Martinez switches vote; Senate reverses doctors' pay cut
By Susan Jaffe
7/10/2008 © Florida Health News
WASHINGTON, D. C. – Florida Sen. Mel Martinez was among nine Republicans who dropped their earlier opposition to sweeping Medicare reform legislation Wednesday, leading the Senate to adopt it by unanimous consent.
The bill reverses a steep pay cut to doctors who treat Medicare patients, taking some money from private health plans. Florida’s other senator, Democrat Bill Nelson, supported the measure all along
Physicians and seniors’ groups had lobbied Martinez and the others heavily after their initial vote on June 26, but the decisive moment in breaking the Republican filibuster came suddenly Wednesday afternoon with the unexpected return to the Capitol of Sen. Edward Kennedy, who is undergoing treatment for brain cancer. His colleagues gave him a standing ovation.
“Without Ted Kennedy, we wouldn’t have gotten the extra nine votes,” Senate Majority Leader Harry Reid later told The New York Times. “They knew the die had been cast, so they gave up.”
In a written statement released late Wednesday on his decision to change his vote on The Medicare Improvements for Patients and Providers Act, Martinez did not mention Kennedy. And Martinez made clear he still wasn’t happy.
“The measure we moved forward today does not provide the kind of solution doctors deserve, but this is the only option to stop doctors in Florida from having their pay cut by 10.6 percent,” the statement said. “It is also the only option to ensure that seniors continue to have uninterrupted access to healthcare.”
Some Florida doctors had said they would not be able to continue to treat Medicare patients if their pay was cut. Some practices had already announced that they would accept no new Medicare patients.
The U.S. House of Representatives overwhelmingly passed the bill, HR 6331, two weeks ago by a margin of 6 to 1. Senate Republicans blocked action in the Senate, however, and a measure to force action failed by one vote. This time, the action to end debate succeeded 69 to 30, swiftly followed by passage of the bill by voice vote with no objections.
The strong bipartisan congressional support for the bill makes it likely that if President Bush follows through on his veto threat, Congress would overrule it.
Martinez’s statement criticized his colleagues for offering doctors only a temporary reprieve. “It continues to frustrate me that Congress has been unable to address the issue of true Medicare reform,” he wrote. “The underlying reason we have to act every year to stop payment cuts to doctors is because the way we pay doctors under the program is broken. The mechanics under which Medicare operates are flawed; the next scheduled rate adjustment Congress will have to avert amounts to a 20.6 percent cut. I will continue to strive for a permanent solution.”
As late as Wednesday morning, Martinez still seemed likely to vote against the bill. His spokesman, Ken Lundberg, said at the time that it was “an irresponsible way of legislating” to tie the pay-cut measure to other matters that hadn’t been adequately discussed. Vice President Dick Cheney urged Senate Republicans over lunch to continue their opposition, The Washington Post reported
A Congressional Budget Office report estimates that the changes in health-plan rules and payments will save about $12.5 billion over five years. One provision would require a type of Medicare Advantage product called a private fee-for-service (PFFS) plan to have a set network of doctors and hospitals. Another would eliminate payments to Medicare plans for indirect medical expenses, which hospitals also receive. The payments would now go only to hospitals.
CBO estimates that these changes will cause enrollment in PFFS plans to decline by 2.3 million by 2013. This would save money because previous studies have found that Medicare’s payments to PFFS plans are about 17 percent higher than costs under traditional Medicare. Payments to other types of Medicare Advantage plans also exceed the costs of traditional Medicare, by 12 to 13 percent.
The bill would also ban unscrupulous sales tactics by Medicare Advantage and prescription drug plans. It would reduce mental health co-payments, help health care providers in rural areas, expand preventive health services and enable more low-income seniors to receive Medicare premium subsidies.
Contact Florida Health News Washington correspondent Susan Jaffe at Susan.Jaffe@FloridaHealthNews.org
