Dem thumbs down to Reid doctors deal

A group of Senate Democrats is threatening to derail a deal Majority Leader Harry Reid offered to doctors in exchange for their support of President Barack Obama’s healthcare initiative.

Sens. Kent Conrad (N.D.), Evan Bayh (Ind.), Russ Feingold (Wis.), Tom Carper (Del.) and Claire McCaskill (Mo.) on Tuesday voiced opposition to separate legislation that would freeze scheduled cuts in Medicare payments to doctors for the next 10 years.

Passing the “doctors’ fix” on the Senate floor this week is central to Reid’s (D-Nev.) strategy for passing a broad healthcare reform bill in coming weeks. Reid told doctors groups in a private meeting last week that he would bring the payment fix bill to the floor but that in return he expected their help in passing the healthcare package later this year.

But the five Democrats are insisting that the legislation, which costs $247 billion, be offset with spending cuts or tax increases. The legislation, which was discussed at the Democratic policy lunch on Tuesday, is not offset in its current form.

Reid had hoped to hold a procedural vote Monday night to call the bill up on the Senate floor, but the objections from within his party have slowed the process down.

Reid seemed to acknowledge Tuesday that Democrats may have to back off from their plan to solidify support from doctors by passing a 10-year fix.

“I’ve had a number of discussions with Kent Conrad, and we’re going to take care of the senior citizens and the doctors,” Reid told reporters. “As I’ve indicated, it could be a one-year fix, it could be a 10-year fix, but we’re going to take care of them.”

Doctors groups such as the American Medical Association (AMA) are considered pivotal players in the debate, and the senators’ opposition to freezing the cuts could derail reform. AMA president J. James Rohack has said doctors would not be inclined to support reform if it does not address the steep cuts to their Medicare payments put in place by a 1997 law.

House Democratic leaders also held firm in objecting to the legislation Tuesday, insisting that the Senate agree to offset the cost of the doctor payments with tax increases or spending cuts, or agree to implement pay-as-you-go budget rules for most legislation, which senators have firmly resisted in recent years.

House Majority Leader Steny Hoyer (D-Md.) said House Democrats would take a stand on the issue after repeatedly backing down from similar confrontations with the Senate in recent years over expensive measures the upper chamber had failed to pay for.

The intra-party feud comes shortly after the deficit reached a record high of $1.4 trillion for fiscal 2009.

“Look, we’re serious about statutory pay-go,” said Hoyer. “We’re serious about focusing on fiscal discipline, and this is part of it. I had a discussion with Sen. Reid last week and I expect to have another discussion with him about it this week.”

Hoyer said that he and Speaker Nancy Pelosi (D-Calif.) reiterated their concerns about passing the doctors legislation without offsets with White House Chief of Staff Rahm Emanuel last week.

Pelosi and Hoyer made their position clear in a letter sent to lawmakers who negotiated the joint congressional budget resolution earlier this year.

Sen. Debbie Stabenow (D-Mich.), the lead sponsor of the Senate measure, said Tuesday that she hoped House leaders could be persuaded to accept the legislation if Congress changed how it calculated the budget deficit. Stabenow argues that freezing scheduled cuts in doctors’ payments should not count against the deficit, since lawmakers from both parties have assumed this would happen every year.

But Hoyer has rejected that argument.

When asked if he could “buy that strategy,” Hoyer answered bluntly: “No.”

Senate Democratic leaders acknowledged they would have to rely on Republicans to pass the doctors legislation.

“We need Republican support,” said Senate Democratic Whip Dick Durbin (Ill.). “If the Republicans are in support of strengthening Medicare, saving it so that that doctors don’t leave Medicare, they need to show it with their votes.

“They haven’t told us how they want to pay for it,” Durbin said.

Senate Democratic Conference Vice Chairman Charles Schumer (N.Y.) said the decision on whether to fix doctors’ payments now rests with Republicans.

“We’re committed to getting this done, but the first question is, Are there enough Republicans?” Schumer said.

Seventeen Republicans voted for legislation averting cuts to doctor payments in July of last year. Democrats scored a big victory on July 9, when the late Sen. Edward Kennedy (D-Mass.) surprised colleagues by appearing on the Senate floor after being diagnosed with terminal cancer to cast the decisive vote. After Kennedy tipped the balance, several GOP senators rushed to support the bill.

Of the 17 Republicans who voted for a one-year freeze in scheduled cuts, 11 are still in the upper chamber: Sens. Lamar Alexander (Tenn.), Saxby Chambliss (Ga.), Susan Collins (Maine), Bob Corker (Tenn.), John Cornyn (Texas), Kay Bailey Hutchison (Texas), Johnny Isakson (Ga.), Lisa Murkowski (Alaska), Pat Roberts (Kan.), Olympia Snowe (Maine) and George Voinovich (Ohio).

Several of those Republicans, however, appear unlikely to vote for a $247 billion bill without offsets only days after the Obama administration estimated the rising federal deficit.

During a floor speech Tuesday morning, Corker criticized Democrats for trying to buy the support of doctors for broader healthcare reform. Cornyn is planning to offer an amendment that would pay for part of the doctors’ payments by implementing medical malpractice reform, which Democrats oppose, according to a GOP source

Murkowski said she is unlikely to support the doctors fix for 10 years unless it is paid for.

Roberts said he did not know how he would vote on the legislation to fix doctors’ payments. He said he would wait to see what amendments are offered and how the debate plays out.

But Democrats may not need to go any further than proposing the fix, Roberts said. The mere fact of trying to pass a 10-year freeze may help Democrats earn the allegiance of some doctors groups, or at least make it easier to pillory the GOP as the “party of no.”

“It’s a very clever way for Harry to propose this because he knows you can’t deny reimbursements to doctors,” Roberts said.  

Jeffrey Young and Walter Alarkon contributed to this article.