Physician pay bill in Senate launches lobbying battle

Physicians and their lobbyists are preparing to come out in force next
week to push for Senate passage of a $247 billion bill that would
achieve the long-sought objective of reforming an obscure Medicare
policy that threatens their pay every year.

The American Medical Association (AMA) is at the forefront of the campaign and is a huge part of the reason Senate Majority Leader Harry Reid (D-Nev.) is bringing the Medicare bill to the floor without budgetary offsets just a week before he plans to open debate on a broad healthcare reform bill.

{mosads}The physician lobby is desperate for the payments issue to be addressed. For most of this decade, the AMA and other groups have had to fight every year to get Congress to block cuts in their Medicare fees that are the result of a payment system widely regarded as flawed. In 2010, payments would be slashed by 21 percent without legislation.

The AMA, which opened a national television advertising campaign in support of the bill Thursday, is not alone in its efforts. Various groups representing specialist physicians along with state medical societies will dispatch their lobbyists to the Capitol and unleash the grassroots power of their members to pressure senators to back the bill despite its costs. The powerful lobby for older Americans, AARP, has also endorsed the bill.

“We’re very enthusiastic supporters,” said Jack Lewin, the CEO of the American College of Cardiology.

In addition to the AMA’s ad campaign and intense lobbying activity, medical societies are calling on their members to pepper senators with phone calls and e-mails. The Texas Medical Association, Tennessee Medical Association and Indiana State Medical Association, for example, issued alerts to all of their members this week. Tennessee Sen. Bob Corker (R) will participate in a conference call with board members of his state’s group Saturday.

“All of us should band together and make it very clear that this wonderful proposal needs to be implemented,” Lewin said.

But the AMA and its allies face some dissension from other groups. The American Association of Neurological Surgeons and the Congress of Neurological Surgeons have already come out against the bill, sponsored by Sen. Debbie Stabenow (D-Mich.), and others may follow. “There’s significant skepticism about this approach,” a lobbyist said.

Lobbyists speaking on background said that some specialty societies and state-based groups were skeptical about the bill’s prospects and suspicious that Democrats would make fixing the payments contingent on other priorities in healthcare reform, such as the creation of a system that links fees to quality measurements and a proposed independent commission to decide on Medicare payment policies.

Democrats on Capitol Hill are also trying to persuade physicians and other medical providers to back the creation of a government-run public option insurance program that would base its rates on Medicare fees plus 5 percent.

Reid will need the assist from the AMA and other groups if the bill has a chance to advance next week. In addition to needing 60 votes for cloture to allow the Senate to vote on the actual bill, Reid and the bill’s supporters will need to overcome an objection to the deficit-spending in the bill, which also needs 60 votes.

But Senate Budget Committee Chairman Kent Conrad (D-N.D.) has also declared he is not on board, as has Sen. Evan Bayh (D-Ind.), while other fiscally conservative Democrats are dubious.

Republicans are describing Reid’s decision to move the bill without offsets as a hypocritical abandonment of the Democrats’ much-ballyhooed “pay-as-you-go” budget rules and a cynical attempt to disguise the true cost of healthcare reform, which itself will cost around $900 billion but would be paid for.

Getting the votes will not be easy, one physician lobbyist said: “There is a coalition of senators that would be made to support it. I don’t know who they are yet.” Because very few people on Capitol Hill or K Street knew in advance that Stabenow was introducing the bill Tuesday or that Reid planned to open floor debate so quickly, the challenge is increased, the lobbyist said. “We kind of got caught off-guard. There’s not a lot of time to organize.”

The House’s healthcare reform bill already includes a permanent physician payment fix that also is not paid for.

Stabenow and other supporters note that the Medicare payment formula for physicians has been broken for the better part of a decade, requiring Congress to step in year after year to fend off cuts. Because Congress would never actually allow the cuts to take place, the argument goes, current budget projections that assume those cuts are not realistic.

Indeed, the high price tag of replacing the current payment system is the main reason why it has not been fixed, and the problem compounds every year. “If we have to pay for this out of this year’s budget, it’s not going to happen,” Lewin said.

The healthcare reform bill passed by the Senate Finance Committee would stop next year’s cut and replace it with a one-year, 0.5 percent increase. “A one-year fix is irresponsible,” Lewin said, because physicians would have to start fighting right away to block a pay cut for 2011.