Medicare dispute delays Senate healthcare votes

Reporting from Washington —  Senate Democrats had to delay votes on the first set of amendments to the healthcare bill Tuesday in the face of stiff Republican opposition, underscoring the fiercely partisan floor debate and threatening the tight timeline for passage.

Party leaders, scrambling to pass a bill by Christmas, had hoped to approve a proposal to expand access to mammograms and other preventive services. Instead, lawmakers spent much of Tuesday tussling over the bill’s potential impact on Medicare.

Democratic leaders propose to offset the cost of expanding insurance coverage to some 31 million people in part by cutting future Medicare payments to hospitals, nursing homes and other providers.

Insurance companies that contract with the federal government to provide Medicare Advantage plans, which offer extra benefits to about one in four Medicare beneficiaries, also face major cuts. Those plans cost the government substantially more per person than regular Medicare.

Many healthcare policy experts believe cuts are necessary to make the healthcare system more efficient and to provide incentives for higher-quality care -- crucial goals if the Medicare program is to remain solvent. Without changes, Medicare’s main fund is slated to run out of money in 2017.

The Senate healthcare bill has also won praise from independent groups such as the AARP, the nation’s leading advocate for seniors, which has been working to reassure its members that the legislation does not jeopardize Medicare.

But many seniors remain nervous, and Republicans took to the Senate floor Tuesday to renew their claims that the cuts would harm seniors.

“How many times have you heard from senior citizens in your state saying, ‘I paid into this trust fund. I paid for my Medicare all my life. Now it’s going to be cut. How is that fair? How is that fair to my generation, the greatest generation?’ ” Sen. John McCain (R-Ariz.) asked.

McCain pushed to send the healthcare bill back to committee with instructions to restore more than $400 billion in proposed cuts over the next decade, much of it in Medicare.

The GOP charges infuriated Democrats, who pointed out that many Republicans have voted for even deeper cuts to Medicare in the past. When McCain was running for president, his top aide talked of trimming Medicare spending to fund new tax credits to help Americans buy health benefits.

“Talk about crocodile tears,” Sen. Tom Harkin (D-Iowa) said Tuesday. “Was it not Newt Gingrich, the former speaker of the House, leader of the Republican revolution, that said he wanted Medicare to, quote, ‘wither on the vine’? Was it not Sen. Bob Dole, the [Republican] standard-bearer for president in the 1990s, who said he had fought against Medicare and was proud he voted against it?”

Sen. Olympia J. Snowe (R-Maine), a centrist who objects to portions of the bill, also took issue with allegations that the legislation would hurt Medicare beneficiaries.

“There are going to be a lot of rewards for seniors in this, and no reductions in their benefits,” Snowe said. “Ultimately, it buoys the system overall in the future.”

Snowe was the only Republican to vote for the bill in committee, but said at the time that her committee vote did not foreshadow her floor vote.

Democrats can probably turn aside McCain’s gambit, but other challenges await.

Senate Majority Leader Harry Reid (D-Nev.) is still trying to broker a compromise within Democratic ranks over the public option, which would create a government insurance plan.

Later this week, the Senate could begin debating a proposal, advocated by Republicans and some conservative Democrats, to further restrict federal funding for abortion.

To overcome a GOP filibuster, Reid must hold together all 60 members of the Democratic caucus -- which includes two independents -- or attract a Republican vote for every Democrat he loses.

noam.levey@latimes.com