Miscalculation delivers loss on Medicare doctor's fix for Majority Leader Reid

By Alexander Bolton - 10/21/09 08:27 PM ET

Senate Majority Leader Harry Reid (D-Nev.) lost the first floor battle of the healthcare reform debate Wednesday when 12 Democrats and one Independent joined all Republicans to defeat a bill to halt Medicare cuts affecting doctors.
The $247 billion bill, which would have imposed a 10-year freeze on cuts in Medicare payments to doctors, was an important part of Reid’s plan for passing the broader healthcare reform bill later this year.

But Reid couldn’t secure enough votes to bring the bill up for debate, with the procedural vote failing 47-53.
The setback immediately raised questions among fellow Democrats over Reid’s handling of healthcare reform strategy and gave Republicans an opening.
The GOP wasted no time in pouncing on Reid, who is facing a difficult reelection next year.
“No one should be surprised that the first vote on healthcare reform that Harry Reid brought to the floor adds nearly $250 billion to our already skyrocketing national deficit,” said Michael Steele, chairman of the Republican National Committee.
“But the real surprise is that despite President Obama’s claim that we’re closer than ever before to passing healthcare reform, the first Senate floor vote was a complete failure.”
A Democratic leadership aide said Reid had to act on the doctors’ fix this week to preserve the cost of broader healthcare reform legislation, which is scheduled to reach the Senate floor in coming weeks.
If the Senate did not vote on the doctors’ fix this week, the aide explained, a lawmaker could offer it as an amendment to the broader healthcare bill. That would serve as a poison-pill amendment because Obama has set a $900 billion limit on healthcare reform legislation and the doctors’ fix would add hundreds of billions more to the price tag.
“If this amendment passed, it would jeopardize final passage of health reform.  And given Republicans’ strong opposition to health reform, it is entirely possible they would have voted for this amendment,” said the aide.
“We have taken the steam out of this issue and defused any efforts to use this amendment to blow up healthcare,” the staffer added. 
Reid brought the bill to the floor in an effort to secure the support of doctors groups such as the American Medical Association (AMA) for the future fight over an overhaul of the nation’s healthcare system.
Reid’s gambit, however, backfired, leaving Reid blaming the AMA for failing to secure GOP votes and the AMA retorting that the leader misinterpreted its pledge.
Reid told colleagues that the AMA said it could deliver 27 Republican votes for the legislation, according to two Senate Democratic lawmakers, who spoke on condition of anonymity.
Some Democrats wondered whether it was reasonable to expect that as many as 27 Republicans would support a 10-year freeze in light of the fact that only 17 Senate Republicans voted for a one-year freeze last July. Of that group, only 11 remain in the Senate.
But Reid reiterated the claim during a news conference on Wednesday.
“I was told by various people that we would have 27 Republican votes, which was pretty reasonable to assume since one of the co-sponsors of this legislation was [Sen.] Jon Kyl [Ariz.], the assistant Republican leader,” Reid told reporters.
But J. James Rohack, the president of the AMA, said that Reid was working with old information and that his organization never claimed it could deliver more than two dozen Republicans for a 10-year fix of Medicare doctor payments.
“The reference to 27 votes was made well before [the bill] was introduced and in the context of bipartisan health reform legislation,” said Rohack.
Now, in the aftermath of Wednesday’s resounding defeat of the bill on the Senate floor, colleagues are privately questioning what the maneuver accomplished.
Sen. Debbie Stabenow (D-Mich.), the lead sponsor of the bill, said the setback would not affect the effort to pass comprehensive healthcare legislation later this month.

A senior Democratic senator who spoke on condition of anonymity said the defeat of Stabenow’s bill could have reverberations, but only if Democratic leaders fail to assure doctors groups that that they will find another way to avert cuts in their Medicare reimbursements, which are mandated by a 1997 budget law.
Reid said at a news conference Wednesday that he would bring up the multiyear freeze after the healthcare reform legislation is passed and will settle for a one-year fix in the meantime.
Hours before Wednesday’s vote, Reid blamed Republicans for playing politics, pointing his finger squarely at Kyl. Reid accused the Republican whip of turning his back on an issue that he once supported.
But Kyl disputed that he ever supported legislation to freeze scheduled cuts in doctors’ payments over a 10-year span. He did, however, co-sponsor measures in 2008 and 2005 that would have implemented a two-year remedy for the cuts to doctors’ payments.
Stabenow said after the vote that Kyl never told her that he would support a 10-year freeze of Medicare cutes.
An aide to Kyl said the measures his boss supported in the past would have indexed future payments to inflation and rising healthcare costs. The aide said that Stabenow’s bill would only freeze payment levels and make no provision for rising costs.
 

Democratic senators are not certain whether the AMA told Reid directly that it could deliver 27 Republicans or made its estimate known through intermediaries.
 

Stabenow told The Hill on Wednesday that she “did not specifically hear that” claim from the AMA but that “others told me.”
Stabenow said the AMA may not have expected to deliver 27 Republican votes but the group thought it could persuade “14 or 15 Republicans.”
Reid, Senate Finance Committee Chairman Max Baucus (D-Mont.) and Sen. Chris Dodd (D-Conn.) met with doctors groups last week to discuss strategy. Two participants in the meeting said Reid and the groups did not talk about a specific number of Republicans that could be persuaded to support the doctors-fix bill.

“No numbers were thrown around,” said a representative of one group. “Twenty-seven is a little ambitious.”