WASHINGTON Senate Democrats closed ranks Thursday behind $460 billion in Medicare cuts at the heart of health-care legislation, thwarting a Republican attempt to reverse the cuts to the popular program for the elderly and disabled.
The bid by Sen. John McCain, R-Ariz., failed on a vote of 58-42 but drew the support of two Democratic lawmakers. Approval would have stripped out money needed to pay for expanding coverage to tens of millions of uninsured Americans.
Democratic Sens. Blanche Lincoln and Mark Pryor of Arkansas voted against the McCain measure, which if approved would have stopped the legislation in its tracks, requiring work to begin anew.
The broader legislation aims to extend health coverage to 31 million who now lack it, while barring insurance industry practices such as denying coverage to people on the basis of pre-existing medical conditions. Though the overhaul is estimated to cost $1 trillion over a decade, the Congressional Budget Office has said it would cut federal deficits by $130 billion over that period and probably reduce them further in the 10 years beyond that.
“Our bill does nothing to reduce guaranteed Medicare benefits,” said Sen. Max Baucus, D-Mont., as several fellow Democrats accused Republican critics of making false claims of potential harm during three days of debate.
The AARP supported the 10-year package of cuts in projected spending. The Democrats’ decision pares subsidies to private Medicare plans as well as payments to hospitals, hospices, home-health agencies and other providers.
Republicans defended their position vigorously. “Medicare is already in trouble. The program needs to be fixed, not raided to create another new government program,” said the minority leader, Sen. Mitch McConnell of Kentucky.
Democrats responded with an alternative that stated that no guaranteed benefits would be cut from the program and that itsfinances would be strengthened.
The lead proponent of that provision was Sen. Michael Bennet of Colorado, who was appointed to his seat earlier in the year and faces a difficult campaign in 2010. “This is a message amendment,” his office informed fellow Democrats in an e-mail unintended for publication.
The bill “does not take away any seniors’ guaranteed Medicare benefits,” Bennet said on the Senate floor. “We know that the bill extends Medicare solvency for five additional years.” It passed 100-0.
McCain made a recording to be telephoned automatically to thousands of voters in states represented by Democrats, urging the deletion of the Medicare cuts. The calls were paid for by the National Republican Senatorial Committee and took aim at Bennet as well as Lincoln, who is seeking a new term next year, and Ben Nelson of Nebraska.
Nelson and Sen. Jim Webb of Virginia were the only Democrats to support Mc-Cain’s proposal.
Republicans said the proposed cuts to health insurance plans and medical providers mean senior citizens in the popular Medicare Advantage program will lose benefits. And they predicted that lawmakers will ultimately back away from the cuts, once senior citizens start feeling the brunt.
Congress frequently plans cuts to Medicare, scheduled for years in the future, but the cuts rarely take effect because lawmakers intervene.
“They do it all the time,” said David Brady, a Stanford University Graduate School of Business political economy professor and senior fellow at the Hoover Institution. “It’s quite frequent. They do it almost yearly.”
Most recently, the House voted Nov. 19 to spend $210 billion over 10 years to overhaul a 1997 budget mechanism intended to control payments to doctors under Medicare. The House plan would create a formula that would boost doctors’ payments by 1.2 percent next year instead of the 21 percent reduction now scheduled to take effect.
The plan has the support of the Obama administration, but the Senate blocked a similar measure in October.
The budget mechanism was created by President Bill Clinton’s 1997 balanced-budget plan and aimed to control Medicare spending by automatically cutting payments to doctors if costs exceeded predetermined levels. Lawmakers allowed payment cuts to take place just once, in 2002.
Since then, lawmakers have intervened each year to boost payment rates to prevent doctors from leaving the program. As a result, the scheduled cuts have accumulated so that unless Congress acts, payments would be cut next year by 21 percent.
Thursday’s Medicare vote came not long after the Senate backed a guarantee for all insured women age 40 and older to receive mammograms with no out-of-pocket costs. The breast cancer screening test would be included in an array of preventive measures that insurance plans would be required to cover.
The proposal cleared on a near party-line vote of 61-39,one more than the 60 needed for passage. It essentially wiped out a federal advisory committee recommendation to defer routine mammograms until women reach the age of 50.
Lincoln and Pryor backed the proposal. Two Democratic senators voted against it - Russ Feingold of Wisconsin and Nelson.
The measure was saved by three Republicans voting in favor - Olympia Snowe and Susan Collins of Maine and David Vitter of Louisiana.
The proposal, long backed by Sen. Barbara Mikulski, DMd., requires the government to develop a list of tests to be covered at no additional cost to the patients.
On Wednesday, Vitter made it explicit that mammograms would be covered for women at age 40.
More broadly, Sen. Lisa Murkowski, R-Alaska, backed an alternative that gave GOP senators opposed to the Democratic proposal a measure they could support. It urged the insurance industry to consult with medical experts in deciding what preventive tests to provide. But it provided no government guarantee that any would be required, did not rule out copays for patients undergoing the procedures, and would have wiped out a list of free tests for men and women that Democrats wrote into their legislation.
It failed on a vote of 59-41 with Nelson siding with the Republicans.
Republicans have accused Democrats for months of supporting a federal takeover of health care. Murkowski shelved an earlier draft of her amendment that would have given the government authority to require additional preventive tests and raised the cost of the bill by $30 billion over a decade. One Republican said conservatives objected, forcing the switch.
The day’s votes were the first since the Senate’s healthcare debate began Monday.
At the same time, Democrats worked in private meetings to settle controversies within the party that are still standing in the way of the bill’s passage. The most contentious of these involves proposals for the government to sell insurance in competition with private companies, an approach supported by liberals but opposed by most Democratic moderates and conservatives.
“Our caucus is now in the process of negotiating with ourselves because we need all 60 of us to get this done,” said Sen. Mary Landrieu, DLa., after one closed meeting. Senate procedures require 60 votes to overcome Republican delaying tactics designed to kill the bill.
Senate Majority Leader Harry Reid, D-Nev., said he expected all such issues to be worked out soon, but he did not specify precisely when.
Information for this article was contributed by David Espo, Ricardo Alonso-Zaldivar and Erica Werner of The Associated Press; by Brian Faler, Laura Litvan, Kristin Jensen and Heidi Przybyla of Bloomberg News; and by Arkansas Democrat-Gazette staff.