Sen. Edward Kennedy returned to the floor of the Senate today for the first time since he learned that he has brain cancer and helped propel a Medicare Advantage bill, H.R. 6331, through the chamber on a voice vote.

Kennedy, D-Mass., also was one of 69 senators who voted to limit debate on the bill, the Medicare Improvement for Patients and Providers Act of 2008, and clear the way for the bill to come up for a vote.

Kennedy entered the Senate along with Sens. John Kerry, D-Mass., and Barack Obama, D-Ill., and drew a long, bipartisan round of applause.

“I return to the Senate today to keep a promise to our senior citizens – and that’s to protect Medicare,” Kennedy says in a statement. “Win, lose or draw, I wanted to be here.”

No Democrats voted to block consideration of H.R. 6331, and 18 Republicans voted to allow consideration of the bill.

The House voted 355-59 to approve the bill June 24.

Senate approval of H.R. 6331 clears the way for the bill to go to President Bush, who has threatened to veto the bill over concerns about the effect the bill might have on the Medicare Advantage program.

The bill goes to the White House with more than enough votes for Congress to overturn a veto. In the past, however, many Republicans have refused to participate in efforts to overturn vetoes, even when they have supported the underlying bills.

If implemented as written, H.R. 6331 would:

- Phase out payments to Medicare Advantage organizations for the costs of indirect medical expenses that are currently paid both to hospitals and plans.

- Require private fee-for-service Medicare Advantage plans to establish provider networks for both individual and employer-group products in areas with at least 2 network plans.

- Extend and modify the authority for Medicare Advantage organizations to offer plans for special needs individuals.

- Rescind all but $1 of the stabilization fund for regional Medicare Advantage plans.

The changes could lead to a significant drop in enrollment in private Medicare plans, according to Peter Orszag, director of the Congressional Budget Office.

Orszag makes that prediction in an analysis sent to Sen. Judd Gregg, the highest ranking Republican on the Senate Budget Committee.

The bill might cut about $12.5 billion in federal spending from 2009 to 2013, and about $47.5 billion in spending from 2009 to 2018, Orszag writes.

The bill provisions requiring the Medicare Advantage private FFS plans to use provider networks and reducing the payments to plans could cut Medicare Advantage plan enrollment, Orszag writes.

Today, there are about 9.6 million people enrolled in Medicare Advantage plans, with 2.3 million of those people in private FFS plans.

The CBO has been predicting that Medicare Advantage plans will cover a total of 14.3 million people in 2013, with 5 million of the beneficiaries in private FFS plans, Orszag writes.

If H.R. 6331 takes effect as written, CBO analysts believe the Medicare Advantage program will cover about 12 million people in 2013, Orszag writes.

The special needs plan provision would increase Medicare Advantage health maintenance organization and preferred provider organization plan enrollment by less than 100,000, Orszag predicts.

Members of Congress developed H.R. 6331 in an effort to find the money to cancel cuts in Medicare physician reimbursement rates that is set to take effect this month.

America’s Health Insurance Plans, Washington, is opposing the bill.

AHIP President Karen Ignagni has put out a statement calling on Congress to address the physician payment issue without hurting Medicare Advantage funding.

“More than 2 million seniors across the country stand to lose their Medicare Advantage benefits,” Ignagni says in the statement. “This could have devastating impact on seniors who rely on the extra benefits and lower out-of-pocket costs these plans provide.”