Capitol Hill Report: Doc Fix Fails in Senate...Smoke and Mirrors?

October 26, 2009


By Mike Amery, Legislative Counsel, Federal Affairs, (202) 349-4299,

The mission of the Academy is to be "indispensable to its members." One way the Academy fulfills this mission is by representing of neurology in the halls of Congress. Capitol Hill Report presents regular updates on legislative action and how the AAN ensures that the voice of neurology is heard on Capitol Hill. The Academy's legislative counsel in Washington, DC, Mike Amery, offers weekly updates on advocacy for neurology and neurologic concerns.

For the first time since the flawed Sustainable Growth Rate (SGR) formula started calling for cuts in physician payments, the US Senate took a vote that would have led to the elimination of the formula. Unfortunately, the 47–53 procedural vote to move forward with the Medicare Physician Fairness Act of 2009 (S. 1776) failed to garner the 60 votes required to send this legislation to a full Senate vote.

The physician community had hoped that this vote would reveal who was for and who was against physicians. The overwhelming vote against the motion, including all 40 Senate Republicans and 13 of their Democratic colleagues, did not lead to that result.

The bill was viewed as a "smoke and mirrors" attempt to limit the cost of the overall health reform bill to below $1 trillion over 10 years. The cost of the "doc fix," as it has become to be known, is $245 billion. Including it in the health reform bill would have meant its cresting over the $1 trillion mark. Proponents, including author Sen. Debbie Stabenow (D-MI), argued that Congress will provide a physician fix whether or not health reform passes, so the Senate might as well do it up front. Opponents objected to adding $245 billion to the deficit.

Even though it didn't go our way, I had the good fortune of having some insight of what was going to happen on the Senate vote. I was travelling to the New York State Neurological Society meeting on Saturday, October 17. I got to the gate area in Washington and encountered Senate Minority Leader Mitch McConnell (R-KY). Never willing to pass up an opportunity, I got the chance to talk to him for about health reform and the Academy's perspective for about five minutes.

But that isn't all! A few minutes after our conversation, I looked back and saw McConnell talking to the House Republican Leader John Boehner (R-OH). I went back and got to talk with both Republican leaders at the same time, and even snapped a grainy picture on my PDA.

They were discouraged by the separate vote on the SGR elimination and McConnell predicted it would be defeated because it wasn't paid for. "Everyone supports the doc fix," said Boehner. "We just have to find a way to pay for it." A little while later, they boarded the plane, well before anyone else was allowed on.

With the failure of S. 1776 to move forward, House and Senate leaders are in the process of combining reform bills that have passed separate committees on each side of the Capitol. Once they have completed this process, the bills will be ready for floor action in both bodies. The Academy continues to work to ensure that physicians do not receive a 21 percent Medicare reimbursement cut on January 1 and also will attempt to amend any health reform bills to ensure that neurology is eligible for bonus payments to physicians who primarily provide cognitive care. To help support this effort, please use the Academy's online advocacy program, Vocus, to contact your members of Congress.

Read all of Mike Amery's reports on the Capitol Hill Report page.