Pelosi: 'No reason' to pass standalone doc fix

Senate Democrats — who passed a Medicare doc-fix bill last week after plucking it from a larger tax extenders proposal — might have made it more difficult to enact both, some healthcare experts warn.

House Democratic leaders were furious at the Senate’s scaled-down doc-fix legislation, in part because it was offset largely by a pension provision unpopular among labor unions. The second problem: Removing that must-pass provision from the extenders proposal has robbed some of the urgency from the underlying bill.

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Some health experts and advocates worry the strategy could threaten the other provisions of the extenders bill, including tens of billions of dollars in funding for state Medicaid programs.

“It’s important to have as much urgency as possible when the bill comes to the floor,” Ron Pollack, executive director of Families USA, a healthcare advocacy group, said Monday. Pollack noted that the doc fix provided a good “counterbalance” to less popular provisions in the underlying bill.

House leaders don’t need convincing. Hours after the Senate passed its doc-fix bill Friday, Speaker Nancy Pelosi (D-Calif.) called the measure “a great disappointment.”

Not only is the five-month pay window “inadequate,” Pelosi said, but separating the so-called doc fix provision from the tax extenders bill threatens the larger proposal. The House last month passed legislation delaying the pay cut for doctors until 2012.

“The bill Senate Republicans allowed to pass is not only inadequate with respect to physician fees, but it ignores urgent sections of the House bill to provide jobs,” Pelosi said in a statement. “The House has repeatedly sent jobs-creating bills to the Senate since December — Build America Bonds, small-business hiring incentives and, importantly, summer jobs — and yet Republicans continue to block approval of jobs legislation.”

The Senate on Friday passed the doc fix by unanimous consent after Sens. Max Baucus (D-Mont.) and Chuck Grassley (R-Iowa), the leaders on the Finance Committee, hammered out a last-minute deal to offset the $6.5 billion cost. The proposal would delay a 21 percent cut to Medicare doctors, which took effect this month, until the end of November.

Although House leaders had separated their 19-month doc fix from the larger extenders bill to appease Blue Dog Democrats, they effectively sent the two proposals to the Senate as a package. Senate Democratic leaders, however, haven’t been able to convince even a single Republican to support the extenders bill, forcing separate consideration of the doc-fix measure.

Sens. Ben Nelson (D-Neb.) and Joe Lieberman (I-Conn.) also opposed the bill during a test vote last week.

The Senate was expected to resume consideration of the extenders bill this week, but Democratic leaders might have to delay a vote because they don’t have the support to pass it.

The saga is pitting Democrats against Republicans, House leaders against Senate leaders and the influential doctors lobby against lawmakers of all stripes. The American Medical Association (AMA) has been urging a permanent fix to the perennial doctor pay problem while simultaneously criticizing Congress for failing to provide a short-term delay this month.

“Congress is playing Russian roulette with seniors’ healthcare,” Cecil B. Wilson, AMA president, said in a statement Friday.

The impasse is also squeezing state officials, who’ve been banking on the additional Medicaid funding, which expires at the end of 2010 — halfway through the budget year of most states.

Last week, the American Public Human Services Association (APHSA) wrote to Senate leaders in both parties arguing that the extra Medicaid funding “has been and will continue to be essential and necessary.”

“It is crucial to ensure that states have the resources necessary to continue to provide these services and supports,” wrote Cari DeSantis, APHSA’s interim executive director.

The Senate’s Medicaid funding, estimated to cost roughly $24 billion, is popular with children’s healthcare advocates because it would also prevent states from scaling back eligibility and benefits. House leaders dropped the funding from their tax extenders bill because of budget concerns, but pressure is building for lower-chamber leaders to reconsider that omission.

Governors from both parties have been lobbying for weeks for the additional funding, warning of layoffs and benefit cuts if it doesn’t arrive. Last week, a long list of freshman Democrats wrote to Pelosi and House Majority Leader Steny Hoyer (D-Md.) urging approval of the Medicaid funding.

“Pulling back the enhanced [funding] would have a severely detrimental effect on our states’ economies at a time when a fragile recovery has begun to take hold,” the lawmakers wrote. The letter was spearheaded by Rep. Ben Luján (D-N.M.).

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Healthcare groups are also urging Congress to extend a program providing insurance premium subsidies to unemployed workers. New enrollment in the COBRA subsidy program — which covers 65 percent of premium costs for unemployed workers — expired June 1, leaving an estimated 144,000 families ineligible each month, according to the National Employment Law Project, an advocacy group.

Sens. Bob Casey Jr. (D-Pa.) and Sherrod Brown (D-Ohio) have offered an amendment to the extenders bill that would extend eligibility through November. The Congressional Budget Office, however, recently estimated the cost of the provision at $4.1 billion — much higher than the sponsors anticipated. That price tag  threatens to sink the amendment.

“That’s not an uphill climb,” said Pollack of Families USA. “That’s a Himalayan expedition.”

This story was updated at 7:55.