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 Physicians have been running ads hinting that patients may find doctors less willing to treat them.
In a particularly vitriolic exchange, Democrats and Republicans blamed each other for what Dr. Nancy H. Nielsen, president of the American Medical Association, said has put the country "at the brink of a Medicare meltdown."
"Seniors need continued access to the doctors they trust. It's urgent that Congress make that happen," the AMA said in ads taken out in Capitol Hill newspapers read by members of Congress and their aides.
One near-certainty was that lawmakers, not willing to face millions of angry seniors at the polls in November, will act quickly when they return to Washington the week of July 7 to reverse the fee cut and provide retroactive payments to doctors for losses they incur after July 1.
Just two years ago, after a cut had taken effect, Congress froze payments retroactively at the previous year's levels. In 2002 doctors had to live with a 5.4 percent cut.
The likelihood of retroactive relief didn't deter dire predictions last Thursday after the Senate fell just one vote short of the 60 needed to proceed to legislation that would have stopped the fee cut.
Doctors have complained for years that Medicare payments have failed to cover rising costs. "Many more physicians will reluctantly retire early or reduce clinical practice time. This hurts access to fragile senior populations," said Dr. Jack Lewin, chief executive officer of the American College of Cardiology.
Beginning Tuesday, payments will be cut for some 600,000 doctors who treat Medicare patients because of a formula that requires fee cuts when spending exceeds established goals. Almost every year, Congress finds a way to block the cuts.
This year majority Democrats homed in on cutting the Medicare Advantage program, which is an ideological issue for both parties. The Bush administration and Republicans like Medicare Advantage because it lets the elderly and disabled choose to get their health benefits through private insurers rather than through traditional Medicare. Democrats argued that government payments to the insurers are too generous.
The White House warned that President Bush would be urged to veto a bill that contained cuts to Medicare Advantage. "The bill would fundamentally change the private fee-for-service program and consequently reduce access, benefits and choices for many of the approximately 2.25 million beneficiaries" in such plans, the White House said in a statement.
That didn't stop the House last Tuesday from approving the legislation 355-59, well above the margin needed to override a veto. Every Democrat supported it, and Republicans, bucking their president, voted 129-59 for it.
In the Senate, however, most Republicans are not facing re-election this fall. They were more united in opposition Thursday in a 58-40 vote, two short of the 60 needed, that would have led to passing the bill. Actually, 59 senators present supported the bill
-- Senate Majority Leader Harry Reid, D-Nev., changed his vote to "no" in a procedural move allowing him to bring up the issue again.
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 Reid said Friday he will hold another vote after lawmakers return next week to give Republicans "another opportunity to reconsider their unfortunate decision to hurt patients and doctors."
Nine Republicans joined Democrats in supporting the legislation. The only nonvoting senators were the ailing Edward Kennedy, D-Mass., and GOP presidential hopeful John McCain, R-Ariz.
After the vote, there was hyperbole on both sides. An angry Reid said Senate Republicans "have done what they thought is appropriate, and that is to wipe out Medicare as we know it today." He chided Republicans for sticking with a lame-duck president with a 29 percent approval rating: "How in the world could anybody be afraid of him vetoing a bill?"
Republican leader Mitch McConnell of Kentucky shot back that Democrats were acting irresponsibly by not granting his request for a 30-day extension of current physician payment rates in order to give the two sides time to work out a compromise. How that would have occurred was unclear; the House already had adjourned until July 8 and couldn't vote on it.
The doctors' cut will take place "because of this recalcitrant view, this excessively partisan approach that refuses to accept any input from this side of the aisle," McConnell said.
Sen. Arlen Specter, a moderate Republican from Pennsylvania, said he objected to the take-it-or-leave-it approach of the Democrats and gave assurances that Congress would take steps in early July to eliminate the doctor cuts and take care of hospitals and providers.
Sen. Jim DeMint, a conservative Republican from South Carolina, said he backed alternative legislation to protect physician fees but couldn't support what he said was "a deliberate attempt to move Americans away from private insurers and into socialized medicine."
Health and Human Services Department Secretary Mike Leavitt said his agency "will take all steps available to the department under the law to minimize the impact on providers and beneficiaries." If and when the higher fee schedules are restored, his department will "move promptly to reprocess claims and take other steps necessary," he said.
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The bill is
H.R. 6331.
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On the Net:
Congress: http://thomas.loc.gov/
[Associated
Press; By JIM ABRAMS]
Copyright 2008 The Associated
Press. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
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