The U.S. Senate on Tuesday fell short of the 60 votes necessary to begin debate on S 1776 by Sen. Debbie Stabenow (D-Mich.) [PDF], the "Medicare Physician Fairness act of 2009." The motion failed on a vote of 47-53. Both senators from Texas – John Cornyn and Kay Bailey Hutchison – voted "no" along with all of their Republican colleagues and numerous Democrats in a roll-call vote whose outcome was known even before it began.
The bill would have repealed the SGR formula [PDF] and eliminated the $245 billion debt that has accumulated under the current payment system [PDF] and driven down physicians' Medicare payments year after year. It also would have stopped the planned 21-percent cut in fees scheduled for Jan. 1, eliminated the $245 billion debt that has accumulated under the SGR, and laid the foundation for a new Medicare payment update system. Under this bill, physicians over the next decade would have received a zero-percent update, but it would have been the first step in the process of working to get a fair payment system. Until we can eliminate the SGR and the accumulated debt, we have no hope of getting a positive update system.
There is widespread agreement among Republicans and Democrats that the formula is broken and must be repealed. Shortly after Tuesday's vote, Senate Majority Leader Harry Reid (D-Nev.) said he will bring up a bill to freeze physicians' Medicare payments for one year after Congress passes broader health system reform. Congress has placed such temporary Band-Aids on the broken SGR formula in the past. Those actions have not only delayed our path to a reasonable Medicare payment system, but also created the deep $245 billion debt that is now one of the principal obstacles to permanent reform.
TMA's focus has been clear: We need a rational Medicare physician payment system that automatically keeps up with the cost of running a practice and is backed by a stable funding source. Although S 1776 would not have provided such a solution, it was the only legislative vehicle that would have eliminated the $245 billion debt. Every year that passes without elimination of the SGR brings about the potential for even deeper cuts the following year.
We are extremely grateful for the hundreds of physicians, medical students, alliance members, and patients who contacted Senators Hutchison and Cornyn and asked them to support S 1776. Strong and continued grassroots action will be absolutely essential if we are to make any progress on this seemingly intractable issue or if we are to have productive input on the continuing congressional health care debates.
William H. Fleming III, MD
Texas Medical Association
TMA's Medicare Meltdown Action Center