ObamaCare Test Vote Delayed?
posted at 12:16 am on October 19, 2009 by Karl
Sen. Maj. Ldr. Harry Reid’s attempt to fast-track changes to the Medicare sustainable growth rate (SGR) formula, off-budget and (ostensibly) separate from ObamaCare, was set for a cloture vote today, but has been delayed following objections from both the GOP and moderate Dems. Republicans want the Democrats to pay for the $248 billion (and maybe twice as much) price tag for the doctors’ fix.
Oddly enough, this position is also espoused by White House Senior Adviser David Axelrod:
“Every year, draconian cuts are proposed for doctors that would have a deleterious effect on patients,” the senior adviser told ABC’s This Week. “And every year, the Congress acts on it and defers on that. And the fact is, it’s a charade.”
“Everyone in the Congress knows they’re not going to let that go forward. All that we’re saying here is, let’s be honest about it. The president provided for it in his budgets, and we ought to acknowledge that this is a — this is an ongoing expense that we’ll have to meet,” he added.
Axelrod presumably wants this done to keep the American Medical Association on board with ObamaCare — but will it? If the AMA gets what it wants in a separate bill, that should be less reason to support ObamaCare, unless there is a back room quid pro quo involved. As Allahpundit would say, “Hmmmmmmmm…”
Sen. Orrin Hatch (R-UT) was right to complain that the separate off-budget SGR fix is an attempt to make ObamaCare feasible without deficit spending. However, Hatch also acknowledges the necessity of a fix. The Baucus vapor bill relied on “savings” from the SGR that even Axelrod has to concede were never going to happen, so forcing the SGR fix on-budget is not only good policy, but one that might make the rest of ObamaCare more difficult to finance.
Moreover, in the bigger picture, Reid’s backpedal on the SGR fix may say something about his inability to force his Democratic and Independent colleagues into a fiscally irresponsible vote on healthcare, even when that vote would make one of the nation’s most powerful lobbies very happy. Reid ought to be doing better on the undercard before moving on to the main event.
Blowback
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We had a doctor speak at our 9/12 Tea Party in Gulfport, MS. He declared he was dropping his AMA membership and that colleagues of his were about to do the same. Hmm, sounds similar to the AARP situation.
The AMA does not speak for even a majority of doctors — they do have brand recognition though. And it appears that they can be bought.
GnuBreed on October 19, 2009 at 5:25 AM
Karl,
I know you realize fixing the slashing of the payments to the physicians won’t change the fact that services to Medicare/Medicaid patients will virtually disappear in the Baucus bill.
In addition to the cuts to physician’s services, the other areas that would see cuts the CBO outlined the following areas:
• Permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector (other than physicians’ services)…
• Setting payment rates in the Medicare Advantage program on the basis of the average of the bids submitted by Medicare Advantage plans in each market…
• The proposal also would establish a Medicare Commission, which would be required, under certain circumstances, to recommend changes to the Medicare program to limit the rate of growth in that program’s spending.( Note: it is unqualified how much money the program would lose)
And the area I want to focus on here:
• Reducing Medicare and Medicaid payments to hospitals that serve a large number of low-income patients, known as disproportionate share (DSH) hospitals, by almost $45 billion—composed of roughly $22 billion each from Medicaid and Medicare DSH payments.
DSH are mainly comprised of “County” hospitals or hospitals whose names start with “Saint” – Charity based hospitals. Their mission is to serve the poor and uninsured; many are your level 1-trauma centers in the largest cities or are attached to teaching hospitals. DSH see the poorest, often most complicated difficult cases with little to no compensation from the patients. For instance, Obama’s diabetic patient with a foot problem – in a DSH that patient is also homeless, beaten up by a gang, raped, had a few teeth knocked out, has lice and a rash that hasn’t been identified yet. Frankly, the diabetic neuropathy in the big toe is a little low on the concern list just now. The DSH also often house large maternity/delivery units, Neonatal units, the burn units, and all manner of critical care units.
Payment comes from a combination of local (State & county/city) & federal funding. Nationwide DSH’s federal allotment for fiscal year 2008 was $10,367,561,890.
As we know local revenues have fallen, DSH received a bolus of a billion dollars from the stimulus package to cover these loses – Making the federal allotment $11,337,262,543 for fiscal year 2009.
The Baucus bill wants to cut the DSH allotment by 5% – that’s every year a 5% cut every year. Unemployment is rising. Obama and his policies are failing to stimulate the economy. More & more families will be joining the Medicaid or simply making use of the DSH for services and not paying. Charity hospitals are not a well of unlimited resources. States hardest hit by unemployment will have fewer funds for DSH and a greater pool of clients of those services.
And none of this covers the damage the bill does in other cuts to nursing homes, medical equipment, out patient services, etc for patients on Medicare or Medicaid. It not just the elderly in nursing homes btw, they serve more than the Medicare population.
Something HondaV65 posted yesterday struck me:
I hope Honda is right -that there is a civil war in the party. The people who support this bill, they are Progressives – and what Honda said it’s a struggle for the final gasp of the Democrat party, will they remain any semblance of Democrats or are they truly Progressives? Do they even understand what they have allowed their party to become?
“If however, there is a needy person among you, one of your kinsmen any of your settlements in the land that the L-RD your G-D is giving you, do not harden your heart and shut your hand against your needy kinsmen. …. For there will never cease to be needy ones in your land, which is why I command you: open your hand to the poor and needy kinsmen in your land. Deuteronomy 15.7 – 15.11
batterup on October 19, 2009 at 11:39 AM
Well, that particular “death spiral” (as opposed to the insurer “death spiral” that is also embodied in the Baucus vapor bill) was beyond the topic of the delayed vote on the SGR fix. Rest assured, we’ll get around to that as bills move toward the floor.
But I have written about the fact that it’s primarily Democrats fighting among themselves that is (currently) the biggest obstacle to ObamaCare.
Karl on October 19, 2009 at 11:49 AM
Thank you for linking that – I missed it. I will go read it all.
A coming storm of Death Spirals, all sucking payment out of health care. Sounds like the making of a crisis, don’t ‘cha think?
batterup on October 19, 2009 at 12:22 PM