What: All Issues : Health Care : Medicare & Medicaid Funding : S 1776. (Medicare reimbursement) Motion to begin debating a bill that would modify the formula that determines how much money Medicare reimburses physicians for various procedures/On the motion (2009 senate Roll Call 325)
 Who: All Members
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S 1776. (Medicare reimbursement) Motion to begin debating a bill that would modify the formula that determines how much money Medicare reimburses physicians for various procedures/On the motion
senate Roll Call 325     Oct 21, 2009
Progressive Position:
Yea
Progressive Result:
Loss
Qualifies as polarizing?
Yes
Is this vote crucial?
Yes

Description: This vote was on whether or not to allow the Senate to begin debating the substance of a bill to set new Medicare reimbursement formulas for physicians.  Republicans had objected to the procedural motion that allows a bill to be called up on the Senate floor (known as a “motion to proceed”), making opening debate on the bill itself impossible.  Much of the Senate’s day to day business depends on the unanimous consent of all members of the Senate in order to proceed.  This makes it easy for just one senator to hold up consideration of a bill, by simply withdrawing their consent for simple motions (such as in this case, where several Republicans objected to the “motion to proceed” to debating the bill).

In an effort to force the Senate to begin debating the bill itself, Democrats called a vote on bringing on this “motion to proceed” to a close.  If the Senate votes to “invoke cloture” – or bring debate to a close – then lawmakers must either hold a vote on the legislation, amendment or motion in question, or move on to other business. This type of motion is most often called on contentious bills, amendments or motions where the leadership is concerned that consideration could be held up indefinitely by a handful of senators.

The bill itself would cancel a 21 percent cut in the amount of money that Medicare reimburses physicians scheduled to take effect next year.  The bill also would scrap the current formula, which has required such cuts since it was enacted in 1997.  The bill is anticipated to cost $245 billion over 10 years.  It was originally included in a larger health care overhaul package Congress is attempting to enact, but the Democratic leadership decided to break the Medicare “doctor fix” out separately into this standalone bill because including it would have pushed the larger health care overhaul bill’s cost to over $1 trillion, which could make it harder to push through to enactment.

Many Republicans support the idea of enacting some sort of “fix” to keep the reimbursement rates from being slashed, but they did not support this particular bill because it doesn’t contain any way to pay for the costs the government would incur.  The Democratic leadership argued that including something to pay for the doctor fix this time was unnecessary because Congress habitually blocks these reductions, which are scheduled to take place each year.

A handful of moderate Democrats agreed with Republicans’ concerns and that is in part why the measure failed in the Senate.

By a vote of 47-53, the motion to close debate on the motion to proceed failed.  Of Democrats present, 46 voted for the motion and 12 voted against it.  Every Republican present voted against the motion.  The end result is that the motion to bring debate to a close on the motion to proceed to the doctor fix bill failed, and as a result the Senate could not bring the measure up on the floor for debate and amendment.  This effectively kills the doctor fix as a separate measure to the overhaul health bill.  This means any additional money for the doctors would have to be included as a part of the oveall health bill.

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