Unanimous votes by Mississippi’s delegates to Congress nullified President Bush’s veto of a bill that would have cut the reimbursement rates doctors receive when treating Medicare patients by 10.6 percent and were received favorably by a Vicksburg physician who had talked with Bush about the matter.

The override vote in the House was a lopsided 383-41, easily meeting the two-thirds threshold needed to nullify the president’s veto. About an hour later, the Senate voted to override, 70-26.

“They stood up for the residents and Medicare patients of Mississippi,” said Dr. Randy Easterling, a family medicine and addiction specialist at River Region Medical Center and president-elect of the Mississippi State Medical Association. “This was a very positive move.”

Bush has vetoed nine bills, and Congress has only had the muscle to override him on a water projects bill and twice on farm legislation prior to Tuesday’s vote.

Lawmakers were under pressure from doctors and the elderly patients they serve to nullify the rate cut, which was effective July 1. The cut is based on a formula that establishes lower reimbursement rates when Medicare spending levels exceed established targets.

“The formula is flawed, and this gives Congress some more time to fix it,” said Easterling. “Congress had got to find a way to do this in a bipartisan way. As it is, the Medicare system is not sustainable.”

Medicare is a federal program that pays for health-care services to people 65 and older. Medi-caid is a federal-state program that serves the indigent and disabled.

Instead of a cut, the legislation will keep Medicare rates for doctors where they are for the rest of 2008 and will increase them by 1.1 percent in 2009. The legislation generates the revenue necessary to pay doctors more by reducing spending on private health insurance plans. Those plans serve more than 9 million people through the Medicare Advantage program.

About 600,000 doctors treat Medicare patients. Many said they would no longer accept new elderly patients if the cuts stood.

“If these cuts would have taken place – in addition to the Medicaid cuts the governor (Haley Barbour) is going to impose in the next 30 days – it would have been almost impossible for a provider to see a Medicare patient,” said Easterling, who met briefly with Bush two weeks ago to discuss the Medicare issue while the president was at a private fundraiser in Jackson.

Bush said he supported rescinding the cut, but he objected to the way lawmakers would finance the plan. “I support the primary objective of this legislation, to forestall reductions in physician payments,” Bush said in a statement. “Yet taking choices away from seniors to pay physicians is wrong.”

Health and Human Services Secretary Mike Leavitt also expressed displeasure.

“Medicare is drifting toward disaster,” Leavitt said. “Congress has once again given in to special interests and shown an unwillingness to change the program’s path and take on the important task of entitlement reform.”

He said he supports “fully reimbursing physicians at pre-reduction Medicare payment levels and we want to fix the way physicians are paid. We do not support many other provisions in the bill which will hurt both taxpayers and Medicare beneficiaries. ”

Providers are paid by a fixed schedule of fees established by the federal government based on specific services provided. The fees are substantially lower than normal charges for the services. There is no requirement that private physicians or clinics accept Medicaid or Medicare clients, but most do.

Leavitt said the bill undermines the very successful Medicare Part D prescription drug benefit by harming competition and driving up prices and it will reduce the ability of many to choose a private plan.

Democratic lawmakers used a variety of terms to describe Bush’s veto earlier Tuesday. Some called it “meaningless.” Others called it “mean-spirited.”

“His days of doing us harm are very, very limited,” said Rep. Charles Rangel, D-N.Y., House Ways and Means Committee chair.

Insurers and the Bush administration argued the changes Democrats sought would lead to benefit cuts and to fewer Medicare Advantage plans. The Congressional Budget Office estimated that over the course of five years, enrollment in Medicare Advantage would grow to 12 million rather than to 14.3 million.

Bush said the bill would reduce “access, benefits and choices for all beneficiaries.”

While the focus on the bill has largely been on changes for doctors and private insurers, virtually every type of health-care provider as well as millions of patients have a stake in the legislation.For Medicare recipients, lawmakers lowered the copayments for mental health treatment and allowed more people to qualify for the government’s help in paying their monthly premiums.

For providers, such as pharmacists, the legislation ensured that they’re paid promptly by Medicare drug plans and delayed changes that would have cut their reimbursements when dispensing generics.

Military families also had a stake as its TRICARE program set reimbursement levels based on Medicare, and lawmakers raised concerns leading up to the vote that those families would have a hard time finding a doctor.

Dr. Nancy H. Nielsen, president of the American Medical Association, said a 10.6 percent cut “would have been devastating to seniors and the disabled who rely on Medicare for the health care they need, as well as to military families who rely on TRICARE for their health care.”

Prior to Bush’s veto, the House had voted in favor of the bill 355-59, so Tuesday’s override vote showed more Republicans breaking with the administration.

The vote in the Senate in passing the bill last week was much closer, 69-30, leaving little margin for error for supporters trying to sustain a two-thirds majority to override.

The Associated Press contributed to this report.

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