Medical Device Daily Washington Editor

The healthcare reform drumbeat goes on with the announcement Wednesday that the a bill designed to address the accumulated cuts in Medicare reimbursement to doctors went down in a vote that suggests that some Senate Democrats are becoming unnerved by accumulating federal deficits.

The bill, titled the Medicare Physicians Fairness Act of 2009 (S. 1776), would have wiped out cuts to physician reimbursement under Part B that have been growing for a decade under the sustainable growth rate (SGR) mechanism imposed by Congress in 1999. The current backlog of cuts to physician payments would remove roughly 21% from aggregate physician reimbursement in January, which Congress is virtually certain to prevent.

S. 1776 would have cost $247 billion over 10 years and was offered as a solo piece of legislation, a move decried by critics as a fiscal smokescreen in the healthcare reform debate while supporters argue that SGR has been an ongoing issue and should be dealt with separately.

Among the dozen Senate Democrats who voted against S. 1776 are Kent Conrad (North Dakota), chairman of the Senate Budget Committee, as well as Evan Bayh (Indiana), Russell Feingold (Wisconsin) and Claire McCaskill (Missouri). Ron Wyden (Oregon), who has been a vocal player in the healthcare reform debate, also voted against the bill. S. 1776 died on a 53-47 procedural vote.

Senate minority leader Mitch McConnell (R-Kentucky) was quoted in the New York Times as saying that the outcome may augur increasing opposition to the healthcare reform bills now in play. "In the Senate's first vote on healthcare spending this year, a bipartisan majority rejected the Democrat leadership's attempt to add another quarter trillion dollars to the national credit card without any plan to pay for it," McConnell said. He also made reference to palpable voter angst over the deficit in remarking that the vote "shows that this message is finally starting to get through to Congress."

According to an Oct. 21 statement issued by the House Energy and Commerce Committee, members of the House leadership issued a statement asserting that the "doc fix" issue is not over yet.

The House Democrats who signed the statement vow that the House "remains committed to a permanent reform in Medicare physician payments," arguing that "fair payment and strong physician participation are essential for the stability of Medicare" and essential to "access to care for its beneficiaries."

The group, which includes House Speaker Nancy Pelosi (D-California) and majority whip Steny Hoyer (D-Maryland), state also that while they "are disappointed in the Senate vote, the House remains strongly committed to addressing this critical issue, while respecting the commitment to statutory 'pay-go' outlined in a letter earlier this year from the Speaker and the Leader." They close the statement with the observation that they are "confident that we will enact the payment reform this year." Also signing the statement were Energy and Commerce Committee chairman Henry Waxman (D-California) and Charles Rangel (D-New York), chair of the Ways and Means Committee.

House E&C passes Markey isotope bill

Also on Wednesday, the House Energy and Commerce Committee passed H.R. 3276, dubbed the American Medical Isotopes Production Act. Drafted by Rep. Ed Markey (D-Massachusetts), the bill is designed to simultaneously reduce the use of high-enriched uranium (HEU) in U.S. nuclear facilities and expand the availability of technetium-99 (Tc-99), a radioisotope of great importance to modern medicine.

The bill got a brief workout in committee last month (Medical Device Daily, Sept. 11, 2009), but some observers remain concerned that the objective of ending domestic use of HEU in seven years may prove unrealistic. Tc-99 has been in short supply due to the recent closures – temporary or otherwise – of several reactors in Canada and the Netherlands that had supplied a major portion of U.S. needs. The isotope is processed from molybdenum-99, which is a byproduct of the decay of uranium used in nuclear power electrical generators. The issue of HEU in these plants is seen as part of a larger effort to stem the proliferation of nuclear weapons in other nations.

Among the supporters of the bill is the Society of Nuclear Medicine (SNM; Reston, Virginia), which e-mailed a statement to Medical Device Daily. Robert Atcher, PhD, chairman of SNM's domestic isotope taskforce, said SNM "is highly supportive of H.R. 3276," and that the association "has been working with Rep. Markey's office to ensure that patients continue to receive access to critical medical isotopes."

Atcher adds that SNM has "been very impressed by how willing Rep. Markey and his staff are to work with the medical community" and notes Markey's "strong interactions with the business community, which we believe has helped them establish reasonable timelines to make a domestic isotope supply a reality." Atcher also said SNM "is encouraging its members to support this bill through letters, emails and calls to their representatives in Congress."

Mark McCarty, 703-268-5690

mark.mccarty@ahcmedia.com