Luke Sharrett/The New York Times
Senators Harry Reid, Patrick J. Leahy and Charles E. Schumer held a news conference Wednesday on health care legislation.
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A blog from The New York Times that tracks the health care debate as it unfolds.
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The Medicare bill has become a proxy for larger issues in the debate over legislation to overhaul the health care system.
Mr. Reid said the bill, by averting big cuts in physician fees, guaranteed that doctors would continue accepting Medicare patients. But since none of the costs were offset or paid for, Republicans said it was fiscally irresponsible, and some Democrats said they shared that concern.
By addressing doctors’ fees in a separate bill, Senate Democrats could hold down the cost of the broader health legislation, keeping it within the limits set by President Obama. House Democrats are considering a similar tactic. Republicans said it was a transparent ploy to hide the cost of a health care overhaul.
Democrats had hoped that by passing the Medicare bill they could appease doctors and secure their support for the broader legislation.
Senate Democratic leaders said the bill to protect doctors’ fees had strong support from the White House, the American Medical Association and AARP.
Among the Democrats who voted against the party leadership were Senators Evan Bayh of Indiana, Kent Conrad of North Dakota, Russ Feingold of Wisconsin, Claire McCaskill of Missouri, Bill Nelson of Florida and Ron Wyden of Oregon.
“I will vote for the doctor fix — when it is funded,” Mr. Nelson said.
Mr. Wyden said, “On the eve of a historic debate on health care, it’s essential to show a commitment to real reform,” which includes fiscal responsibility.
Mr. Reid said the Republicans had suddenly “gotten religion” and were being very frugal. In the past, he said, they did not worry about paying for tax cuts or for the drug benefit added to Medicare in 2003.
Under current law, doctors face a 21.5 percent cut in Medicare fees in 2010 and then annual 5 percent cuts for several years. Since 2003, Congress has stepped in to postpone such cuts, but it has usually found ways to offset the cost to the government.
The bill this year, by Senator Debbie Stabenow, Democrat of Michigan, had no offset and would have repealed the current cost-cutting formula, known as the sustainable growth rate.
The Senate Republican leader, Mitch McConnell, said he felt vindicated by the vote.
“In the Senate’s first vote on health care spending this year,” Mr. McConnell said, “a bipartisan majority rejected the Democrat leadership’s attempt to add another quarter-trillion dollars to the national credit card without any plan to pay for it. With a record deficit and a ballooning national debt, the American people are saying enough is enough.”
Despite the Senate vote, proponents of sweeping health care legislation moved ahead on other fronts.
At a meeting of the House Democratic Caucus, Speaker Nancy Pelosi indicated that she would push for a “robust” liberal version of a government-run health insurance plan, to compete with private insurers, if she could get the 218 votes needed to win approval in the full House.
An aide to the House Democratic leadership said Ms. Pelosi had told the caucus that she had 200 votes, “or a little over 200,” for this option, which would use Medicare rates as a basis for paying hospitals and doctors. Under another option, the government plan would negotiate rates with providers, as private insurers do.
Ms. Pelosi said the first alternative saved more money and would give the House leverage in negotiations with the Senate. But Representative Earl Pomeroy, Democrat of North Dakota, said he could not vote for this proposal because it would be damaging to his district and was likely to be dropped in negotiations with the Senate.
In North Dakota, as in many other rural areas, Mr. Pomeroy said, Medicare rates are far below those paid by private insurers.
Democrats in both chambers agreed Wednesday on one point: they want to revoke the exemption from federal antitrust law that health insurance companies have long enjoyed.
By a vote of 20 to 9, the House Judiciary Committee approved the antitrust change, which is likely to be included in the broader health care legislation. It would outlaw price-fixing, bid rigging and “market allocations” by companies that sell health insurance or medical malpractice insurance.
Mr. Reid and the chairman of the Judiciary Committee, Senator Patrick J. Leahy, Democrat of Vermont, said they would offer a similar plan as an amendment to health legislation in the Senate.
“Criminal conduct that would land people in jail in other industries is legal when insurers do it,” Mr. Leahy said.
The insurance business has been largely exempt from federal antitrust law since 1945. The Supreme Court ruled in 1944 that insurance was interstate commerce subject to federal antitrust law. But the insurance industry won a reprieve nine months later, when Congress passed the McCarran-Ferguson Act.
States regulate health insurance and have sued insurers for anticompetitive conduct. But state officials said they had received little help from the federal government.
Richard Blumenthal, the attorney general of Connecticut, said: “I feel strongly that the exemption should be repealed. It is a legal and historical anomaly that there is such a sweeping and all-encompassing exemption for an entire industry. It makes no sense as a matter of logic or law.”
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