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Congress faces fights over Medicare

By Alan Fram


Racing the calendar, Senate leaders are pushing toward congressional approval of a bipartisan compromise that reshapes how Medicare pays physicians as lawmakers return from a spring break tangled up in domestic and foreign policy disputes.

Republican and Democratic senators are trying to influence an emerging nuclear deal with Iran, and there’s a fight over abortion. Also, President Barack Obama is awaiting Senate action on his long-delayed nomination of federal prosecutor Loretta Lynch to become attorney general.

For Senate Democrats, the two-week break proved tumultuous.

Minority Leader Harry Reid, D-Nev., announced he will not run for re-election in 2016. Reid anointed Sen. Chuck Schumer, D-N.Y., to succeed him, creating uncertainty over the rest of their leadership posts.

New Jersey Sen. Bob Menendez was indicted on federal corruption charges and relinquished his job as top Democrat on the Senate Foreign Relations Committee, just as it plays a pivotal role on Iran.

The Medicare doctors’ legislation presents Senate Majority Leader Mitch McConnell, R-Ky., with his most pressing problem. The $214 billion package would permanently retool how Medicare reimburses physicians and it also would provide money for children’s health, community health centers, low-income patients and rural hospitals.

The normally divided House rallied behind the measure last month with a 392-37 vote. Eager to signal that Republicans now running the Senate can do so effectively, McConnell said the bill would be handled “very quickly” when lawmakers return and he envisioned passage “by a very large majority.”

The measure would block a 21 percent cut in physicians’ Medicare reimbursements that technically took effect April 1. By law, the federal agency that writes those checks can’t do so until 14 days after it receives a claim, and it plans to start making payments at the lower rate on Wednesday. The federal Centers for Medicare and Medicaid Services makes roughly 4 million Medicare payments to doctors daily.

The Senate returns to work Monday, which gives leaders two days to finish the bill or risk fielding complaints from physicians and seniors. Doctors say payment cuts make them less likely to treat patients of Medicare, which helps the elderly pay medical bills.

McConnell’s biggest problem is that senators from both parties are clamoring to amend the legislation, which was a rare compromise between House Speaker John Boehner, R-Ohio, and House Democratic leader Nancy Pelosi of California.

Congressional aides and lobbyists say conservatives, including GOP Sens. Jeff Sessions of Alabama, Ben Sasse of Nebraska, and Mike Lee of Utah, want to require savings so the measure will not add a projected $141 billion to federal deficits over the coming decade.

Democrats, including Sen. Ron Wyden of Oregon, want to expand the bill’s two years of extra money for the Children’s Health Insurance Program to four years and offer other amendments, though Wyden said Thursday he would support the measure without changes.

Leaders were hoping to avoid votes on any amendments, and the chances that any would pass seemed small. Any changes would return the measure to the House, where its fate would be uncertain.

On Tuesday, the Senate Foreign Relations Committee takes center stage, debating whether a push by lawmakers of both parties to influence a potential deal curbing Iran’s nuclear program will hamper negotiations among Tehran, the U.S. and other world powers.

The committee plans to vote on legislation by the chairman, Sen. Bob Corker, R-Tenn., and Menendez that for 60 days would block Obama from waiving Iran sanctions imposed by Congress. The White House wants lawmakers to hold off until the June 30 deadline for a nuclear deal passes.

Iran says its program is for civilian purposes, but the U.S. and other countries suspect it is developing nuclear weapons.

The Senate also is trying to settle a dispute over legislation cracking down on sex trafficking. Democrats are blocking action because they say the bill would toughen restrictions on abortions. Efforts to reach a compromise have fallen short for weeks.

Lynch’s nomination as attorney general is backed up behind the trafficking legislation. McConnell says the bill must be cleared before he will hold a confirmation vote. Lynch appears to have a narrow majority in her quest to succeed Attorney General Eric Holder and become the first black woman to hold the job.

The chairmen of the House and Senate Budget committees said formal negotiations to resolve disputes over defense spending and complete a compromise budget-balancing plan could start this week. A deal is crucial because it would let Republicans send filibuster-proof legislation repealing Obama’s 2010 health care law to his desk later this year.

With the tax-filing deadline Wednesday, the House plans votes this week on repealing the inheritance tax on large estates and other bills trimming taxes and curbing the IRS. — AP

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