As the month of March began, Congress missed another opportunity to enact change and the scheduled 21% cuts in the Medicare Sustained Growth Rate (SGR) took effect.

A Centers for Medicare and Medicaid Services spokesperson said Medicare can hold claims it receives for 10 working days, but that the cuts would take effect after that point. If Congress blocks the cuts retroactively to March 1st, physicians would need to file new claims to recoup the money lost from the lower reimbursements.

Last Thursday, the House of Representatives passed HR 4691 via voice vote, which would have delayed the SGR cuts  be delayed until March 28. The bill would also have extended a 65% subsidy in COBRA benefits for the unemployed.

However when the bill was moved to the Senate, Senator Jim Bunning (R-Kentucky), bucking his own party, objected to the measure and blocked its passage.

Bunning said to Washington, DC, media that his objection to the bill is that it would add to the federal budget deficit by as much as $10 billion and that it is classified as ‘emergency spending.’ This classification means its costs would not need to be offset.

“If we can't find $10 billion somewhere for a bill that everybody in this body supports, we will never pay for anything," Bunning said in CQ Today.

Bunning also said Friday that he would sustain his objection, meaning the cloture process will be necessary to pass the bill.

The California Medical Association, following the lead of the American Medical Association, quickly called on Congress to act.

"It's unconscionable that Congress has not intervened to prevent this coming train wreck," said Brennan Cassidy, MD, president of CMA. "America's elderly, who have devoted their lives to working for this nation, deserve better treatment than this. Sadly, if these cuts take effect, senior citizens will have a tougher time getting access to a doctor because many physicians will not be able to afford to deliver care under Medicare."

Cassidy bemoaned the fact that while Congress has been working on health care for more than a year, there has been no progress on this front.

Senate Majority Leader Harry Reid (D-Nevada) and other Senators contend they might be able to avoid the 21% payment reductions if this bill is passed in the next two weeks.

The American Medical Association said the Senate had failed Medicare beneficiaries and physicians. 

"Our message to the U.S. Senate is stop playing games with Medicare patients and the physicians who care for them," said AMA President J. James Rohack, MD.

In 2009, insurance providers such as Blue Cross-Blue Shield, United Health Group, and Aetna increased spending on lobbying by an average of 24% from 2008. For instance, the Blue Cross-Blue Shield Association increased its spending to $8.9 million in 2009 from $7.5 million in 2008.

The Hill, a Washington, DC, publication, studied mandatory disclosure reports submitted by the organizations, insurers and health maintenance organizations to arrive at these figures.

Overall, these organizations employed almost 1,000 lobbyists and spent almost $54M on lobbying efforts last year, according to the web site www.opensecrets.org by the Center for Responsive Politics.

While $54M is a considerable sum of money, it is still dwarfed by the amount spent by pharmaceutical manufacturers, who spent more than $200M on lobbying efforts in 2009.

*in millions of dollars; all figures from The Hill.