Docs risking ire of GOP on Medicare

Lobbying groups representing physicians have been taking a noticeably partisan tack in their fight to protect their Medicare fees, siding with Democrats and risking a backlash from Republicans in the process.

Trade groups tend to be wary of favoring one party, since politicians have long memories and today’s minority could be tomorrow’s majority.

{mosads}But sometimes interest groups find themselves in a position where they have to risk future comeuppance for present gain.

“It’s a calculated risk that’s made,” said a lobbyist who has worked to pass the Medicare bill. “It certainly can come full circle and bite you on the butt in the end,” the lobbyist said. “We’ll see what happens in future years.”

The immediate interests of the American Medical Association (AMA) and allied groups clearly lie with the Democrats, who control Congress and have been pushing legislation to undo a 10.6 percent cut in Medicare payments to doctors that kicked in on July 1.

Senate Republicans have stood in their way. Though the House passed a Democratic bill to prevent the cuts by a whopping 355-59 vote, a cloture vote in the Senate failed by a single vote, with most Republicans voting against cloture.

That drew public condemnation from the AMA, backed up by a television and radio advertising campaign over the Independence Day recess. The broadcast spots called out individual Republican senators by name, including Sens. John Sununu (N.H.), Roger Wicker (Miss.) and Arlen Specter (Pa.), who all voted against cloture.

“There are no permanent enemies, no permanent allies,” said Christian Shalgian, the interim director of the American College of Surgeons.

Republicans who have borne the brunt of the physician lobby’s criticisms, however, might not see it that way.

Specter was not pleased with the ads. “I’m a little surprised when there are issues that are very important to the AMA, the shoe may be on the other foot. … I’ve been a very good friend of America’s doctors, so a little surprised to see one vote in this context the subject of media advertising,” he told The Hill.

Until the Senate Republican leadership held the line against the Democratic Medicare bill, physician groups by and large steered clear of pointing their fingers at the GOP, even though the partisan divide over the bill had always been clear.

{mospagebreak}When the Medicare bill failed by a single vote, though, the AMA and some of its allies let their “outrage” show and directed their invective squarely at the Republican Party.

In states like Texas, Mississippi and New Hampshire, medical societies took aim at their incumbent senators. The Texas Medical Association made headlines when it withdrew its endorsement of Sen. John Cornyn (R-Texas) in retaliation for his “no” vote. If Cornyn holds on to his seat, he’s not going to forget that his state’s doctors turned their backs on him.

From the physicians’ perspectives, they’re siding with themselves, not congressional Democrats.

{mosads}“We would hope that those senators who voted against the bill would understand the impact … of the problems that they’ve created with their votes,” said James Rohack, a Temple, Texas-based cardiologist and the AMA’s president-elect.

The inescapable fact is that Republicans, and only Republicans, voted against advancing the legislative vehicle that would have blocked the physician pay cut, Shalgian said.

“It just so happened that it was 39 Senate Republicans who voted against it,” Shalgian said. “It comes from the Senate Republican leadership and it comes from the White House.

The AMA has an idiosyncratic relationship with the political parties. The group has sided in the past with Democrats on issues such as the Patient’s Bill of Rights and with Republicans on medical tort reform.

Invariably, the other side was irked at the AMA.

The AMA’s move to cozy up with Senate Democrats also occurred in the context of a rift between the group and Finance Committee Chairman Max Baucus (D-Mont.). Earlier this year, as the Medicare legislation was being written, Baucus barred AMA representatives from meeting with his staff. In a clear sign that the ice was thawing, Baucus and AMA President Nancy Nielsen appeared side by side at a press conference on Medicare the day the Senate voted. The AMA also has a notoriously rocky relationship with Rep. Pete Stark (D-Calif.), who chairs the Health Subcommittee of the Ways and Means Committee.

That the Democrats are widely predicted to increase their majorities in the House and Senate this year also is part of the calculation. So is the possibility of Sen. Barack Obama (D-Ill.) winning the presidency and giving Democrats control of two branches of government for the first time since 1994.

The ads, the lobbying, the harsh rhetoric and even the support of powerful interests like the AARP and other segments of the healthcare industry, however, still might not be enough to win a successful cloture vote.

That’s part of the calculated risk.

“What I have seen is that eight to 10 senators are more worried than I have ever seen,” Shalgian said.

Whether that translates into any of those senators changing their votes, he acknowledged, is anybody’s guess.

Senate Republicans and the White House have demonstrated remarkable fortitude with their opposition to the Democratic Medicare bill, which includes spending reductions on private Medicare Advantage plans that, the White House argues, would reduce the availability of these private plans to Medicare beneficiaries.

The Republicans who opposed the bill have by now explained time and again to the physicians in their home states why they voted against the bill even though they universally support fixing the doctor payments problem.

Republicans have also complained about strong-arm tactics by Senate Democratic leaders, and point out that Senate Democrats refused to consider a one-month fix to the pay cuts issue and instead insisted on their own bill.

But the doctors aren’t buying it, and Democrats are using the votes as campaign fodder. Republicans are also facing pressure from interests in the pharmacy, kidney dialysis, medical equipment and other sectors that like parts of the bill.

Seemingly only the health insurance industry is supporting the Republican position. America’s Health Insurance Plans demonstrated that support over the recess, running ads to counter the AMA’s campaign and warning lawmakers that people enrolled in Medicare Advantage are going to be awfully upset if they can’t sign up for their plans again next year.

Manu Raju contributed to this article.

APPROPRIATIONS
• The Senate Energy and Water Appropriations subcommittee has scheduled a markup for the Energy and Water spending bill this Tuesday at 10:30 a.m. in 192 Dirksen.
• The Senate Appropriations Transportation-Housing and Urban Development subcommittee has scheduled a markup for the Transportation-Housing and Urban Development spending bill this Thursday at noon in 116 Dirksen.
• The Senate Appropriations Committee has scheduled a markup for the Energy and Water, Financial Services and Transportation-Housing and Urban Development spending bills this Thursday at 2 p.m. in 106 Dirksen.

DEFENSE
• The House Armed Services Air and Land subcommittee will hold a hearing on the Air Force’s controversial tanker program on Thursday, July 10 at 2 p.m. in 2118 Rayburn.

ENERGY
• The Senate Environment and Public Works Subcommittee on Clean Air and Nuclear Safety examines the Renewable Fuels Standard at a hearing on Thursday at 10 a.m. in 406 Dirksen.
• The House Energy and Commerce Energy and Air Quality subcommittee will examine carbon capture and storage on Thursday at 10 a.m. in 2123 Rayburn.

FINANCE
• The House Financial Services Housing and Community Opportunity subcommittee will hold a hearing titled “Federal Spending Requirements in Housing and Community Development Programs: Challenges in 2008 and Beyond” on Wednesday at 9:30 a.m. in 2128 Rayburn.

HEALTHCARE
• The House Oversight and Investigations Committee’s Domestic Policy subcommittee will hold a hearing on state and local regulations to reduce dental mercury emissions on Tuesday at 2:30 p.m. in 2154 Rayburn.
• The House Veterans’ Affairs Committee has a hearing on safety issues facing veterans with post-traumatic stress disorder using the anti-smoking drug Chantix on Wednesday at 10 a.m. in 334 Cannon.

NUTRITION
• The House Education and Labor Committee will examine how rising food costs affect federal child nutrition programs at a hearing Wednesday at 10 a.m. in 2175 Rayburn.