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Medicare Bill Passes Despite Veto Threat


While the world remembers a medical pioneer, Washington continues to skirmish over Medicare. It started with a scheduled 10 percent pay cut for doctors. First, the Senate rejected a bill to cancel that pay cut. This week, though, the bill passed. It was a scene. Ted Kennedy flew back from Massachusetts, where he's being treated for a brain tumor for what he thought would be a pivotal vote. Then, nine Republicans changed their votes. That gave the bill veto-proof majorities in both houses. Still, President Bush says he'll veto it, and that means when doctors get their checks this week their pay will be cut.

To make sense of all this, NPR's Julie Rovner is with me now. Hi, Julie.


SEABROOK: Let me make sure I have this straight: everyone, including President Bush agrees that this pay cut for doctors should not happen. Then there are enough votes in Congress to override President Bush's veto and he's still going to veto this anyway? Why?

ROVNER: Well, two words: Medicare Advantage. That is the private plan program under which private insurers are paid by the government to provide Medicare to about 20 percent of Medicare beneficiaries. All the budget analysts say that those plans are being overpaid and this bill would reduce those payments very, very slightly to make up for the physician pay cut. The president doesn't like that and that's why he's vetoing this bill. Actually, the Republicans don't really like it either but they're going along.

SEABROOK: So, why would the Senate Republicans who change their vote, why would they do that?

ROVNER: Well, three words in this case: the American Medical Association. Over the July 4 recess, the AMA launched a blistering ad attack in the states of senators who voted no, particularly but not exclusively senators who are up for reelection. Here's a clip from one of those ads:

(Soundbite of advertisement)

Unidentified Man: Across America, families celebrate our nation's birthday, but there's no celebrating for the millions of seniors, the disabled and military families who will lose their access to health care.

SEABROOK: Military families? Aren't military families covered under a different law than Medicare?

ROVNER: Yes, that's right. Military families are not part of Medicare but this is yet another twist in this story. The pay scales that's used for doctors in Medicare, which covers about 44 million seniors and the disabled, is also used for the Tricare program, which covers about nine million active-duty members in the military and their families. So, if doctors stop taking these patients, which many have threatened to do if the cut actually takes effect for real, you're talking about more than 50 million people who could potentially be affected by this.

SEABROOK: Julie, I think it's really interesting, this Medicare bill. And all the talk about it has been about the issue of paying doctors - how much they'll get paid for their services, the cut in that. But there's a lot more in this bill.

ROVNER: There is and, you know, we've talked about the doctors and we've talked about the private insurance companies and whether they're cut one's pay and or the other's pay. But there are really many more aspects to this bill that no one has really talked about. For instance, assuming that Congress overrides the president's veto, this bill would establish mental health parity for Medicare.

Right now if you get mental health care under Medicare, instead of paying 20 percent of the bill you have to pay 50 percent of the bill. This would change that gradually. And this bill would extend a program that allows people with low incomes to have their Medicare premiums paid. A lot of people with very low incomes have a program that's permanent but this is a program that continues to lapse and Congress has to keep renewing it, and this bill would do that.

And also there was in the Medicare Prescription Drug bill that passed in 2003, there was a kind of inexplicable ban on coverage of minor tranquilizers. They're called Benzodiazepines. And this would…

SEABROOK: That's Xanax, that's Ativan…

ROVNER: Exactly, and…

SEABROOK: …yeah.

ROVNER: …valium. This would actually repeal that. This is something also that people have been working for for quite a long time. So, there are a lot of other things in this bill that nobody has talked about.

SEABROOK: NPR's Julie Rovner. Thanks so much, Julie.

ROVNER: You're welcome. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Andrea Seabrook covers Capitol Hill as NPR's Congressional Correspondent.