The U.S. Senate voted late June 17 not to block a 21 percent reduction in Medicare reimbursement rates, meaning the medical profession woke up this morning facing a serious pay cut.

Congress voted for years to bypass rate reductions mandated by deficit reduction laws, which mandate a so-called "sustainable growth rate" aimed at keeping Medicare solvent. Senate Democrats were unable to muster the 60 votes needed to bypass the cuts one more time, with Sens. Ben Nelson (D-Neb.) and Joseph Lieberman (I-Conn.) voting with Republicans to reject a measure that would have forestalled the cuts for another 19 months.

The cut passed despite stiff opposition from the American Medical Assn., which spent millions ad vertising against it warning that it would prompt physicians to limit the number of Medicare patients they treat. The group cited a survey of 9,000 members showing that 17 percent would see fewer Medicare patients and 31 percent of primary care docs following suit, according to Medscape. Even before it passed, the cut moved some docs to stop treating Medicare patients. In 2008 the system treated 45 million patients (PDF).

In a last-ditch effort to stop the cut, the AMA condemned the six-month compromise extension, blasting Congress for breaking a promise to senior citizens and the military.

""Delaying the problem is not a solution," AMA president Dr. Cecil Wilson said a press release titled "Senate Fiddles as Medicare Burns."

"Continued short-term actions are creating severe instability that harms seniors as physicians make decisions to protect their practices from Medicare's volatility," Wilson said. "Continuing down this path just slaps a Band-Aid on a problem that needs urgent surgery."

Sen. Harry Reid (D Nev.) is haggling with Sen. Susan Collins (R-Maine) for a half-year extension Reid wants included in the Democrats' economic relief package, according to Politico.