'Doc fix' collapses, Reid tells colleagues AMA led him astray

A group of Democrats joined all Republicans in blocking a 10-year freeze of scheduled cuts to doctors' Medicare payments, legislation that was considered important to getting a broader healthcare bill through later this year.

Prior to the 47-53 procedural vote, Senate Majority Leader Harry Reid (D-Nev.) blamed the American Medical Association (AMA) for giving him bad information on the number of Republicans expected to support the measure.

Reid had offered the doctors group a deal to pass the "doctors' fix" in return for support from the doctors on President Barack Obama's broader healthcare initiative, which is slated for the Senate floor later this year.
 

Reid told colleagues that the AMA said it could deliver 27 Republican votes for the legislation, according to two Senate Democratic lawmakers, who spoke on condition of anonymity. Reid needs the GOP votes because at least five members of his party have vowed to vote against the doctors' fix.

Reid said at a news conference Wednesday that he would bring up the 10-year freeze after the healthcare reform legislation is passed and will settle for a one-year fix in the meantime.

"We'll take this up again when we finish healthcare," Reid said Wednesday, "and we'll have a multiple-year fix for this. Right now, we'll only have a one-year fix."

The doctor payment cuts are mandated by a 1997 law. 

“The reference to 27 votes was made well before S. 1776 was introduced and in the context of bipartisan health reform legislation," said J. James Rohack, AMA president. "The majority of Democrats and Republicans support SGR repeal for seniors and baby boomers, but today’s vote appears to be becoming the victim of Senate politics. Congress needs to fulfill its obligation to seniors, baby boomers and military families, and repeal of the SGR is an essential element for health reform to succeed.”

Though many Republicans say they want to save doctors from Medicare cuts, they have balked at the quarter-trillion-dollar bill, citing a lack of spending cuts or tax increases to pay for its cost.
 
Twelve Democrats and one independent joined all 40 Senate Republicans in defeating a motion by Reid to begin debate on the doctors fix bill on Wednesday.
 
Reid brought the $247 billion bill to the Senate floor this week as part of a deal to secure the support of doctors groups such as the AMA for passage of a separate, broader healthcare reform bill later this year. But the strategy has backfired.
 
Reid knew that he needed Republican votes because several centrist Democrats made it clear to him before this week that they would not vote for the measure if its cost was not offset. Reid though he could count on a few Republican crossover votes.

Senate Republican leader Mitch McConnell (Ky.) said in a brief hallway interview that he didn’t think the motion to proceed to the bill would pass.
 

Reid told reporters on Wednesday that he was led to believe that more than two dozen Republicans would vote for the bill, though he did not mention the AMA by name.
 
“I was told by various people that we would have 27 Republican votes, which was pretty reasonable to assume since one of the co-sponsors of this legislation was [Sen.] Jon Kyl [Ariz.], the assistant Republican leader.

“I was stunned when I was told by his cosponsor Sen. Stabenow after we introduced this legislation that [Kyl] couldn’t support it. Even though he is a cosponsor he couldn’t support the legislation,” Reid said, making reference to Sen. Debbie Stabenow (D-Mich.), the lead sponsor of the 10-year doctor payment fix.

Kyl did not cosponsor the 10-year fix. Last year and in 2005 he cosponsored a measure that would have implemented a two-year freeze on the cuts to Medicare payments to doctors.
 
An aide to Kyl said that those measures would have indexed future payments to inflation and rising healthcare costs. The aide said that Stabenow’s bill would freeze payment levels and make no provision for rising costs.
 
Another factor is that the nation’s fiscal picture is much different than it was last year. The Obama administration recently estimated the federal deficit at $1.4 trillion.
 
Democratic senators are not certain whether the AMA told Reid directly that it could deliver 27 Republicans or made its estimate known through intermediaries.
 
Reid, Senate Finance Committee Chairman Max Baucus (D-Mont.) and Sen. Chris Dodd (D-Conn.) met with doctors’ groups last week to discuss strategy. Two participants in the meeting said Reid and the groups did not talk about a specific number of Republicans that could be persuaded to support the doctors-fix bill.
 
“No numbers were thrown around,” said the representative of one group. “Twenty-seven is a little ambitious.”