Democrats struggle to line up votes on bill containing 'doc fix,' COBRA subsidy extension

A jobs and benefits bill that would extend subsidies to help laid-off workers keep their health insurance and would avert payment cuts to Medicare doctors is still pending in Congress. 

Roll Call: "Democratic infighting could put the blame for inaction squarely on the majority's back. Unless Democratic leaders can get their act together quickly, unemployment benefits will expire while Congress is on its weeklong Memorial Day recess. On Tuesday, House and Senate Democratic leaders were still struggling to find the votes to pass a nearly $200 billion tax extenders bill that happens to include the latest extension of unemployment benefits. That extension would last until the end of the year." Many say the bill is too expensive and Democratic defections are "piling up" (Pierce and Dennis, 5/25).

CongressDaily: Democrats may have to scale back the package to win votes, including shortening the "doc fix" — which would avert a 21 percent reduction in payments to doctors who serve Medicare patients scheduled for June 1 — to win votes. "House Majority Leader Hoyer confirmed that there were last-resort options, such as a one-month extension of expiring programs. Among the biggest issues for the House was their old enemy: the Senate. 'They don't understand that we don't have 60 votes over here,' acknowledged Senate Health, Education, Labor and Pensions Chairman Tom Harkin." If lawmakers decide to extend the Medicare doctor fix through only the end of the year, it could save $57 billion in cost in the bill's score. "But House Energy and Commerce Chairman Henry Waxman said putting off the problem just makes a permanent fix more expensive later" (Cohn, 5/26).

The Washington Post reports that neither side is happy at the moment. Some Republicans are saying the expansions of jobless benefits "encourage people to spend a longer time looking for a new job and therefore increase the unemployment rate." Some Democrats "are expressing concerns about the growth of the federal budget deficit."

"Liberals, meanwhile, want Congress to pay for a New Deal-style program in which the federal government would send money to states and localities, which would then directly hire people" (Bacon, 5/26).

The Hill: "Senate Budget Committee Chairman Kent Conrad (D-N.D.) and others in his party want to reduce the bill's price tag by changing the 'doc fix,' which at $65 billion accounts for nearly a third of the tax bill's cost." Conrad would like to trim $27 billion from the cost by instituting a two-year freeze on the scheduled Medicare cut instead of a three-and-a-half year one. "House leaders on Tuesday showed no signs they're willing to pare down the extenders package or the Medicare payment fix" (Heflin and Pecquet, 5/25).

Modern Healthcare: Senate Majority Leader Harry Reid said he expects the Senate to get the bill Wednesday. "Under [the Medicare payment] measure, physicians would see a pay increase of 1.3% through the balance of 2010 and another 1% in 2011. After that, the [formula for figuring physician payments, called the "Sustainable Growth Rate"] baseline would be set at zero even though doctors are likely to see some level of update under a restructured formula for 2013 and 2014. When asked if Democrats are considering refiguring that measure or finding a way to pay for it, Sen. Claire McCaskill (D-Mo.) said, 'Both'" (DoBias, 5/25).

The Wall Street Journal: Conrad said the jobless benefits and COBRA subsidy — which pays 65 percent of the cost of health insurance for laid-off workers who remain on their former employer's plan — "are justifiably considered emergency spending and shouldn't have to be paid for by savings elsewhere in the budget. ... If a moderate and influential Democrat such as Mr. Conrad is publicly expressing misgivings about the legislation, it could be difficult for Senate Democratic leaders to corral the necessary 60 votes to pass the measure" (Boles, 5/25).