When the votes were tallied late Thursday, the sum was 58 -- not enough for U.S. Senate passage, and certainly not enough to override a presidential veto.

The failure to pass the Medicare Improvements for Patients and Providers Act means, among its other implications, that new rules for suppliers of durable medical equipment -- wheelchairs and oxygen tanks, for example -- are now set to take effect in the Pittsburgh area.

Pittsburgh was selected as a pilot area for Medicare's new "competitive bidding" procurement process. Small companies that used to be able to contract through Medicare to supply chairs, beds, oxygen equipment, walkers and other goods simply by meeting Medicare's price quotes now won't be able to unless they've bid successfully for the job, falling into a new, lower price range set by Centers for Medicare and Medicaid Services.

About a quarter of the companies that bid to be suppliers were selected, said Kerry Weems, acting administrator of CMS.

That means many outside-looking-in companies won't be able to continue doing business with new Medicare beneficiaries.

Others may be selected as subcontractors to the winning bidders, he said. Still more may be "grandfathered" in and allowed to continue servicing existing clients.

But in any event, the companies that have been lobbying against the new regulations, approved in 2003 and set to take effect July 1, aren't CMS' primary concern.

"The savings don't just accrue to the federal government," Mr. Weems said. Because beneficiaries pay up to 20 percent of equipment costs, they, too, see savings.

Oxygen tanks rental, for example, might cost $2,400 a year. If the new bidding constraints can knock 30 percent off that price, to $1,680, the savings to the beneficiary over the course of a year is about $144.

The simple fact is that "the federal government and beneficiaries are overpaying for durable medical equipment," said Mr. Weems, in Pittsburgh on Friday to discuss the rule changes.

But U.S. Rep. Jason Altmire, D-McCandless, said whatever savings the government nets will be offset by jobs lost and by impersonal service.

"The fact that they couldn't get it through the Senate is incredibly disappointing," especially after the bill sailed through the House, 355-59.

"This is going to have a material impact on a lot of these local companies," he said. There are 400-plus medical equipment providers in the Pittsburgh area.

A Robert Morris University study commissioned by the Pennsylvania Association of Medical Suppliers said "any short-run cost savings will be more than offset by long-run increases as successful bidders gain market power over time," creating an oligopoly.

The new bidding system also is taking effect in nine other pilot regions: Charlotte, N.C.; the Cincinnati area; Cleveland; Dallas-Fort Worth-Arlington; Kansas City; Miami; Orlando, Fla.; Riverside, Calif.; and San Juan, Puerto Rico. Congress could revisit the Medicare bill after its Fourth of July recess.

Those with questions about the new rules should call 1-800-MEDICARE, or 1-800-633-4227.