Senate Approves a Bill on Changes to Medicare

WASHINGTON — The Senate on Tuesday overwhelmingly approved sweeping changes in the way Medicare pays doctors, clearing the bill for President Obama and resolving an issue that has bedeviled Congress and the Medicare program for more than a decade.

The 92-to-8 vote in the Senate, following passage in the House last month by a vote of 392 to 37, was a major success for Republicans, who devised a solution to a complex policy problem that had frustrated lawmakers of both parties. Mr. Obama has endorsed the bill, saying it “could help slow health care cost growth.”

The bill, drafted in the House in negotiations between Speaker John A. Boehner and Representative Nancy Pelosi, the Democratic leader, also extends the Children’s Health Insurance Program for two years, through 2017.

Without action by Congress, doctors would have faced a 21 percent cut in Medicare fees on Wednesday or Thursday. Senate leaders cleared the way for final passage by allowing votes on several amendments sought by liberal Democrats and conservative Republicans.

Medicare spent $70 billion last year under the fee schedule used to pay doctors and some other health care professionals. That accounts for about 12 percent of all Medicare spending. Ninety-eight percent of people enrolled in the traditional fee-for-service Medicare program receive at least one physician service during the year.

The legislation moves Medicare in a direction espoused by Mr. Obama and many health policy experts, toward payment based on the quality and value of care, rather than just the volume of services. Organized medicine now accepts that change in principle, and the American Medical Association lobbied strongly for the bill, demanding that Congress “fix Medicare now.”

Congress has passed 17 short-term bills since 2003 to block cuts in Medicare doctors’ fees that were called for under the existing law. Such cuts would most likely prompt some doctors to accept fewer Medicare patients.

The Senate majority leader, Mitch McConnell, Republican of Kentucky, said the bill taken up Tuesday was “designed to ensure that seniors on Medicare don’t lose access to their doctors.”

“It’s a solution to a broken Medicare payment system that has vexed congressional leaders of both parties for years,” he said. “It would mean an end to the annual exercise of Congress passing a temporary fix to the problem one year and then coming right up to the very same cliff the next year, without actually solving the underlying problem.”

Senator Ron Wyden of Oregon, the senior Democrat on the Finance Committee, called the bill “a milestone for Medicare.” But he and other Democrats said it would have been better to extend the children’s insurance program for four years, rather than two.

Mr. Wyden said the current formula for paying doctors was “horrendously flawed” but had “dominated much of the discussion” in the last 18 years.

Before passing the bill, the Senate rejected a half-dozen proposed amendments on Tuesday night. Democrats, for example, wanted to provide more money for women’s health care. Republicans wanted to repeal a provision of the Affordable Care Act that requires most Americans to have health insurance, and they tried to force Congress to pay for the Medicare bill so it would not increase budget deficits.

The current payment formula, set by Congress in 1997, links Medicare spending on doctors’ services to growth of the overall economy. Medicare spending has regularly exceeded the targets. Under the law, the excess is supposed to be recouped in subsequent years through cuts in payment rates for doctors.

The bill would repeal that formula. Fiscal conservatives object because only one-third of the cost would be offset. The rest, $141 billion from 2015 to 2025, would add to federal budget deficits.

“This bill is not paid for,” said Senator Jeff Sessions, Republican of Alabama.

New spending would total $211 billion over 10 years, the Congressional Budget Office estimated. Higher-income Medicare beneficiaries would pay additional premiums totaling nearly $35 billion, and Medicare would save a similar amount by trimming payments to hospitals, nursing homes and home health agencies.

Senator Mike Lee, Republican of Utah, said the bill “doubles down on Medicare’s broken price control model” and “inflates the administration’s power as regulator and compliance officer.”

“The principal change proposed in this bill is to move from a Medicare payment system based on volume to one based on bureaucratic measures of quality and value,” Mr. Lee said.

The votes against the bill came from Republicans: Mr. Sessions and Mr. Lee, along with Senators Ted Cruz of Texas, David Perdue of Georgia, Marco Rubio of Florida, Ben Sasse of Nebraska, Tim Scott of South Carolina and Richard C. Shelby of Alabama.

For a few hours on Tuesday, it seemed senators might also be close to an agreement to vote on Mr. Obama’s nomination of Loretta E. Lynch to be attorney general, but the prospect evaporated.

Senator John Cornyn of Texas, the No. 2 Senate Republican, offered a plan to overcome an impasse over abortion restrictions in a sex-trafficking bill, but Democrats quickly rejected it. Republican leaders have held up a vote on Ms. Lynch until the Senate finishes work on the trafficking bill.

Democrats on Tuesday repeated their opposition to the abortion restrictions and denounced the delay of Ms. Lynch’s nomination. “They can stall her for 157 days; she is going to be attorney general of the United States,” said Senator Harry Reid of Nevada, the Democratic leader.

Commenting on the Medicare bill, federal officials welcomed its emphasis on the quality of care but said it would probably not provide a permanent solution.

Paul Spitalnic, the chief actuary of the Medicare program, said the bill could lead to “a payment reduction for most physicians” after 2025. “If not addressed by subsequent legislation,” he said, “we expect that access to and quality of physicians’ services would deteriorate over time for beneficiaries.”