Congress votes to override veto on Medicare bill

WASHINGTON -- Congress on Tuesday rejected President Bush's veto of legislation protecting doctors from a 10.6 percent cut in their reimbursement rates when treating Medicare patients.

The override vote in the House was 383-41, easily meeting the two-thirds threshold needed to nullify the president's veto. About an hour later, the Senate voted to override, 70-26.

Bush has vetoed bills nine times, and Congress has had the muscle to override him only on a water projects bill and twice on farm legislation.

Lawmakers were under pressure from doctors and the elderly patients they serve to void the rate cut, which went into effect July 1. The cut is based on a formula that establishes lower reimbursement rates when Medicare spending levels exceed established targets.

The president said he supported rescinding the pay cut, but he objected to the way lawmakers would finance the plan, largely by reducing spending on private health plans serving the elderly and disabled.

"I support the primary objective of this legislation, to forestall reductions in physician payments," Bush said in a statement. "Yet taking choices away from seniors to pay physicians is wrong."

About 600,000 doctors treat Medicare patients. Many said they would no longer accept new elderly patients if the cuts stood.

Democratic lawmakers used a variety of terms to describe Bush's veto earlier Tuesday. Some called it "meaningless." Others called it "mean-spirited."

"His days of doing us harm are very, very limited," said Rep. Charles Rangel, D-N.Y., the chairman of the House Ways and Means Committee.

Instead of a cut, the legislation would keep Medicare rates for doctors where they are for the rest of 2008 and would increase them by 1.1 percent in 2009. The legislation generates the revenue necessary to pay doctors more by reducing spending on private health insurance plans. Those plans serve more than 9 million people through the Medicare Advantage program.

Insurers and the Bush administration argued the changes Democrats sought would lead to benefit cuts and to fewer Medicare Advantage plans. The Congressional Budget Office estimated that over the course of five years, enrollment in Medicare Advantage would grow to 12 million rather than to 14.3 million.

Bush said the bill would reduce "access, benefits and choices for all beneficiaries."

"We don't have to punish the patients to help the doctors," said Rep. Mike Rogers, R-Mich.

However, Democratic lawmakers and some Republicans believe the government's payments to the plans are too generous and that those payments drive up costs for taxpayers as well as the 44 million participants in the program.

"We wasted no time in reversing the president's carelessness and protecting our nation's doctors and the patients they treat," said Senate Majority Leader Harry Reid, D-Nev. "This responsible and overdue Medicare fix is now law."

Rep. Lloyd Doggett, D-Texas, said the federal government spends more on patients in Medicare Advantage than on comparable patients in traditional Medicare, leading to billions of dollars in additional costs annually.

"We take some of that unnecessary waste and we use it to pay physicians who are working hard and ought not to have a cut in their reimbursement rates," Doggett said.

While the focus on the bill has largely been on changes for doctors and private insurers, virtually every type of health care provider as well as millions of patients have a stake in the legislation.

For Medicare recipients, lawmakers lowered the copayments for mental health treatment and allowed more people to qualify for the government's help in paying their monthly premiums.

For providers, such as pharmacists, the legislation ensured that they're paid promptly by Medicare drug plans and delayed changes that would have cut their reimbursements when dispensing generic drugs for Medicaid patients.

Military families also had a stake as its TRICARE program set reimbursement levels based on Medicare, and lawmakers raised concerns leading up to the vote that those families would have a hard time finding a doctor.

Dr. Nancy H. Nielsen, president of the American Medical Association, said a 10.6 percent cut "would have been devastating to seniors and the disabled who rely on Medicare for the health care they need, as well as to military families who rely on TRICARE for their health care."

Prior to Bush's veto, the House had voted in favor of the bill 355-59, so Tuesday's override vote showed more Republicans breaking with the administration.

The vote in the Senate in passing the bill last week was much closer, 69-30, leaving little margin for error for supporters trying to sustain a two-thirds majority to override.