For President Barack Obama, the MRIs and other medical scans for Medicare patients that cost the government billions are prime targets for cuts to help finance health care overhaul.

The response from physicians and industry: a lobbying counterattack accusing Obama of denying patients the lifesaving tools they need.

Patients, rural doctors and advocacy groups who back the procedures will gather in the House Wednesday for a panel discussion, part of the campaign.

The industry spearheaded a bipartisan letter to Obama from 57 House members objecting to the cuts. It has staged events in North Carolina and other states where senators face re-election next year. And it is using a Web site and newspaper ads to encourage people to complain to Congress about the proposal.

The fight highlights a pivotal moment for one of Obama’s chief priorities, revamping the nation’s health care system to reduce costs and cover the nearly 50 million uninsured Americans, while finding the roughly $1 trillion needed to do it over the next decade. As the president and lawmakers translate rhetoric into legislation, it is decision time for groups that so far have backed the concept of improving health care without knowing the fine print.

The specifics have sparked grumbling from interests like the insurance industry and the U.S. Chamber of Commerce who dislike what they see. They have also triggered intensified efforts by would-be winners — like labor and advocates for low-income people — to nail down potential gains.

"I think you’ll see a lot of skepticism because specifics have pain attached to them," said David French, a lobbyist for the International Franchise Association, which represents franchised businesses from restaurants to tanning salons and dislikes key parts of Obama’s plan. "We’re no longer shooting at ghosts. There are real targets."

The Senate Health, Education, Labor and Pensions Committee is in its second week of work on a health care bill. Top House Democrats revealed theirs last Friday, and another measure is taking shape in the Senate Finance Committee. As they work, the fight over Medicare reimbursements for medical imaging is typical of the intensified lobbying.

Use of the procedures grew to 182 million in 2007, according to an industry study. The Obama administration cites figures showing Medicare’s price tag for the services doubled from $7 billion in 2000 to $14 billion in 2006.

Though that spending dropped to $12 billion in 2007 as cuts enacted by Congress took effect, the administration says overly generous reimbursement rates and other factors encourage doctors to overuse imaging equipment. Obama has proposed reducing the Medicare payments by $5.9 billion over the next decade — a plan doctors and equipment makers say is based on flawed, outdated data.

"This is exactly where medicine is going" because the scans diagnose diseases and save money, said Timothy Trysla, executive director of the Access to Medical Imaging Coalition, which represents doctors, manufacturers and patients. "Our biggest concern is Medicare’s use of these tools is slowed."

Not all groups are waiting for detailed legislation.

Hoping to stave off even steeper costs, the Pharmaceutical Research and Manufacturers of America this week struck a deal with the White House and lawmakers to contribute $80 billion over the next decade by lowering some seniors’ drug costs and paying for a portion of the health care overhaul.

For many others, the specifics that have emerged are already unacceptable.

In a letter to senators Tuesday, America’s Health Insurance Plans and the Blue Cross Blue Shield Association, the two largest insurance industry groups, said creating an optional public insurance plan would wreck the coverage many people get from their employers. A public plan is a priority for Obama and many congressional Democrats as a way to force private insurers to trim their prices.

AHIP has a new Twitter account to contact supporters and is holding weekly conference calls with member companies. Asked if the stepped-up mobilizing could be a prelude to a drive to defeat the legislation, spokesman Robert Zirkelbach said, "We’re hitting the button on a strong grass-roots campaign right now in support of reform."

Last week, the Chamber of Commerce wrote leaders of the Senate health panel, saying it would oppose their bill unless it is reworked because it would be "harmful to businesses of all sizes, to the economy, and to American workers." The letter from the group, representing 3 million U.S. businesses, was one of the most explicit statements of opposition so far from a major participant.

The chamber wants to kill provisions requiring employers to offer health coverage, creating a federally run insurance plan and creating a government board to help make benefit decisions.

On the other side, labor leaders and other supporters of Obama’s effort planned a Capitol Hill rally for Thursday with speakers including actress Edie Falco, who now stars in the Showtime series "Nurse Jackie." Health Care for America Now, backed by progressive and labor groups, launched $1.1 million in television ads in 10 states supporting Democrats’ health efforts, including states with lawmakers on committees writing the legislation.

"Tell your senators — it’s your health. It should be your choice," the ad says.


Associated Press writers Ricardo Alonso-Zaldivar and Erica Werner contributed to this report.

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