Articles On Information: Senate Approves a Bill on Changes to Medicare

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WASHINGTON —  The Senate on Tuesday overwhelmingly approved sweeping changes in the way <a class="meta-classifier" href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicare/index.html?inline=nyt-classifier" title="Recent and archival health news about Medicare.">Medicare</a>
 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.</div>
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The 92-to-8 vote in the Senate, following <a href="http://www.nytimes.com/2015/03/27/us/house-passes-bill-changing-medicare-fee-formula-and-extending-childrens-insurance.html" title="New York Times article">passage in the House</a>
 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.”</div>
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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.</div>
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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.</div>
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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.</div>
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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.”</div>
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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.</div>
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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.”</div>
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“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.”</div>
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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.</div>
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Mr.
 Wyden said the current formula for paying doctors was “horrendously 
flawed” but had “dominated much of the discussion” in the last 18 years.</div>
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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 <a class="meta-classifier" href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/index.html?inline=nyt-classifier" title="Recent and archival health news about health insurance and managed care.">health insurance</a>, and they tried to force Congress to pay for the Medicare bill so it would not increase budget deficits.</div>
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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.</div>
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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 <a class="meta-classifier" href="http://topics.nytimes.com/top/reference/timestopics/subjects/f/federal_budget_us/index.html?inline=nyt-classifier" title="Recent and archival news about the federal budget.">federal budget</a> deficits.</div>
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“This bill is not paid for,” said Senator Jeff Sessions, Republican of Alabama.</div>
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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, <a class="meta-classifier" href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/nursing_homes/index.html?inline=nyt-classifier" title="Recent and archival health news about nursing homes.">nursing homes</a> and home health agencies.</div>
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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.”</div>
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“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.</div>
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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.</div>
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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.</div>
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Senator John Cornyn of Texas, the No. 2 Senate Republican, offered a plan to overcome an impasse over <a class="meta-classifier" href="http://health.nytimes.com/health/guides/surgery/abortion/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Abortion.">abortion</a>
 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.</div>
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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.</div>
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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.</div>
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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.”</div>
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