By Alexander Bolton - 10/20/09 10:00 AM EDT
The White House and Democratic leaders are offering doctors a deal: They’ll freeze cuts in Medicare payments to doctors in exchange for doctors’ support of healthcare reform.
At a meeting on Capitol Hill last week with nearly a dozen doctors groups, Senate Majority Leader Harry Reid (D-Nev.) said the Senate would take up separate legislation to halt scheduled Medicare cuts in doctor payments over the next 10 years. In return, Reid made it clear that he expected their support for the broader healthcare bill, according to four sources in the meeting.
Also in the meeting were: Senate Finance Committee Chairman Max Baucus (D-Mont.); Sen. Chris Dodd (D-Conn.); White House Chief of Staff Rahm Emanuel; Office of Management and Budget Director Peter Orszag; and Nancy-Ann DeParle, director of the White House healthcare office.
“They said they’re going to need our help in getting healthcare reform over the goal line and they expect our support,” said a participant who represents doctors. “Reid, Baucus and Dodd. All three said the same thing: They want and expect our support.”
At last week’s meeting, Emanuel and Orszag met with the doctors groups for only a few minutes at the start of the session before walking over to the House side of the Capitol. Doctors groups interpreted their short visit as a signal from the White House that it supported Reid and the Senate Democrats.
A second participant said Emanuel and Orszag “were in for five minutes and then went to the House side to talk strategy.”
“They were there because the White House wanted to show how serious they were and to give their stamp of approval,” said the source.
Reid also asked that doctors ease up on demands for medical malpractice reform during the upcoming healthcare debate. Democrats have traditionally resisted calls for tort reform, which trial attorneys — a reliable base group — staunchly oppose.
But the primary focus of the meeting was on Democratic plans to bring to the Senate floor a standalone bill costing nearly $250 billion that would freeze cuts in doctors’ payments mandated by a 1997 law. Without the freeze, doctors would see their Medicare payments drop by 21 percent next year and by 40 percent by 2016. The bill’s costs are not offset by tax increases or spending cuts at a time when the Obama administration estimates the federal deficit at $1.4 trillion.
J. James Rohack, president of the American Medical Association (AMA), said that it would be very difficult for doctors to support the broader Senate healthcare legislation if there were no effort to address long-term cuts to Medicare payments. The Finance Committee health reform bill would increase doctors’ payments by 0.5 percent in 2010 at a cost of $10 billion, but it would leave doctors facing a 25 percent cut in 2011.
“It would be very challenging for physicians looking at a .5 percent increase next year and 25 percent cut the following year to say, ‘Yay, let’s support the reform bill’ or to say the health reform bill would be viable,” said Rohack.
Rohack, who did not attend last week’s meeting, applauded Reid for moving a separate bill and “highlighting this program of broken physician payment formula that has to be solved.”
The AMA, considered one of the most influential healthcare trade groups, spent $8.1 million on lobbying through the first six months of this year.
Reid and other Democratic leaders said they would rely on doctors groups to round up enough votes to pass the “doctors fix” legislation at a time of high anxiety over the deficit. But they also made clear that Democrats expect something in return for pushing a bill that Republicans will criticize as fiscally reckless.
Leaders stressed the importance of supporting healthcare reform, but Reid also urged doctors to go easy on their longstanding demands for tort reform.
“It was a brief remark that was said like, ‘Oh yeah, one more thing.’ He said, ‘I would appreciate it if you don’ t push for medical liability reform amendments. We know how things stand in the Senate and we can get some good things done for doctors on other issues. Let’s work together,’ ” according to a source who described Reid’s remarks.
Three other sources confirmed Reid made the remarks.
The representative of one doctors group, however, characterized Reid’s comments on medical malpractice reform as less explicit. This source said Reid merely argued that medical malpractice reform would save little money and that it would not have close to enough votes to pass the Senate.
Addressing a joint session of Congress in September, President Barack Obama raised the possibility of including some measure of tort reform in the healthcare overhaul as a way to entice Republicans to sign on.
A White House aide who was briefed on the meeting said that it should not be viewed as a deal because doctors groups have yet to agree to any concessions. That contrasts with the pharmaceutical industry, which struck a deal with the White House under which it would support healthcare reform and provide $80 billion in savings to seniors on brand-name prescription drugs.
White House officials and Baucus also struck a deal with hospitals to lure their support. The Senate Finance Committee’s bill would exempt hospitals from federal payment cuts mandated by a new Medicare Payment Advisory commission it would create.
At last week’s meeting with Democratic leaders were representatives from the AMA, the American College of Surgeons, the American Society of Anesthesiologists, the American College of Emergency Physicians, the American Academy of Ophthalmology, the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the Alliance of Specialty Medicine, the American Osteopathic Association and the American Academy of Pediatrics.
Several of these groups have raised strong objections to provisions in the Senate Finance Committee’s legislation, such as the proposed creation of the Medicare commission and a 5 percent cut in payments to doctors who rank in the top 10 percent for amount of Medicare resources used.
Healthcare policy experts say that organized opposition from doctors, whom Americans consistently rank as highly trustworthy in public opinion polls, could derail efforts to overhaul the nation’s health system.
“What’s really important is that doctors are not vocally in opposition,” said Henry Aaron, a senior fellow at the Brookings Institution who specializes in healthcare financing. “If they mobilize strongly in opposition and ran ads and talked to their patients, it hurts. It would be a serious obstacle. As long as they’re not out fighting, I think the administration has achieved most of the gain.”