Senate Vote on Doctor Fees Carries Risks for McCain (Update1)

By Aliza Marcus

July 9 (Bloomberg) -- Senator John McCain will be on the spot, even in his absence, when the Senate takes up a measure today to halt a cut in Medicare payments to doctors.

Republicans have stalled Democratic-backed legislation to reverse the 10.6 percent cut in doctors' fees by reducing payments to insurance companies instead. Democrats on June 26 fell one senator short of the 60 they will need to force a floor vote. Two were absent: Edward Kennedy, a Democrat from Massachusetts who is being treated for brain cancer, and McCain of Arizona, the presumptive Republican presidential nominee.

For McCain, who campaigned in Ohio today and said he would have voted with the Republicans, today's vote posed a political dilemma.

``In one case McCain could be voting against his party and in the other he could be voting against an issue framed as pro- senior and pro-physician,'' Robert Blendon, a health policy professor at Harvard University's School of Public Health in Boston, said in a telephone interview yesterday.

Republicans and Democrats are fighting over how to block the cut in fees that took effect July 1 for doctors who treat patients under Medicare, the U.S. health program for the elderly and disabled. Democrats say the money should come from reducing payments to private insurers that provide care through Medicare Advantage plans. Republicans object, saying insurers would be forced to pare back benefits they provide to senior citizens.

House Approved

The House approved the Democratic proposal on June 24 with enough Republican support to override President George W. Bush's threatened veto. It stalled in the Senate, with Republicans blocking a motion to cut off debate and take up the measure. Senator Barack Obama of Illinois, the presumptive Democratic presidential nominee, voted for the legislation.

McCain, asked today about the Democratic-backed measure, said, ``I would have voted against it.''

McCain's staff this week tried to walk a delicate line in discussing the Medicare dispute.

``John McCain is disappointed that the physician-payment legislation became a vehicle for partisan rhetoric in an election year at the risk of millions of our seniors,'' said Douglas Holtz-Eakin, McCain's economic adviser, in an e-mailed statement. ``This failure is a clear example of what's wrong with Washington -- partisan bickering that promotes rhetoric over real solutions for the American people.''

Democrats said they will blame McCain if the Medicare measure falls short again today.

``I hope he's for Medicare,'' Senator Dick Durbin of Illinois, the deputy Democratic leader, said on the Senate floor yesterday. ``It's time for Senator McCain to make his position clear and return to the Senate for this critically important vote.''

McCain's Goal

McCain, 71, wants Congress to come up with a bipartisan agreement to ensure funding for physicians while ``promoting choice'' in Medicare, Holtz-Eakin said.

Medicare Advantage plans offered by insurers, promoted as an alternative to conventional Medicare, are paid on average 13 percent more than it costs the government to provide benefits directly.

McCain's failure to endorse the Democratic-backed legislation may hurt him with swing voters, said Democratic pollster Celinda Lake, president of Lake Research Partners, based in Washington. She cited especially older, non-college educated women, who she said are strongly pro-Medicare and are ambivalent about the Republican candidate.

``Opposing the bill isn't popular with anybody, but you particularly don't want to get between seniors and their doctors,'' Lake said.

AMA Ads

The American Medical Association is running television commercials in six states whose Republican senators opposed the measure, although not in McCain's home state, urging action to reverse the fee cut.

Republicans have proposed a temporary measure to halt the doctor-fee cuts for 30 days, giving Congress time to find a compromise on reimbursements. Democrats say that a short-term ``fix'' would be too complicated and wouldn't resolve the issue. The 10.6 percent cut was required under a complex formula Congress passed a decade ago to hold down spending.

AARP, the largest association representing people ages 50 and older, has sent letters thanking senators who voted for the Democratic measure and calling on those who opposed it to reconsider. The organization is reminding senators, including McCain, that this is an important vote they should make, said James Dau, an AARP spokesman, in an interview yesterday.

McCain has always said that he would return from campaigning for Senate votes if his presence would make a difference, said Robert Fischer, his Senate spokesman.

To contact the reporter on this story: Aliza Marcus in Washington at amarcus8@bloomberg.net

Last Updated: July 9, 2008 16:10 EDT

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