A project of


110th Congress, Vote 491; House of Representatives #6331

Medicare Improvements for Patients and Providers Act of 2008

Official Title: To amend titles XVIII and XIX of the Social Security Act to extend expiring provisions under the Medicare Program, to improve beneficiary access to preventive and mental health services, to enhance low-income benefit programs, and to maintain access to care in rural areas, including pharmacy access, and for other purposes.

HR 6331 Medicare Bill
Senate first passed the legislation, by voice vote 69-30, July 9, 2008. President George W. Bush vetoed the bill, but Senate voted to override his veto, 70-26, July 15, 2008


This legislation set out to nix a 10.6 percent cut in Medicare payments to doctors scheduled for 2008, and a 5.4 percent reduction scheduled for 2009. Instead, the bill called for a 1.1 percent increase in Medicare reimbursements to physicians. The bill also called for cuts in privately administered Medicare Advantage plans.

Just before the Fourth of July recess, the House passed the by a vote of 355 to 59. But in the Senate, Republicans blocked initial efforts to take up the bill, so the cut to physicians payments were set to take effect July 1, as required by the "sustainable growth rate' (SGR) formula. (For a discussion of the SGR, see "HR 3961 Revising Medicare Physician Fee Schedules" under "House of Representatives.") But the Bush administration delayed processing of new claims from physicians, hoping to give Congress time to come up with a compromise.

But that didn't happen.

Instead, on July 9, Senator Edward Kennedy, who had been absent from Washington for several months while undergoing treatment for brain cancer, showed up to save the day, casting the 60th vote to stop the filibuster. His visit was a surprise, and when he entered the chamber where he had served for nearly 45 years, members of both parties cheered. At that point 9 more Republicans crossed party lines, and HR 6331 was approved 69-30. In total, eighteen Republicans voted for the bill, joining all 49 Democrats and the chamber's two independents.

President George W. Bush, who was opposed to cutting payments to Medicare Advantage insurers then vetoed the legislation./ But on July 15 the House voted to override the veto, 383-41; later in the day, the Senate voted in favor of the bill 70-26.

In addition to blocking a reduction in Medicare reimbursements to physicians while reducing the payments to private insurers, HR 6331 expanded coverage for beneficiaries, increasing benefits for mental health, reducing the beneficiary's co-payment; and lifting assistance for low-income seniors. The legislation also set high standards for the marketing tactics that Medicare Advantage insurers could use.

Why supporters pushed for this bill

  • House Speaker Nancy Pelosi told the New York Times: "Seniors' organizations and disabilities groups support this legislation. Just about every health-care-providing group in our country supports this legislation, except one, and that is health insurance industry. I guess the president is voting with them and not with America's seniors."
  • In theory, private sector "Medicare Advantage" plans were supposed to be more efficient than traditional government-run Medicare, but independent studies had reported that the private "Medicare Advantage" plans, sold by insurers like Humana and UnitedHealth, cost the government more per person. This was in part because some offered additional benefits, such as eye care and reduced fees for gym memberships, but the value of the new benefits did not add up to justify the higher payments from Medicare. /li>
  • The legislation set out to curtail high-pressure Advantage sales tactics that had prompted complaints from beneficiaries and state insurance regulators.

Why opponents tried to stop the bill

  • In his veto message, President Bush said: "I support the primary objective of this legislation, to forestall reductions in physician payments. Yet taking choices away from seniors to pay physicians is wrong." He argued that cutting federal payments to Medicare Advantage plans would slow the growth of such plans, offered by insurance companies as an alternative to traditional Medicare.
  • Representative Jim McCrery, Republican of Louisiana, said the bill "just kicks the can down the road, and does not fix fundamental flaws in the formula for paying doctors. In 18 months," Mr. McCrery predicted, "doctors will face a 20 percent cut in their Medicare payments."
07/15/2008 Status: House passed

More: select a member to see his or her other key Medicare votes.

Yes (383)
Our pick
R Don Young AK
R Robert Aderholt AL
R Spencer Bachus AL
D Robert Cramer AL
D Artur Davis AL
R Terry Everett AL
R Mike Rogers AL
D Robert Berry AR
R John Boozman AR
D Mike Ross AR
D Victor Snyder AR
D Gabrielle Giffords AZ
D Raúl Grijalva AZ
D Harry Mitchell AZ
D Ed Pastor AZ
R John Shadegg AZ
D Joe Baca CA
D Xavier Becerra CA
D Howard Berman CA
R Brian Bilbray CA
R Mary Bono Mack CA
R Ken Calvert CA
D Lois Capps CA
D Dennis Cardoza CA
D Jim Costa CA
D Susan Davis CA
R David Dreier CA
D Anna Eshoo CA
D Sam Farr CA
D Bob Filner CA
R Elton Gallegly CA
D Jane Harman CA
R Walter Herger CA
D Michael Honda CA
R Duncan Hunter CA
R Darrell Issa CA
D Barbara Lee CA
R Jerry Lewis CA
D Zoe Lofgren CA
R Daniel Lungren CA
D Doris Matsui CA
R Kevin McCarthy CA
R Howard McKeon CA
D Jerry McNerney CA
R Gary Miller CA
D George Miller CA
D Grace Napolitano CA
R Devin Nunes CA
D Nancy Pelosi CA
R George Radanovich CA
D Laura Richardson CA
R Dana Rohrabacher CA
D L. Roybal-Allard CA
D Linda Sánchez CA
D Loretta Sanchez CA
D Adam Schiff CA
D Brad Sherman CA
D Hilda Solis CA
D Jackie Speier CA
D Fortney Stark CA
D Ellen Tauscher CA
D Mike Thompson CA
D Maxine Waters CA
D Diane Watson CA
D Henry Waxman CA
D Lynn Woolsey CA
D Diana DeGette CO
R Doug Lamborn CO
R Marilyn Musgrave CO
D Ed Perlmutter CO
D John Salazar CO
D Mark Udall CO
D Joe Courtney CT
D Rosa DeLauro CT
D John Larson CT
D Christopher Murphy CT
R Christopher Shays CT
R Michael Castle DE
R Gus Bilirakis FL
D Allen Boyd FL
D Corrine Brown FL
R Virginia Brown-Waite FL
R Vern Buchanan FL
D Kathy Castor FL
R Ander Crenshaw FL
R Lincoln Diaz-Balart FL
R Mario Diaz-Balart FL
R Tom Feeney FL
D Alcee Hastings FL
R Ric Keller FL
D Ron Klein FL
R Connie Mack FL
D Tim Mahoney FL
D Kendrick Meek FL
R Jeff Miller FL
R Adam Putnam FL
R Ileana Ros-Lehtinen FL
R Clifford Stearns FL
D D. Wasserman Schultz FL
D Robert Wexler FL
R C. Young FL
D Sanford Bishop GA
R Nathan Deal GA
R Phil Gingrey GA
D Henry Johnson GA
R Jack Kingston GA
D James Marshall GA
R Tom Price GA
D David Scott GA
D Neil Abercrombie HI
D Mazie Hirono HI
D Bruce Braley IA
R Tom Latham IA
D David Loebsack IA
R Michael Simpson ID
D Melissa Bean IL
R Judy Biggert IL
D Jerry Costello IL
D Rahm Emanuel IL
D Bill Foster IL
D Luis Gutiérrez IL
D Phil Hare IL
D Jesse Jackson IL
R Timothy Johnson IL
R Mark Kirk IL
R Ray LaHood IL
D Daniel Lipinski IL
R Donald Manzullo IL
R Peter Roskam IL
D Janice Schakowsky IL
R John Shimkus IL
R Gerald Weller IL
R Dan Burton IN
D André Carson IN
D Joe Donnelly IN
D Brad Ellsworth IN
D Baron Hill IN
R Mark Souder IN
D Peter Visclosky IN
D Nancy Boyda KS
D Dennis Moore KS
R Jerry Moran KS
R Todd Tiahrt KS
D Ben Chandler KY
R Geoff Davis KY
R Harold Rogers KY
R Ed Whitfield KY
D John Yarmuth KY
R Rodney Alexander LA
R Charles Boustany LA
D Donald Cazayoux LA
D William Jefferson LA
D Charles Melancon LA
D Michael Capuano MA
D Barney Frank MA
D Stephen Lynch MA
D Edward Markey MA
D James McGovern MA
D Richard Neal MA
D John Olver MA
D John Tierney MA
D Niki Tsongas MA
R Roscoe Bartlett MD
D Elijah Cummings MD
D Donna Edwards MD
R Wayne Gilchrest MD
D Steny Hoyer MD
D C. Ruppersberger MD
D John Sarbanes MD
D Chris Van Hollen MD
D Thomas Allen ME
D Michael Michaud ME
D John Conyers MI
D John Dingell MI
R Vernon Ehlers MI
R Peter Hoekstra MI
D Dale Kildee MI
D Carolyn Kilpatrick MI
R Joseph Knollenberg MI
D Sander Levin MI
R Thaddeus McCotter MI
R Candice Miller MI
D Bart Stupak MI
R Fred Upton MI
R Tim Walberg MI
R Michele Bachmann MN
D Keith Ellison MN
R John Kline MN
D Betty McCollum MN
D James Oberstar MN
D Collin Peterson MN
R James Ramstad MN
D Timothy Walz MN
D Russ Carnahan MO
D Wm. Clay MO
D Emanuel Cleaver MO
R Jo Ann Emerson MO
R Sam Graves MO
R Kenny Hulshof MO
D Ike Skelton MO
D Travis Childers MS
R Charles Pickering MS
D Gene Taylor MS
D Bennie Thompson MS
R Dennis Rehberg MT
D George Butterfield NC
R Howard Coble NC
D Bob Etheridge NC
R Virginia Foxx NC
R Robin Hayes NC
R Walter Jones NC
R Patrick McHenry NC
D Mike McIntyre NC
D R. Miller NC
R Sue Myrick NC
D David Price NC
D Heath Shuler NC
D Melvin Watt NC
D Earl Pomeroy ND
R Jeff Fortenberry NE
R Lee Terry NE
D Paul Hodes NH
D Carol Shea-Porter NH
D Robert Andrews NJ
R Michael Ferguson NJ
R Rodney Frelinghuysen NJ
R Scott Garrett NJ
D Rush Holt NJ
R Frank LoBiondo NJ
D Frank Pallone NJ
D Bill Pascrell NJ
D Donald Payne NJ
D Steven Rothman NJ
R H. Saxton NJ
D Albio Sires NJ
R Christopher Smith NJ
D Tom Udall NM
R Heather Wilson NM
D Shelley Berkley NV
R Dean Heller NV
R Jon Porter NV
D Gary Ackerman NY
D Michael Arcuri NY
D Timothy Bishop NY
D Yvette Clarke NY
D Joseph Crowley NY
D Eliot Engel NY
R Vito Fossella NY
D Kirsten Gillibrand NY
D John Hall NY
D Brian Higgins NY
D Maurice Hinchey NY
D Steve Israel NY
R Peter King NY
R John Kuhl NY
D Nita Lowey NY
D Carolyn Maloney NY
D Carolyn McCarthy NY
R John McHugh NY
D Michael McNulty NY
D Gregory Meeks NY
D Jerrold Nadler NY
D Charles Rangel NY
R Thomas Reynolds NY
D José Serrano NY
D Louise Slaughter NY
D Edolphus Towns NY
D Nydia Velázquez NY
R James Walsh NY
D Anthony Weiner NY
R Steve Chabot OH
R David Hobson OH
D Stephanie Jones OH
D Marcy Kaptur OH
D Dennis Kucinich OH
R Steven LaTourette OH
R Robert Latta OH
R Deborah Pryce OH
R Ralph Regula OH
D Tim Ryan OH
R Jean Schmidt OH
D Zachary Space OH
D Betty Sutton OH
R Patrick Tiberi OH
R Michael Turner OH
D Charles Wilson OH
D Dan Boren OK
R Mary Fallin OK
R Frank Lucas OK
R John Sullivan OK
D Earl Blumenauer OR
D Peter DeFazio OR
D Darlene Hooley OR
R Greg Walden OR
D David Wu OR
D Jason Altmire PA
D Robert Brady PA
D Christopher Carney PA
R Charles Dent PA
D Michael Doyle PA
R Philip English PA
D Chaka Fattah PA
R Jim Gerlach PA
D Tim Holden PA
D Paul Kanjorski PA
D Patrick Murphy PA
R Tim Murphy PA
D John Murtha PA
R John Peterson PA
R Joseph Pitts PA
R Todd Platts PA
D Allyson Schwartz PA
D Joe Sestak PA
R Bill Shuster PA
D Patrick Kennedy RI
D James Langevin RI
R Henry Brown SC
D James Clyburn SC
R Bob Inglis SC
D John Spratt SC
R Joe Wilson SC
D S. Herseth Sandlin SD
R Marsha Blackburn TN
D Steve Cohen TN
D Jim Cooper TN
R David Davis TN
D Lincoln Davis TN
D Barton Gordon TN
D John Tanner TN
R Michael Burgess TX
D Henry Cuellar TX
R John Culberson TX
D Lloyd Doggett TX
D Thomas Edwards TX
R Louie Gohmert TX
D Charles Gonzalez TX
R Kay Granger TX
D Al Green TX
D Gene Green TX
R Ralph Hall TX
D Rubén Hinojosa TX
D Sheila Jackson Lee TX
D Eddie Johnson TX
D Nicholas Lampson TX
R Michael McCaul TX
D Solomon Ortiz TX
R Ted Poe TX
D Silvestre Reyes TX
D Ciro Rodriguez TX
R Pete Sessions TX
R Lamar Smith TX
R Mac Thornberry TX
D Jim Matheson UT
D Frederick Boucher VA
R Thomas Davis VA
R Thelma Drake VA
R J. Forbes VA
R Virgil Goode VA
R Bob Goodlatte VA
D James Moran VA
D Robert Scott VA
R Robert Wittman VA
R Frank Wolf VA
D Peter Welch VT
D Brian Baird WA
D Norman Dicks WA
R Doc Hastings WA
D Jay Inslee WA
D Rick Larsen WA
D Jim McDermott WA
R C. McMorris Rodgers WA
R David Reichert WA
D Adam Smith WA
D Tammy Baldwin WI
D Steve Kagen WI
D Ron Kind WI
D Gwen Moore WI
D David Obey WI
R Thomas Petri WI
R Paul Ryan WI
R Shelley Capito WV
D Alan Mollohan WV
D Nick Rahall WV
No (41)
R Jeff Flake AZ
R Trent Franks AZ
R Rick Renzi AZ
R John Campbell CA
R John Doolittle CA
R Edward Royce CA
R Thomas Tancredo CO
R John Mica FL
R David Weldon FL
R John Linder GA
R Lynn Westmoreland GA
R Steve King IA
R Bill Sali ID
R Stephen Buyer IN
R Mike Pence IN
R Ron Lewis KY
R James McCrery LA
R Steve Scalise LA
R Dave Camp MI
R Mike Rogers MI
R W. Akin MO
R Roy Blunt MO
R Adrian Smith NE
R John Boehner OH
R Jim Jordan OH
R Tom Cole OK
R James Barrett SC
R John Duncan TN
R Joe Barton TX
R Kevin Brady TX
R John Carter TX
R K. Conaway TX
R Jeb Hensarling TX
R Sam Johnson TX
R Kenny Marchant TX
R Randy Neugebauer TX
R Ronald Paul TX
R Rob Bishop UT
R Christopher Cannon UT
R Eric Cantor VA
R F. Sensenbrenner WI
Not Voting (11)
R Jo Bonner AL
D John Barrow GA
R Paul Broun GA
D John Lewis GA
D Leonard Boswell IA
D Danny Davis IL
D Bobby Rush IL
D William Delahunt MA
R Stevan Pearce NM
R Zach Wamp TN
R Barbara Cubin WY