Yesterday afternoon, the Senate rejected a cloture motion that would have brought Sen. Debbie Stabenow's Medicare Physician Fairness Act of 2009 to the floor. Here at the Gaggle we don't normally write about the daily dramas on the Senate floor. So why is this vote worth analyzing? Because it shows how deeply nervous Senate Democrats are about spending increases.

Stabenow's bill would have changed the payment regime for doctors treating Medicare patients; those doctors are facing a 21 percent cut in reimbursement rates as a result of a quirky formula dating back to 1997. Each year Capitol Hill scrambles to come up with a temporary fix for the situation, fearing that reductions in reimbursements will prompt doctors to start turning away elderly patients. That's not a situation any politician wants, ethically or politically. They rarely forget that seniors tend to take voting seriously. With Stabenow's bill dead, Harry Reid has promised yet another one-year fix. Just one more patch for a chronic problem.

For some time, doctors were hopeful about the Stabenow bill's prospects. It had the strong backing of the AMA, and  Reid had reportedly been promised 27 GOP votes. But, at the 11th hour, Republicans balked. The problem with Stabenow's bill was the price tag. Her fix would have cost about $247 billion over 10 years, but no source to offset that cost had been identified. Republicans refused to support this unfunded fix, leaving a bemused Reid explaining Tuesday that the bill would fail. Never mind that Republicans will likely support the annual fix, and each subsequent one. Never mind that all those yearly votes will end up costing a similar amount over 10 years. That amount won't show up in budget projections. Taken as a whole, the unfunded amount was simply too high to take back to Republican voters already concerned about government spending. The Capitol Hill blame game is in full swing, with Republicans alleging that Reid refused to consider amendments that would have brought the cost down, and Reid blaming GOP obstructionism. "The story is the Republicans are opposing this even though they support it," Reid said, according to The Hill. 

The vote proceeded regardless, so at least Democrats could be on the record supporting a measure that doctors, a key interest group, roundly applaud. But it didn't exactly work out that way. After the GOP pulled its support, some Democrats got nervous, and the motion ended up failing, with only 47 votes for and 53 against. That means 13 Democrats voted against it, which is why this vote is interesting.  Here's a vote that was popular with doctors, probably with seniors, and unlikely to rile up folks who would vote for a Democrat, and many Dems still got cold feet. On the first real Senate vote in the health-care debate, Reid failed to get the numbers. Not a good look.

To be fair, Reid probably didn't push his senators too hard on this one. He doesn't want big spending in the headlines either. But it does raise question marks about the ability of Dems to stick together when the going gets tough. On this vote, the measure wouldn't even get through the budget reconciliation process, which only requires a simple majority (51 votes) to pass bills. That has repeatedly been mentioned as a last-resort option if moderate Dems dig in their heels. 

Here's the list of Dems who voted nay:
Evan Bayh (Indiana)
Robert Byrd (West Virginia)
Kent Conrad (North Dakota)
Bob Dorgan (North Dakota)
Russ Feingold (Wisconsin)
Herb Kohl (Wisconsin)
Joe Lieberman (Connecticut)
Claire McCaskill (Missouri)
Bill Nelson (Florida)
Jon Tester (Montana)
John Warner (Virginia)
Jim Webb (Virginia)
Ron Wyden (Oregon)

Some of those names are more surprising than others. Feingold, Lieberman, and Bayh often worry about spending, for example, and Wyden has made his case vocally for a different version of health-care reform. Perhaps what is more surprising is who was left off the list: Blanche Lincoln, Ben Nelson, and Mary Landrieu have each made Reid's life difficult on health care, yet they voted for the measure. So what gives?

Probably that the senators on the above list represent states that have been hard hit by the recession, so the news that they signed off on a large unfunded spending bill wouldn't have sat well with their electorates. This vote gives us an insight into what some Senate Democrats, like Kohl or Tester, who have been relatively quiet about health-care reform, are thinking, and likely whispering to leadership. And it seems that their ideas look a lot more like Max Baucus's plans than Nancy Pelosi's.  Pundits have been focused on the votes of a core group of moderate Democrats, like Lincoln and Nelson, but perhaps it's time to add few new names to those lists.