September 24: By a vote of 15 to 3 , with 5 members "passing," the Senate Finance Committee reduced the ability of the representatives of the people to check the enormous authority of an unelected Medicare Commission. The original proposal from Chairman Baucus allowed Congress to pass a different set of limits on Medicare growth than recommended by the Commission by a majority vote. Under the Rockefeller Amendment, in order for Congress to overturn the Commission’s dictates would require a 2/3 vote.
The Medicare Commission is given almost unlimited powers to change Medicare in order to reduce Medicare payments to fit with the limits on growth it is designed to achieve. The only limits in the Chairman’s Mark not qualified by the term "if feasible" are that its proposals "not impact providers scheduled to receive a reduction to their inflationary payment updates in excess of a reduction due to productivity in a year in which the Commission’s proposals would take effect" and that they not "ration care, increase revenues, or otherwise change Medicare beneficiary cost-sharing, benefits, or eligibility standards." (Page 156 of Chairman’s Mark as modified).
Consequently, the Commission, without a vote by the people’s representatives in Congress, could, for example, significantly curtail the Private-Fee-for-Service alternative in Medicare Advantage. Under current law, the private fee-for-service alternative is the only one that permits senior citizens, without being subject to limits that could be imposed by the Center for Medicare and Medicaid Services, to add their own money on top of the government contribution in order to get health insurance that is less likely to limit access to medical treatment through managed care techniques or other means. With the significant cuts in Medicare funding that this legislation imposes in order to finance extending subsidies to cover the uninsured, it is particularly important to preserve this option for older Americans to allow them to protect their own life and health with their own money.
The three "no" votes came from Senators Hatch, Bunning, and Cornyn. Senators Grassley, Kyl, Crapo, Roberts, and Enzi passed. All Democratic Senators on the committee and Senators Snowe and Ensign voted in favor.