines phased in between 2014 and 2017. Those forced to pay more than 8 percent of their income to buy insurance are exempt.
Expansion of Government

Employers with 50 or more workers would pay a fee, though in contrast to other pending bills, penalties for companies that don’t offer health benefits would only apply to those workers who qualify for a lower-income tax credit to get their own policy. The penalty could reach as high as $400 per worker receiving a tax credit.

The measure seeks a sweeping expansion of government aid to reduce insurance costs for every American with an income below 400 percent of the federal poverty level. That level is $18,310 for a family of three in 2009.

Beginning in 2014, non-elderly people with an income below 133 percent of the poverty level would be covered by Medicaid. The measure also establishes an online insurance exchange where others without insurance can purchase a policy.

Legislation approved by three House committees and the Senate health panel would create a public option within the exchange which, like Medicare, would compete with insurers to provide coverage. The finance committee bill’s nonprofit co-ops are a bid to appeal to Republicans and centrist Democrats. The co-ops would get $6 billion in seed money.

Taking All Customers

The finance committee would bar insurers from excluding new enrollees based on pre-existing medical conditions. It would also allow variation in premium rates based on age limited to a 4 to 1 ratio, meaning older people could be charged no more than four times what younger policyholders are.

By contrast, the Senate health measure has a much-stricter 2 to 1 ratio for insurers, making that another issue of interest to industry that Democratic leaders must decide before the measure goes to the Senate.

Democrats on the committee made clear they will seek changes during Senate debate that include amendments to create a public option, scale back the penalties for those who fail to get coverage, and further expand subsidies.

To contact the reporters on this story: Laura Litvan in Washington at Last Updated: October 13, 2009 16:44 EDT


((Rep. Cantor has been a strong voice during the health care debate, and I'm attaching this invitation to an event this coming Sunday with Rep. Cantor at the request of a friend...following is one story about Rep. Cantor's positions on health care reform. If you're interested in the event featuring Rep. Cantor this Sunday, from 11:30 a.m. to 1 p.m. in Bryn Mawr, PA, please contact

October 8, 2009 8:00 AM
Cantor: Health Care Plan Savings Dubious

Posted by
Daniel Carty

(CBS)Rep. Eric Cantor, R-Va., disputed an assessment that the Senate Finance Committee's draft $829 health care bill would
cut the federal budget deficit by $81 billion over 10 years. "The claims that we're saving $81 billion by spending $829 billion, you know, you can say that if you want to go ahead and really rob Peter to pay Paul. And that's exactly what's going on here," Cantor, the House Minority Whip, told "Early Show" co-anchor Maggie Rodriguez Thursday.

On Wednesday, the nonpartisan Congressional Budget Office released a preliminary estimate on the cost of the proposal, projecting budget savings of $81 billion over the next decade. It also said "continued reductions in federal budget deficits" were probable in the years beyond.

The plan would cover 94 percent of legal, nonelderly Americans within 10 years and would be paid for through a combination of tax increases and spending cuts. "The way that they are expanding coverage is by taxing employers, is by taxing those of us who have insurance, and, frankly, to the tune of $500 billion," Cantor claimed. "And they're adding on top of that $400 billion worth of cuts to Medicare, which that will mean seniors will have less opportunity, less benefit, less ability to choose the kind of health care that they want."

Throughout the firestorm of conservative criticism of his health care agenda, President Obama has insisted the only thing he would eliminate from Medicare is wasteful spending, not quality of care.

Mr. Obama's late-summer media blitz appears to have softened public resistance to reform. A recent AP poll found Americans split – 40 percent in favor, 40 percent opposed – on health care, a sharp drop from the 49 percent opposition a month earlier. Resistance among seniors is down as well – just 43 percent opposed compared with 59 percent a month ago.

But Cantor said one key element of more liberal proposals – the public option – has been "resoundingly rejected by the American people."

The Senate Finance Committees proposal doesn't contain a provision for a public option, but would subsidize health care for low-income Americans. That plan is just one of several in Congress, so lawmakers will have to merge the varying proposals – some of which still contain a public option provision – into one bill. That process will likely change the overall cost and deficit projections.

Cantor said he would meet with House Majority Leader Rep. Steny Hoyer to "look at the things that we can agree upon." But he insisted that Republicans would "reject the notion of the government takeover" of health care.


((From a politically active New Jersey physician, about a large physician demonstration on November 21...Pennsylvania organizers are needed. Please respond directly to Dr. Abuzeni, whose contact information appears at the end of this item.))


I received this e-mail a couple of days ago from one of the Million Med March organizers. If you could spread the word through your e-mail updates, that would be wonderful and greatly appreciated. They need organizers in PA....especially as I'm a South Jersey boy!
Hopefully, someone can step up to the plate while I work on this side of the river.Thanks so much!! Ira-----

Original Message-----From: Patrick Abuzeni To:

Sent: Tue, Oct 13, 2009 5:42 pm

Subject: MMM Needs Your Help!!!

Folks, As you all know we can't stop spreading our message. As you also may know national media coverage was practically non-existent at the last MMM. A reporter sent me an email expressing her disgust at the total absence of any news that day over any of the satellite feeds about our march.

The good news is that local media seems to have a good appetite for that sort of stuff. I am proposing that we Capitalize on that. Therefore, we are organizing a Multi-state, Multi-city simultaneous and synchronized march in as many cities as possible. The local media will eat it up. And the coverage, if not picked on satellite feeds, will be cover to cover anyway. In fact, I believe the national media will have no choice but to cover the story. The proposed date is November 21, 2009. We don't have much time and not too many date options, and I need volunteers in every state to coordinate. Can I count on your help? When replying please indicate City and State.

Patrick Abuzeni, MD

Tel: 305-444-2888 Fax: 305-444-2333


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please email, put "Subscribe" in the subject line, and send.****


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