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Merkley Might Be a Health Care Holdout 

Senate Democrats are hopeful they have a filibuster-proof majority in favor of a health care reform package that would offer Medicare to people as young as 55 - but Jeff Merkley could throw a monkey wrench into the works.

Oregon's junior senator told Huffington Post blogger Sam Stein that the bill in its present form would worsen Oregon's health care problems because doctors in the state are woefully underpaid for Medicare patients and are increasingly unwilling to treat them.

"The basic challenge for Oregon is that a program that expands Medicare using existing Medicare rates would be of very little use in our state," Merkley told Stein. "And the reason why is because the reimbursement rates are so low in the state of Oregon that doctors aren't taking additional Medicare patients. ... They can fill their agenda and their schedules with higher-paying patients."

Merkley - who Stein called "one of the leading young progressive voices in the party" - didn't say outright that he wouldn't vote to break a filibuster. "But his objections complicate the notion that Senate Democrats now stand on the doorstep of historic legislation," Stein wrote. "The Oregon Democrat said he is going to work to make sure his state and others aren't disadvantaged by the newest wave of health care reform compromises. Medicare expenditures by the federal government, he noted, are 25% more (per person) in California and 38% more (per person) in Florida than they are in Oregon."

The federal government determines Medicare reimbursements to doctors on the basis of the historical costs of medical care. Oregon officials say this results in reimbursement rates being unfairly low here. "We are punished for being efficient," Rep. Earl Blumenauer told The Oregonian in May 2008.

The Oregonian reported that in 2004 about 12% of the state's primary care physicians wouldn't take new Medicare patients, but by 2006 the number had doubled to almost 24%. Small cities and rural areas have the worst problem because reimbursements are slightly higher in the Portland area.

Back in September of this year, Dr. Peter Bernardo, president of the Oregon Medical Association, told The Oregonian that "For Oregon, any health care reform that's not tied to Medicare reform is not going to fly."

According to Stein, Merkley also "said that he was 'enormously frustrated' by the unwillingness of his party's more conservative members [to] deal with its progressive members on a public option for insurance coverage."

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