With Nudge By Kennedy, Medicare Bill Passes

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Raw Video: Ailing Sen. Kennedy Returns to Senate

Sen. Edward M. Kennedy, battling a brain tumor, walked through a wall of applause into the Senate on Wednesday and cast a stunningly unexpected vote on long-stalled Medicare legislation.

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Despite Cheney's lobbying, 18 Republicans supported the measure -- twice as many as last time. All 49 Democrats and both independents voted for it.

Democrats credited Kennedy's vote as the moment when some Republicans realized the bill would be approved, offering them a last chance to side with physicians. "Once we hit 60, it became a lot more," said Senate Majority Whip Richard J. Durbin (D-Ill.).

Kennedy spoke with his doctors this week about making the trip, something they did not encourage or discourage.

"If the doctors had really put their foot down, I don't think he would have made the trip," Dodd said.

Dodd said Kennedy's family hoped to minimize his contact with others because his immune system has been weakened by the treatment. It was a difficult task as dozens of colleagues lined up to greet him. Kennedy returned to Massachusetts immediately after the vote.

Some doctors have stopped taking new Medicare patients until the payment-cut issue is resolved, saying the reductions would make treating the elderly financially impossible.

"These 10 percent cuts, if they go through, if I get called in the middle of the night to the hospital to see a new Medicare patient, I won't do it," said Charles Moss, a vascular surgeon in Hackensack, N.J.

William Rich said his Northern Virginia ophthalmology group just voted to stop taking new Medicare patients. "It's totally untenable for us to take another 10 percent cut," he said. "I'm saddened, and I'm absolutely furious."

Since the initial vote, Republicans had come under intense pressure from the American Medical Association, which aired advertisements in states where such Republicans as Sen. John Cornyn (Tex.), who opposed the provision, were facing reelection. The Texas chapter of the AMA withdrew its endorsement of Cornyn after his first vote. Yesterday, he switched sides.

The Medicare fee reductions are based on a funding formula more than a decade old that requires payment cuts to doctors whenever the growth rate in Medicare costs climbs above the growth in the gross domestic product.

Soaring health-care costs have caused regular payment cuts, but Congress has postponed them. The current reduction took effect July 1, but the government has said it would delay processing claims until early next week.

Staff writers Shailagh Murray and Robin Shulman contributed to this report.