Look out taxpayers. Washington, without enacting any separate spending cuts or tax increases, is seeking to spend $245 billion of your money to keep Medicare doctors from being hit with steep cuts in federal reimbursement fees.
And moderate Senate Democrats are not happy, concerned their colleagues are gearing up to inflate the deficit by hundreds of billions more.
"The amount of cuts the doctors have to take each year is too big, because it's compounded over the years. But we need to fix that problem in a fiscally responsible way," said Sen. Evan Bayh, D-Ind., who opposes the move.
Senate Democratic leaders and top White House officials decided to push for the Medicare money at a meeting Wednesday night in the office of Senate Majority Leader Harry Reid. The meeting included the chairmen of several big Senate panels, White House Chief of Staff Rahm Emanuel and Office of Management and Budget Director Peter Orszag.
Sen. Debbie Stabenow, D-Mich., who authored the 10-year $245 billion so-called "doctor fix," said her measure repeals the formula that determines payments to physicians who serve Medicare patients. Stabenow said she is trying to give doctors more confidence that the cuts will not be implemented, as more and more doctors are refusing to treat Medicare patients.
The fix is very popular with members of all political stripes, but it is seen by many as straight deficit spending.
Asked if there should be a way to pay for the change, Stabenow bluntly said: "No ... We all know this is something we do every year. ... This is something we always end up doing at the last minute. We make it very difficult for doctors to operate, and patients are extremely concerned about it."
Reid, who plans to bring the bill to a vote next week, also downplayed the issue.
"This is nothing different than we've done before. This is a flawed formula, and we know we have to fix the problem each and every year so that the seniors are able to see their doctors. That's what this is all about," he said.
But asked repeatedly if he would find a way to pay for the fix, Reid did not respond.
For fiscally moderate Senate Democrats, the looming red ink does not sit well.
Senate Budget Committee Chairman Kent Conrad, D-N.D., and Bayh, D-IN, both said they would vote against the measure.
According to a source, Conrad made his views known to the gathering last night in Reid's office.
Bayh said it should "absolutely be paid for."
"Look, one of the things we're trying to do is reform health care in a way that's fiscally responsible and doesn't drive up the deficit. A vote that will increase the deficit by $245 billion violates that principle," he said.
Sen. Ben Nelson, D-Neb., another moderate, said he heard there may be a move afoot to find a way to pay for the bill.
"If it's one year, it should be paid for. If it's 10 (years), it should be paid for, regardless," he said.
Reid needs 60 votes to get past procedural hurdles, and if he cannot rely on a handful of Democrats, he must turn to Republicans.
But Senate GOP Leader Mitch McConnell, R-Ky., indicated that might be tough. He complained that Democratic senators were divorcing this spending from the health care reform overhaul so as to claim health care reform is deficit-neutral.
"I think virtually all of my members are in favor of fixing this reimbursement problem, but we think there are ways to pay for it," he said. "This is so transparent. They're taking this issue out of health care, suggesting that we spend a quarter of a trillion dollars, not pay for it, so that they can then argue, the very next week potentially, that this trillion-dollar health care bill is paid for. I mean, this really makes you want to shake your head. I mean, it doesn't have a whole lot of credibility."
Republicans are expected to offer a number of amendments to pay for the fix, including one that will take the money from the $787 billion economic stimulus, about 60 percent of which is not spent.
The health care reform bill voted two days ago out of the Senate Finance Committee includes a one-year fix giving physicians a .5 percent increase in 2010 -- but the door is left open for future increases.
House Democratic leaders have also expressed a desire to jettison the fix from their health care bill, doing away with future cuts as well and creating a new payment formula.
Physicians groups are a powerful lobby in Washington, and every year they exert a great deal of pressure to reverse the cuts.
According to the Center for Responsive Politics, a nonpartisan group that tracks campaign donation, physicians, as part of a group of labeled "health professionals," contributed $95 million to members of Congress, 53 percent of which went to Democrats.