With Nudge By Kennedy, Medicare Bill Passes

By Paul Kane
Washington Post Staff Writer
Thursday, July 10, 2008

Sen. Edward M. Kennedy (D-Mass.) made a dramatic return to the Capitol yesterday to help the Senate pass legislation that would rescind a sharp cut in Medicare payments to physicians.

Kennedy, who underwent surgery June 2 to remove a life-threatening brain tumor, appeared on the Senate floor at 4:15 p.m., the first time in more than seven weeks. He brought the chamber's proceedings to a halt and prompted a standing ovation that lasted several minutes.

The legislation was approved by a veto-proof margin, 69 to 30, after falling one vote shy of passage less than two weeks ago. Kennedy cited that close vote, and his potential to make a difference, as the reason for his reappearance.

Kennedy, who is undergoing chemotherapy at Massachusetts General Hospital in Boston, was ushered into the chamber by longtime friends Sens. Christopher J. Dodd (D-Conn.) and John F. Kerry (D-Mass.). Sen. Barack Obama (D-Ill.), whom Kennedy endorsed in January for the presidential nomination, and Kennedy's son, Rep. Patrick J. Kennedy (D-R.I.), also walked into the chamber with him. Kennedy's appearance brought tears to some colleagues' eyes and pats on the back from both sides of the aisle.

"Aye," a smiling Kennedy bellowed, flashing two thumbs up, when the Medicare issue came up for a vote.

His wife, Vicki Kennedy, and niece Caroline Kennedy were in the VIP section of the chamber's gallery, along with most of the senator's staff. Vicki Kennedy had recently e-mailed friends that the senator's recovery was progressing, but he was not expected to return to the chamber until at least the fall.

"It's great to be back. I love this place," Kennedy said as he left the Capitol. He said the Medicare vote was important, and "I didn't want to miss the opportunity to be able to express my voice and my vote."

Kennedy cast his vote to prevent a 10.6 percent cut in payments to doctors who treat Medicare patients. On June 26, just 59 senators voted in favor of the legislation, which needed 60 votes to overcome Republican objections to the bill. Kennedy was not present for that vote.

The White House has threatened to veto the measure because of provisions written by Democrats that would instead reduce payments to private insurers who participate in an alternative program, Medicare Advantage.

The cuts in that program, which supporters say benefits elderly patients in rural communities, would allow Democrats to postpone the pay cut to doctors for 18 months but would cost the insurers $14 billion over five years.

The House approved the bill June 24 by a 355 to 59 vote. That veto-proof majority prompted Senate Majority Leader Harry M. Reid (D-Nev.) to continue pushing the bill for a vote, even after it fell the vote short 11 days ago.

Yesterday, Vice President Cheney attended a luncheon of Senate Republicans just hours before the vote, speaking against the Medicare legislation and assuring senators that Bush would veto the bill, according to sources familiar with the meeting.

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.

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