By Michael Abramowitz and Paul Kane
President Bush sought to block a bill yesterday aimed at forestalling an 11 percent cut in payments to doctors taking care of Medicare patients, but Congress quickly overrode his veto.
The House voted 383 to 41 to override the veto, while the Senate voted 70 to 26, in both cases far more than the two-thirds necessary to block the president's action.
With organized medicine and other lobbies promoting the popular measure in an election year, Republicans broke heavily from the White House. A total of 153 House Republicans voted to defy the White House, 24 more than in a June 24 vote that started the momentum toward passage of the Medicare doctors' bill yesterday. Twenty-one Senate Republicans voted for the bill this time, including four senators who had voted 'nay' in the two previous Medicare votes.
The Medicare bill is the third, along with the recent farm bill and a water resources bill, to become law despite Bush's veto. Overall, Bush has vetoed 12 pieces of legislation during his presidency, including a 'pocket veto' of last year's defense authorization bill.
At issue in this bill was how the government should respond to a planned reduction in Medicare doctors' fees, mandated by a formula that requires the cuts if certain spending targets are not reached. Under the formula, a 10.6 percent cut in fees for doctors was supposed to go into effect July 1, but Congress overwhelmingly voted instead to reduce the reimbursement to insurance companies that serve Medicare beneficiaries under its managed-care program. Those reductions would allow the postponement of the pay cut to doctors for 18 months, but would cost the insurers $14 billion over five years.
Bush said the cuts to insurers would harm the managed-care program, which his administration sees as giving seniors more choices and eventually leading to lower health costs for the federal government.
'I support the primary objective of this legislation, to forestall reductions in physician payments,' Bush said in his veto message. 'Yet taking choices away from seniors to pay physicians is wrong.' He called the bill 'fiscally irresponsible' and charged that it 'would undermine the Medicare prescription drug program.'
But Democrats said their legislation would prevent doctors from fleeing the traditional treatment practices that are used by more than 80 percent of the mostly elderly Medicare patients. They said private insurers were receiving too much funding in the Medicare Advantage program.
'I guess the president is voting with them and not with America's seniors and those with disabilities when he vetoed this bill,' said House Speaker Nancy Pelosi (D-Calif.).
The House and Senate votes followed a large political push by the American Medical Association -- which ran ads in home states and districts of key Republicans -- and AARP, which held a lobbying campaign in which 1.2 million of its activists contacted members of Congress urging the veto override.
Health-care experts said Congress is simply moving the problem down the road, since lawmakers will be confronted within the year with the need to take additional steps or allow a major cut in physician fees.
'This is stopgap Medicare legislation,' said Charles N. 'Chip' Kahn III, president of the Federation of American Hospitals. 'It is not confronting any of the major spending or organizational issues concerning Medicare.'
Yesterday's congressional votes were not as dramatic as the maneuvering that occurred last month over the original legislation. On June 26, Senate Democrats fell one vote short of the 60 needed to pass the measure.
But last Wednesday, Sen. Edward M. Kennedy (D-Mass.) -- recuperating from brain surgery to remove a cancerous tumor -- left Boston after a morning treatment of chemotherapy and radiation at Massachusetts General Hospital to return to the Senate for another Medicare vote. Once his vote assured Democrats of the 60 needed for passage, another nine Republicans switched sides, pushing the margin to a veto-proof 69 votes.