Washington — Doctors across Nevada are weighing whether to continue accepting new Medicare patients if Congress fails to stop a 10 percent pay cut to Medicare providers scheduled to take hold next week.

Usually, Congress has been able to prevent the annual pay cut, an unintended consequence of new Medicare reimbursement formulas since 2001.

But this year, with a fiercely divided Congress facing the biggest physician pay cut to date, the expected fix is coming down to the wire in a partisan standoff.

The Senate could vote again as soon as today on the bill that has passed the House but failed by one vote last month in the Senate.

Even if the bill were to pass, President Bush has threatened a veto.

Doctors say the cut could severely threaten their ability to care for seniors in a state with a growing retiree population.

“It’s probably the most critical time I’ve seen in Medicare,” said Larry Matheis, executive director of the Nevada State Medical Association.

Last month, the House surprised many when it overwhelmingly passed the fix with a veto-proof majority despite the objections of Republican leadership and the Bush administration.

Nevada’s three lawmakers, Democratic Rep. Shelley Berkley and Republican Reps. Jon Porter and Dean Heller, all voted yes. Nevada has more than 320,000 Medicare recipients.

But in the Senate the bill was blocked by one vote, drawing an angry rebuke from the floor last month by Senate Majority Leader Harry Reid.

The Republican leader, Sen. Mitch McConnell of Kentucky, said Democrats were engaging in a partisan stunt by holding a vote on a bill they know Bush has pledged to veto.

But Reid virtually taunted Republican senators who voted against the bill, asking them why they were afraid of Bush when the president’s approval ratings were so low. (Congress’ own ratings are lower than Bush’s.)

The next day Berkley dashed off a release criticizing Republicans for putting Nevada’s seniors in harm’s way.

“With the Valley’s rapidly growing senior population, Las Vegas will be especially hard hit if this drastic cut in reimbursement rates is not reversed,” Berkley said.

Reid said if the bill fails again, “Republicans are going to have to live with that.”

Both Republicans and Democrats want to stop the pay cut, but the sticking point is how to raise the funds needed to do so.

Democrats want to trim Medicare Advantage, the private insurance-run program some on Medicare choose.

Democrats say Medicare Advantage costs more to run than traditional Medicare. But twice in June, bills to cut one to pay for the other have been blocked by Senate Republicans.

Republicans and the Bush administration worry that trimming Medicare Advantage will harm the privately run programs they are trying to foster.

Republicans complain that Reid refused to allow a vote on a temporary extension. They were working with Democrats in committee to develop a fix both parties could accept when Reid pushed the Democratic bill to a vote last month.

Doctors groups from Nevada said they were now targeting Republican Sen. John Ensign, who voted against the bill.

Ensign said more than 8 million seniors nationwide rely on Medicare Advantage. Matheis said 30 percent of the Medicare recipients in Nevada use the private plan. Ensign co-authored a bill with other Republican leaders in June to halt the doctors’ pay cuts without cutting the private program.

“The Democrats forced a vote on a partisan measure knowing that it faced a veto threat,” Ensign said in a statement after the first Democratic bill was shot down in mid-June. “We cannot afford to wait any longer to pass a physician payment fix.”

Dr. Edward Kingsley, a co-founder of Comprehensive Cancer Centers of Nevada in Las Vegas, said he left a voice mail at Ensign’s office on the issue.

Kingsley said his medical group will continue taking Medicare patients, but he knows other doctors are worried about how they will cover costs.

“Some physicians are not going to be able to afford that or it’s not worth it to them,” Kingsley said. “That’s ultimately what we all fear — these patients are not going to have access to the care they need.”

Does it look to you like the politicians over in Sacramento are playing games with taxes and access to public services as they gear up for another budget fight?

Do you think it should be easy for Gov. Arnold and the California legislature toupdated_nextten_banner.gif balance their states’ budget? Fine. Go ahead and try it yourself.

Go to NextTen.com and test your skills with “The California Budget Challenge” – a remarkable new online, interactive tool that allows those who visit the site to create their own state budget, setting spending and revenue-generating priorities for the next 10 years.

It is fun, demanding and educational all at the same time. The challenge is simplified to make it workable. However, it’s still complex enough to give the user a sense of the extent of the problems and the choices Californians face.

Think of it as “state budgeting for dummies.” The program is straightforward. It explains the issues facing the state’s finances clearly and outlines the pros and cons of controversial choices.

Next Ten was founded by Menlo Park venture capitalist and philanthropist Noel Perry, saying he is “concerned about California today and the California our children will inherit.”

“Next Ten is an independent, nonpartisan organization that educates, engages and empowers Californians so that, together, we can improve our future economy and quality of life. We call ourselves Next Ten because we aren’t here for the quick fix. We have our sights set on joining with others to improve the state over the next ten years, and the ten years after that. Next Ten believes that together, we can create the brighter future we all want for ourselves and our children.”

Now, will someone adapt this program to Nevada and give us the opportunity “to deepen our understanding of how today’s political decisions will shape our lives over the next 10 years?” Would we want “a tool that educates, engages and empowers Nevadans so that, together, we could improve our future economy and quality of life?”

In its first few weeks, more than 10,000 Californians have ‘taken the Challenge’ .

Would Nevadans participate?  Maybe yes. Maybe no. Isn’t it just a whole lot easier leaving it up to the lobbyists, bureaucrats and casinos to make the decisions?

The top five vote-getters in Clark County:

• County Assessor Mark Schofield                              252,022
• County Treasurer Laura Fitzpatrick                           246,750
• Supreme Court Justice Michael Cherry (unopposed)   244,256
• County Sheriff Doug Gillespie                                   217,417
• NV Attorney General Catherine Cortez Masteo           210,022

In a quick conversation with State Sen. Maurice Washington, the legislative health committee member said there has been too much political grandstanding on the issue of the health clinic scare. He said it’s time for everyone to step back, clam down and take a rational view of the entire picture.

But he acknowledged that the state is unequipped for annual inspections of ambulatory surgical centers. He dismissed the idea of letting accrediting agencies take the responsibility for increased inspections. But he said he would like to explore giving the job to county health departments, “who have the soldiers on the ground.” He said county health inspectors should make regular inspections, backed up by random state inspections.

U.S. Rep. Dean Heller, standing nearby, asked how the state can be so unequipped if it has been able to complete a statewide inspection blitz of all 50 centers in two weeks.

Nevada’s taxable sales were up in April for the first time this calendar year, albeit only by a third of a percent.

Carson City continued to be hit hard by sluggish auto sales, which are the city’s biggest sales tax generator. Although taxable sales were down only 1.6 percent overall in Carson, car sales were off 15.7 percent to $16.5 million. In addition, food services and drinking sales were down more than 15 percent to $6.6 million.

The capital was helped out considerably by a 10.5 percent increase in building material sales and a nearly 17 percent increase in sales by food and beverage stores. In addition, taxable sales from amusement, gambling and recreation nearly quadrupled to $1.97 million. Altogether, Carson City reported a total of $73.8 million in taxable sales for the month.

Douglas County didn’t fare as well, dropping 6.3 percent to $50.9 million for April. There, food and beverage stores, general merchandise stores, gas stations and electronics stores were all down.

But the big hit in Douglas came from its largest category - food services and drinking places at the Stateline casinos - which fell 18 percent from April 2007 to $9.9 million.

There were two bright spots in western Nevada. Churchill County’s taxable sales rose 11.9 percent compared to April 2007 to $27 million and Lyon County’s total increased 40.9 percent to $42.9 million.

In Churchill, there were huge increases in utilities - by a factor of 17 - specialty contractors and heavy construction as well as numerous small categories.

In Lyon, one of the fastest growing counties in the nation, there were increases in most construction categories. But taxable sales from general merchandise stores jumped to $2.79 million - five times what it was a year ago.

Statewide, total sales reported to the Department of Taxation were $3.92 billion with the largest increase, 45.4 percent, by electronics and appliance stores.

In a good sign for the tourism industry, the number for accommodations was up more than 16 percent compared to April 2007.

Overall in Nevada, the Motor Vehicles and Parts category, one of the largest sales tax generators in the state, was down 20.3 percent for the month.

The state general fund’s share of sales and use taxes is $87.7 million - 8.2 percent - below the May 2007 projections by the Economic Forum.

Gov. Jim Gibbons issued a cautious statement, saying the April sales tax figures still reflected a sluggish economy.

But he pointed to indicators of growth in commercial construction in southern Nevada, a 16.2 percent increase in taxes on accommodations representing tourist activity, and what he called “cautious consumer purchases within select categories.”

• Contact reporter Geoff Dornan at gdornan@nevadaappeal.com or 687-8750. The Associated Press contributed to this story.

County Taxable Sales Change from 4/07

Statewide $3.92 billion 0.3%

Carson City $73.8 million -1.6%

Churchill $27 million 11.9%

Douglas $50.9 million -6.3%

Lyon $42.9 million 40.9%

Storey $8.6 million -34.2%

Washoe $550 million -1%

Clark County $2.9 billion 0.2%

McElhaney, who manages the seven newspapers in the media group, said Gladys’ extensive background in sales and management will benefit the Appeal and its readers.

“She’s enthusiastic and able to grasp the big picture,” he said. “She has an extensive professional background and understands how the business works.”

Among her accomplishments, Gladys was named to the board of directors for the North Dallas Chamber of Commerce in 2007 and was recognized nationally as “Top 20 under 40″ by Presstime Magazine in December 2001.

She will be joined by her husband, John, and two children Amelia, 6, and Jack, 20 months.

Fire and sheriff’s departments likely need the extra staff that would be hired through one ballot initiative, according to many candidates for Carson City mayor, but say another initiative that would raise sales taxes for the V&T Railway asks too much from voters.

The city has invested millions of dollars in the tourist railroad that will run from Virginia City to Carson City, said locksmith Steve McClung, but it should be finished by private funds.

“I mean, everyone is hurting now,” said McClung, one of six candidates for mayor. “They don’t want more taxes piled on them.”

His life was saved by a paramedic after an artery in his heart burst several years ago, however, and he said the experience helps him appreciate how important the public safety ballot question is.

“You just don’t pick services out of trees,” he said. “They have to come from somewhere.”

Both ballot questions would raise taxes, but in different ways.

The V&T plan would give $10 million to the V&T tourist train project through a one-eighth cent sales tax in exchange for 5 percent of ticket sales over 99 years. The city has given $21 million of the expected $55 million cost.

Mayor Marv Teixeira, who will not seek a fourth term, has said he expects the plan to cost the average resident about $12 a year and pay for what the city’s already given well after the sales tax sunsets around 2020.

The proposed property tax for public safety would raise money for staff that the sheriff’s and fire departments say are critical for public safety.

Funds would be raised through a 12.6-cent tax on every $100 of assessed property and any extra money collected through the tax would go to general public safety.

School board member and mayoral candidate Bob Crowell said he supports the public-safety plan because the city needs to keep people safe and create an environment where new residents will feel comfortable.

He said he won’t know if he’ll advocate for the V&T ballot question until he learns more about the business plan.

Taxpayers should not have to pay anything more for a tourist attraction, said candidate and podiatrist Sean Lehmann, and the project could be finished through alternatives, such as bonds that could be paid off by train profits.

He said he is more likely to support the public safety question, but hasn’t decided if he will yet. The sheriff’s department did recently open a new multi-million-dollar building, he said.

Pastor Ken Haskins and Realtor Jim Shirk have both said a mayor should follow and support voters’ decision on the ballot questions.

Haskins said he thinks the mayor should help raise private money for the V&T Railway, whether the question is approved or not.

Shirk said he needs to analyze the questions more before he decides how he will vote.

“I believe in both of these cases no one could make a determination at this time as to how they would be for or against either ballot issues,” he said in an e-mail.

Entrepreneur and candidate Pete Hansell, however, said there is not enough evidence to support either ballot question.

The management of the V&T project so far has been “ridiculous,” said Hansell, who pointed to the rising costs and delayed completion time.

For the public safety initiative, the fire and sheriff’s departments haven’t proved that the staff they’re asking for will actually help fix their problems, he said.

Most importantly, he said, the plan has failed to answer the question: “What’s it going to give me?”

In a midnight email to the supporters of his former presidential bid, New Mexico Gov. Bill Richardson endorsed U.S. Sen. Barack Obama today. Richardson, a popular Western governor and a Latino, was a highly-sought after endorser, with both campaigns keeping in constant contact with him since he ended his own run in January.

Richardson credited Obama’s race speech as the tipping point:

“As a Hispanic, I was particularly touched by his words. I have been troubled by the demonization of immigrants–specifically Hispanics– by too many in this country. Hate crimes against Hispanics are rising as a direct result and now, in tough economic times, people look for scapegoats and I fear that people will continue to exploit our racial differences–and place blame on others not like them.

“Senator Obama has started a discussion in this country long overdue and rejects the politics of pitting race against race. He understands clearly that only by bringing people together, only by bridging our differences can we all succeed together as Americans.”

Time will tell what role Gov. Kenny Guinn plays in the 2006 election. So far, he is off to a slow start, other than signaling his displeasure with the GOP frontrunner, U.S. Rep. Jim Gibbons, R-Nev. Guinn has said he will spend his final year touring the state. The tour could be the perfect opportunity to stump for his favorite GOP candidates. Guinn also could be a powerful voice for or against the myriad initiative petitions circulating such as Tax and Spend Control for Nevada, which would put a cap on government spending into the constitution. Guinn was at the top of the ticket in 2002 when the GOP swept all six constitutional offices. But this year he has signaled he won’t be taking the lead in ensuring a repeat. In an interview last week, Guinn demurred when asked which candidates and petitions he would be supporting. Here’s as close as he would get:

Guinn is clearly concerned about the TASC initiative, but won’t slam it yet. When asked if there is a way it could be written that would win his support he said: “I can’t think of a way.”

As for the candidates: “I’ve talked to a number of people and I’m willing to help. But I’m not going to pick individual people.”

I keep saying it’s early. The primary election is eight months away and the public doesn’t engage until maybe a month before they hit the polls. But pretty soon, it will be too late to say it’s still early.