The Kaiser Daily Health Policy Report has a rundown on the next steps for legislation to put off cuts to physician reimbursement from Medicare. Senate Majority Leader Reid is reported to expect a vote either tomorrow or Wednesday on cloture for HR6331. Cloture would then allow HR6331 to come to the floor of the Senate for a vote.
HR6331 is expected to pass the Senate and then receive a veto from President Bush. If the Senate vote is more than 66 Senators voting in favor of the bill, HR 6331 would have enough votes in the House and the Senate to overturn the veto. If HR6331 passes but with fewer than 66 votes in the Senate then the veto would hold. This seems like the most likely outcome.
After a perfunctory vote to overturn the veto the Senate would then have to bring one of their bills to the floor either: S3101 (the Baucus bill, which the President has said he'd veto) or S3118 (the Grassley bill which doesn't have majority party support) or a compromise hybrid Senate bill that one assumes the President would agree to sign. HR6331 and the two existing Senate bills (S3101 and S3118) would push the still looming physician cuts out 18 months. A final option proposed at the end of last week by Senators McConnell and Grassley is to pass legislation that would delay the cuts for 31 days.
As it now stands (link from RenalWEB) the deadline is July 15th to get this sorted out:
The Centers for Medicare and Medicaid Services (CMS) announced that it has instructed its contractors to hold claims for physicians, nonphysician practitioners, and other fee-for-service (FFS) providers paid under the Medicare physician fee schedule for the first 10 business days of July.
If the Senate passes a bill that is then quickly vetoed there will be a very compressed time frame to get a new bill through both the House and the Senate by the 15th. It is when legislation is rushed through the legislative process under a crises deadline that creates an atmosphere that allows lobbyists to thrive. Last minute deals that are never vetted can result in significant changes to the legislation. For a small section of the bill like the ESRD provisions this might mean resurrecting the MSP extensions, which would be a bad idea or making slight language changes which would be a good change.
Forces far larger and politically far more powerful than the dialysis community - military families, the AARP, insurance companies - are for and against the bill. The dialysis community is just a flea on this big dog legislation.
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