Senators were surprised to see Sen. Edward Kennedy (D-MA) return to the Senate floor for a pivotal Medicare vote Wednesday afternoon. They were even more surprised minutes later, when a bill that just days earlier seemed mired in partisan limbo passed by a veto-proof 69-30 margin.
Kennedy's unexpected appearance was just the latest twist in the saga of a Medicare bill that has defied predictions at every turn.
Almost until the vote was over, it seemed that Kennedy's was the vote that would send President Bush the bill to cancel a 10.6 percent pay cut to doctors that officially took effect July 1. Then Republicans started to change their votes — "lots of Republicans who said they weren't going to change their mind at the last minute. I mean, this was a stampede at the end," said health policy analyst Robert Laszewski.
Laszewski, who consults for health insurance companies, says passage of the bill is significant not just because it cancels the cut for doctors, but because of how the bill is paid for — by trimming payments to private insurance plans that serve Medicare patients.
"Democrats used the impending 10.6 percent cut to accomplish something I think that they would consider more important — and that is to begin to stem the tide against the expansion of private Medicare," he said.
Indeed, Republicans and Democrats always agreed that doctors shouldn't have their Medicare pay cut. But they were divided over where to get the money. Democrats, like Sen. Dick Durbin of Illinois, say the private plans are an obvious target because they are already getting overpaid by Medicare.
"We believe that they can cut back on their profits. They can reduce their costs. And they can still help seniors," Durbin said during the Senate debate Wednesday.
But Republicans, like Utah's Orrin Hatch, have steadfastly refused to cut the private plan program, known as Medicare Advantage.
"We finally figured out how to provide choice to Medicare beneficiaries in both rural and urban areas and how to pay plans appropriately. But my friends on the other side cannot leave a good thing alone and insist on making changes to a program that is working very well today," Hatch said.
The bill passed the House two weeks ago by an overwhelming 355-59 margin; far more than the number needed to override the veto threatened by President Bush. But when it got to the Senate, Republicans refused to go along. There, it fell one vote short of the 60 required to move to a final vote.
Enter the American Medical Association. It was the nation's biggest independent spender on television last week, with ads targeting Republicans who voted against the bill. One of the ads intoned over pictures of seniors that "a group of U.S. senators voted to protect the powerful insurance companies at the expense of Medicare patients' access to doctors."
It was clear from the debate that at least some senators had been rattled by the campaign. One was Texas Republican John Cornyn. After he voted against the bill, the Texas Medical Association unceremoniously yanked its support for his re-election campaign. Cornyn tried to make it up by offering a bill to fix doctors' Medicare problems not just this year, but into the future.
Senate Finance Committee Chairman Max Baucus (D-MT) quickly batted Cornyn down, calling Cornyn's bill "a big warm kiss on doctors to show to them they love doctors when in fact this is going nowhere."
But it was still unclear as of Tuesday whether any Republicans would switch their votes, leaving Democrats still one vote short of the 60 needed to get the measure to President Bush. So Kennedy called Senate Majority Leader Harry Reid on Tuesday night, volunteering to fly back to Washington for the vote.
In the end, it turned out, Kennedy's vote wasn't strictly necessary. Nine Republicans switched from no to yes, joining the nine who voted for the bill the first time. The final tally was a veto-proof 69-30, with only Republican John McCain noticeably absent.
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