Medicare gridlock looms

By Mal Leary, Capitol News Service
http://bangornews.com

AUGUSTA, Maine – Because the U.S. Senate has failed to block a decrease of more than 10 percent in Medicare payments to doctors, Maine senior citizens on the federal program could have difficulty finding a physician and doctors face the loss of $50 million over the next 18 months.

“If this doesn’t get fixed, it has huge ramifications for Maine,” Gordon Smith, vice president of the Maine Medical Association, said Monday. “It would be catastrophic. We already have a shortage of physicians; we are looking for 237 doctors to fill vacancies now. Many Maine physicians just would feel that they can’t afford to see Medicare patients if they are going to take a cut of that magnitude.”

While the average cut nationally is 10.6 percent, it will have a greater impact on Maine doctors because of the high number of seniors living in the state, the highest percentage in the country, and because of the complexities of the Medicare reimbursement formula.

Smith said that in York and Cumberland counties, doctors were cut 11.8 percent on July 1, but in the remaining 14 counties the cut was more than 12 percent. The cuts were part of legislation passed last year that were supposed to be “fixed” before they took effect.

There are reports of some specialists in other states refusing to accept any more Medicare patients after the cuts took effect, and Smith expects some Maine doctors will take that step if the gridlock in the Senate continues.

“It will happen in some specialties,” he said. “They can’t afford to take any more patients.”

While there were ads by the American Medical Association in other states over the holiday weekend urging Congress to resolve the problem, Smith said no ads ran in Maine because all members of the congressional delegation have supported legislation that not only would block the decrease in rates but also would increase them by 1.1 percent on Jan. 1, 2009.

“Our delegation has worked hard to resolve this, but the Senate fell short,” he said.

The House passed legislation last month by a vote of 355-59, with Democratic Reps. Tom Allen of the 1st District and Michael Michaud of the 2nd District both supporting the measure. Republican Sens. Olympia Snowe and Susan Collins also have supported attempts to pass the measure.

“It’s caught up in excessive partisanship,” Smith said. “It is a shame to see that the right thing can’t get done even when everybody agrees this cut is inherently unfair and shouldn’t happen.”

Snowe serves on the Senate Finance Committee, which has jurisdiction over Medicare funding. She said the failure to garner the 60 votes in the Senate to move the legislation forward was just one more example of the partisan gridlock that has plagued the Senate this year.

“There is plenty of blame to go around with the leaders of both parties,” she said. “This is one of the issues that we need to get resolved and move forward and stop the game playing in the United States Senate.”

Collins said this session has been the most partisan since she took office in 1997. She agreed with Snowe that both parties are to blame for the gridlock, but she also expressed optimism that the Senate will act swiftly on the Medicare legislation.

“Those cuts can be undone and they certainly need to be undone,” she said. “It is absolutely unacceptable that congress went home without settling this issue.”

Collins said the legislation has broad, bipartisan support and she believes the Senate will pass legislation swiftly.

But Smith said the issue underlying the measure is how the “undoing” of the cuts would be done. The money would come from reducing payments to insurance companies that offer private Medicare Advantage plans to seniors as an alternative to traditional Medicare.

“We have a few offered in Maine, but in some states out West this is a big deal,” he said.

President Bush has threatened to veto the legislation over the Medicare Advantage issue, so Smith said the Senate needs to pass legislation with a vetoproof margin. He said that while the delegation believes there are votes to override a veto, as there was with the farm bill, he is concerned the measure will drag on.

“Payments at the lower rates will start going out next month, and if that happens, it will not be good for Maine doctors,” he said. “It won’t be good for Maine seniors.”

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