President's Veto on Medicare Overridden

On July 16, 2008, National Public Radio reported in a broadcast segment entitled "Congress Overrides Bush Veto On Medicare Bill" by Julie Rovner, that "President Bush's veto of a Medicare bill didn't survive Congress".

The House and Senate were able to easily override his attempt to strike down a bill that protects doctors from a more than 10 percent cut in their Medicare reimbursement rates. It was the third veto override of the Bush presidency.

The legislation vetoed was H.B. 6331, the "Medicare Improvements Patients and Providers Act of 2008."

On July 12, 2008, Julie Rovner & Andrea Seabrook had reported in another NPR broadcast "Medicare Bill Passes Despite Veto Threat" that provided more background and links to prior reports.

Congress this week passed — by a veto-proof margin — legislation to cancel a 10.6 percent pay cut to doctors who care for Medicare patients.

But President Bush says he'll veto it anyway, because the bill also reduces funding to private insurance plans that participate in Medicare. * * *

President Bush's Message to the House of Representatives, dated July 15, 2008, relaying his veto, recited his reasons:

I am returning herewith without my approval H.R. 6331, the "Medicare Improvements for Patients and Providers Act of 2008." I support the primary objective of this legislation, to forestall reductions in physician payments. Yet taking choices away from seniors to pay physicians is wrong. This bill is objectionable, and I am vetoing it because:

• It would harm beneficiaries by taking private health plan options away from them; already more than 9.6 million beneficiaries, many of whom are considered lower-income, have chosen to join a Medicare Advantage (MA) plan, and it is estimated that this bill would decrease MA enrollment by about 2.3 million individuals in 2013 relative to the program's current baseline;


• It would undermine the Medicare prescription drug program, which today is effectively providing coverage to 32 million beneficiaries directly through competitive private plans or through Medicare-subsidized retirement plans; and


• It is fiscally irresponsible, and it would imperil the long-term fiscal soundness of Medicare by using short-term budget gimmicks that do not solve the problem; the result would be a steep and unrealistic payment cut for physicians -- roughly 20 percent in 2010 -- likely leading to yet another expensive temporary fix; and the bill would also perpetuate wasteful overpayments to medical equipment suppliers. * * *
  

The lobbying effort to overturn the veto was substantial -- by AARP (see "AARP Makes Medicare Override A "Key Vote" - Association Will Report Roll Calls To Its 39 Million Members", July 16, 2008), by the American Medical Association (see "Congress hears patient and physician voices and overrides presidential veto to stop Medicare physician payment cuts ", July 15, 2008), and by the American Public Health Association (see "APHA Applauds Congressional Override of Medicare Veto", July 15, 2008), among many other groups.

Nancy H. Nielsen, MD, the President of the AMA -- perhaps the group most affected by the cuts in Medicare payments -- issued a statement after the veto was overridden by Congress:

"The 10.6 percent cut in payments to physicians who treat Medicare patients 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.

"This congressional debate underscores the need for lawmakers to permanently replace the flawed Medicare physician payment formula so physicians can focus on the real work at hand: taking care of patients.

"We are encouraged that this bill stops Medicare cuts for the next 18 months and gives physicians a 1.1 percent payment update to help payments keep up with the increasing cost of providing health care to seniors. Current Medicare payments to physicians are about what they were in 2001, while the cost of running a medical practice has increased substantially.

"The bill contains a number of other important provisions, including an extension of expiring provisions that boost payments in rural areas, bonuses for quality reporting, a phase-out of higher co-pays for mental health services, an expansion of the medical home demonstration project and increased payments for anesthesia teaching programs.

"Along with the AMA, many patient, physician, and military groups called on Congress to pass this bipartisan bill. The only group opposing the bill was the health insurance lobby, which was eager to protect health plan subsidies and profits. Seniors, the disabled, and military families celebrate with us today as this bill becomes law to protect their access to needed health care."

One politician, the Speaker of the House, Nancy Polosi, was quoted in a news report entitled "With Override of President's Veto, Congress Will Strengthen Medicare for America's Seniors" regarding the bi-partisan support for the override.

"All of the seniors' organizations, disabilities groups, of course, support this legislation. But just about every health care providing group in our country supports this legislation as well.

Except one, and that is some in the health insurance industry and I guess the President is voting with them and not with America's seniors and those with disabilities when he vetoed the bill.* * *

This is a stunning display of the political power of health care providers and elder advocates. But it does not solve the long-term concerns for a viable health care system in America.