Medicare legislation state of play: status of S3101; S3118; HR6331

The best overview of the situation is the Kaiser Daily Health Report Senate Fails To Take Up Legislation That Would Delay Medicare Physician Fee Cut. The House bill HR6331 passed with a veto proof majority (to override a veto requires a two-thirds majority vote in both the House of Representatives and Senate) so the House sees their work as being done. In the Senate the focus is on S3101 but it can not come to the floor of the Senate until there are 60 votes to end debate.

The Senate voted 58 to 40 to end debate with McCain and Kennedy not present; the vote was really 59 to 39 because one Senator (Senate leader Reid) voted no to maintain his ability to reopen the issue. The ball is entirely in the Senate's court. The Senate is going to work over the weekend - they had been scheduled to be on their 4th of July break - and have another vote on Sunday.

Underlying this is the threat of a Presidential veto. He has said he'll veto if something like the House bill is approved by the Senate and sent to the President to be signed. The Senate seems to have a range of options. One, they could pass S3101 with 66 votes which combined with the House vote on HR6331 would make the bill veto proof. Two, the Senate could manage to bring S3101 to a vote and send it to the President with fewer than 66 Senators supporting the legislation which would mean a veto would stop the legislation. Three, they could craft a compromise bill that the President is willing to sign then the House would have to act on something similar to the new bill or a compromise bill could be sent to the President, the veto calculus is unknowable without the details. Four, there is a Republican proposal to delay the pending doctor reimbursement cut for 30 days - which if it was passed by both chambers and signed would allow the members to get on with their vacations and start the whole process again in July.

There are sure to be other options too but the thing underlying all this, the 11% cut in Medicare reimbursement to physicians as of July 1, it is agreed is too big an issue let happen. However, since no one person is actually in charge of the process and inaction will result in the cut, the cut could happen despite everyone agreeing that it shouldn't. The option of last resort would be to fix the problem after the fact by retroactively reimbursing physicians. This would be hugely problematic administratively and certainly there would some disruption in people's care.

I guess it'll be Monday before we know what to expect.

Comments

[RO]

How about they cut the senators salary by 10.6% and put that money into the medicare system without punishing the physicians.

[Bill Peckham]

The annual salary of each senator, as of 2008, is $169,300. So cutting their salaries entirely for ten years would pay for one tenth of one percent of the legislation to fix the pending cuts.

I assume this cut is because of some previous budget shenanigans - presumably the cut was built into legislation some years ago so that some other program increase was "paid for" per the rules of "budget neutrality". I think the value of a sensible healthcare system would far outweigh its costs. However, as long as we are patching this Frankenstein monster of a system people are going to feel like it is a bad value.