Doctors’ lobby scolds GOP over cuts in Medicare fees

Frustrated by a lost opportunity to prevent a deep cut in its Medicare fees, the American College of Surgeons lashed out last week at the GOP for its criticism of a Democratic plan to fix the payment problem.

{mosads}The society’s political action committee (PAC) sent a letter to National Republican Congressional Committee (NRCC) Chairman Tom Cole (Okla.) on Friday, saying it was “extremely disappointed” at NRCC ads targeting 19 House Democrats who voted for Medicare legislation in August that would have given doctors a small, two-year pay increase in place of a 10 percent cut that otherwise would hit them in 2008.

The lobby’s highest priority this year is preventing the cut from taking place, but lawmakers face a high hurdle in finding budgetary offsets to cover the billions of dollars a year the fix would cost. Doctors’ groups have been waging the same campaign for several consecutive years without getting reforms to the underlying formula that calls for the fee reductions.

The surgeons’ PAC traditionally has favored Republican candidates, though the balance has predictably shifted since the Democrats took control of Congress.

The strongly worded letter takes aim at Republican lawmakers for not dealing with the physician payment issue while in the majority and complains that GOP attacks on the Democratic plan miss the mark because Republicans haven’t come up with an alternative.

“Republican leaders have always indicated to us that they support efforts to stop the Medicare physician payment cuts. Unfortunately, this year, they have yet to offer any plan to finance yet another short-term fix,” the letter says.

A lobbyist at the surgeons’ society made clear that the group is not satisfied with House Republicans this year.

“The American College of Surgeons’ PAC has been a supporter of the NRCC for years and we wanted them to know we’re unhappy,” said Christian Shalgian, manager of legislative affairs for the surgeons’ association.

The American College of Surgeons Professional Association-Surgeons PAC has contributed $10,000 to the NRCC this year, compared to $5,000 to the Democratic Congressional Campaign Committee (DCCC), according to CQMoneyLine.com. In the previous two-year election cycle, the PAC gave $15,000 to the NRCC and $7,500 to the DCCC.

In addition, the surgeons’ PAC strongly favored GOP candidates and leadership PACs in past election cycles. In the 2005–2006 cycle, the PAC gave $334,250 to Republican candidates and $78,000 to GOP leadership PACS. Democratic candidates received $127,500 and Democratic leadership PACS got $31,000 in the same period.

This year, the pattern has changed. Through July 31, the surgeons’ PAC had given Democratic candidates $57,500 and GOP candidates $54,000. Republican leadership PACS maintain a $9,500-to-$7,000 advantage, however.

Although Shalgian said the surgeons are levying pressure on lawmakers from both parties, he pointedly noted that House Democrats passed a bill, known as the CHAMP Act, that addresses physician payments. “The Democrats — with some Republicans as well — in the CHAMP Act voted for a proposal that would fully fund a physician pay fix,” Shalgian said. Five Republicans voted with 220 Democrats for the bill.

Physicians are caught up in a larger political fight over the future of Medicare Advantage, the program through which private health plans provide Medicare benefits, and over the reauthorization of the State Children’s Health Insurance Program (SCHIP).

With near-universal opposition from Republican lawmakers, the House last month passed an SCHIP-Medicare bill that would have cut spending on Medicare Advantage by $50 billion over five years. The money would have been shifted to help offset a $20 billion physician payment fix and a $50 billion expansion of SCHIP.

Congress and the physician lobby will have to go back to the drawing board: On Tuesday, the House is scheduled to vote on an SCHIP reauthorization, based on a Senate-passed bill, that does not include any Medicare provisions. The Senate will vote on the bill later in the week.

The Bush administration and congressional Republicans maintain that cutting Medicare Advantage would reduce beneficiaries’ access to the private plans and the additional benefits many offer, especially in rural areas.

Democratic proponents of the Medicare Advantage cuts note that Medicare Advantage payments, on average, are 112 percent of the cost of providing the same benefits through traditional Medicare.

The NRCC’s ads began a two-week run last week in the local newspapers of Democratic lawmakers. The ads state, for example, that “Zack Space voted to cut Medicare for seniors … Over 3 million seniors would lose their current coverage,” referring to the freshman Ohio Democrat. The GOP projects that the cuts would cause health plans to abandon Medicare Advantage, which would force beneficiaries back into traditional Medicare.

“Republicans have delivered for physicians time and time and time again,” NRCC spokesman Ken Spain said. “We have a role in holding the Democrats accountable for their votes.”

In its letter to the NRCC, the surgeons’ group defends the Medicare Advantage cuts as necessary to pay for “very modest payment increases for physicians.” Moreover, the surgeons criticize Republicans for failing to devise an alternative offset and pin the blame for this year’s problems on actions taken by the GOP last year.

“Eliminating these payment cuts is very expensive and, in fact, was made more costly because of a decision made by the Republican-controlled Congress in 2006.” Last year, Congress enacted a temporary fix to the 5 percent cut that would have taken effect for 2007 by doubling the cut slated for 2008. The letter states the GOP-led “Congress was unwilling to make the difficult choices involved in finding offsets.”

The surgeons are not supporting Medicare Advantage cuts primarily on their own merit, Shalgian said, but because they would have served to offset the physician fee increase. The group is open to an alternative proposal, he said.