Senate Democratic leaders are poised to blame Sen. John McCain (R-Ariz.) for the chamber’s failure to advance Medicare legislation.

The measure that would avert a sharp cut in payments to physicians stalled in the Senate on June 26 by one vote. McCain, the GOP presidential candidate, did not attend the vote and has yet to declare his position on the issue.

Any one of the 39 Republicans who voted no could rescue McCain from a politically damaging situation. One GOP leadership aide hinted that Texas Sen. Kay Bailey Hutchison, among the no votes, is “concerned” about the impasse but has yet to reveal her intentions.

Hutchison would not comment on whether she would reverse course and support advancing the bill, her spokesman said.

In the meantime, Democrats keep pointing to McCain.

“There’s nothing to stop [the cut] unless the Republican senators give us one more vote, and we’d like to know where John McCain is on the issue,” said Senate Democratic Whip Dick Durbin, a national co-chairman of fellow Illinois Sen. Barack Obama’s presidential campaign.

The stalemate has prompted doctors’ groups to launch blistering attacks against Republicans who supported the filibuster. The bill would prevent a 10.6 percent cut in payment rates for doctors who operate under Medicare, and would be paid for by cuts to private plans known as Medicare Advantage, a central point of contention.

The Arizona Medical Association has been quiet about McCain. He has largely dodged criticism from the national group as well as from his Senate GOP colleagues, who have borne the brunt of the criticism through televised attack ads.

With Democrats planning to bring the bill back up for a critical test vote Wednesday, they are now prepared to pinpoint McCain if they cannot advance a measure that doctors’ groups say is needed to ensure access is not cut to Medicare for the elderly and military veterans.

“If we don’t get 60 votes, the Republicans are going to have to live with that,” Senate Majority Leader Harry Reid (D-Nev.) said.

The same may be true for some doctors’ groups.

“We’ve been asking a lot of the same questions about McCain,” said Christian Shalgian, interim director of the American College of Surgeons. “He’s ducking this vote, and we don’t know why.”

Spokesmen in McCain’s Senate and campaign offices did not respond to inquiries seeking comment. The Arizona group also did not return several telephone calls seeking comment.

Most Republicans who opposed cloture last month appear ready to do it again. Senate Minority Leader Mitch McConnell (R-Ky.) and Minority Whip Jon Kyl (R-Ariz.) have been immovable in their opposition to the Democratic bill and have sent unmistakable signals of what is expected from the rank and file.

Even some of those senators most squarely in the crosshairs are not backing away from their votes. GOP Sens. John Sununu (N.H.), John Cornyn (Texas), Thad Cochran (Miss.) and Roger Wicker (Miss.) — all of them up for reelection this year — have given no hint that their next vote on cloture will be any different than the last one.

By contrast, other vulnerable Republicans — such as Sens. Norm Coleman (Minn.), Gordon Smith (Ore.) and Ted Stevens (Alaska) — voted with Democrats.

The Texas Medical Association withdrew its endorsement of Cornyn in his Senate race because of his vote to sustain a filibuster and is also pressuring Hutchison.

Cornyn signaled Tuesday he would likely stick by his vote.

“I’m going to ask the majority leader and the Democrats, rather than engage in this kick-the-can-down-the-road and sort of political point-scoring, to actually solve the problem,” Cornyn said. “We’re frankly whistling past the graveyard with these temporary little patches.”

If none of those GOP senators flip, McCain could find himself in a tough spot. If he votes for the measure, he would please physicians’ groups but anger insurance companies, many of his Senate Republican colleagues and the White House, which has threatened a veto. But if he skips the vote or opposes the bill, he would open himself up to attacks of supporting a cut in doctors’ payments and stiff-arming elderly and military veterans’ access to Medicare.

McCain has rebelled against his conference on a hot-button Medicare issue before, voting in 2003 against a prescription drug bill and supporting the importation of prescription drugs. But he also has sided largely with the GOP view that the private sector is better at dealing with healthcare than the government.

“We’re trying to get one more vote, and we hope it’s John McCain,” Durbin said.

Republicans oppose the cuts, saying that it would hurt access for patients in less-populated areas.

Democrats say the plans get too much money.

The American Medical Association has backed the Democrats’ position and accused the GOP senators of siding with insurance providers over doctors who might have to limit access for patients because of the cuts.

Republicans have insisted they be allowed to offer amendments and have offered a month-long extension until the two parties reach a resolution. But Democrats say amendments would slow down a bill that has already been approved by a 355-59 vote in the House.

“Even the American Medical Association — which has not been a patch that we Democrats have worn to our campaign rallies in the past — they’re running ads against Republicans in specific states saying they’re wrong,” Reid said.

McConnell said Reid was taking the wrong approach since Bush has promised a veto, which would further delay the restoration of doctors’ payments.

“We’d like to get a result, and a vetoed bill does not produce a timely result,” McConnell said.

Don Stewart, a McConnell spokesman, said Republicans have repeatedly sought to stave off the doctors’ cut by seeking a month-long extension, but noted that Democrats have blocked these efforts.

“But when it comes to doctors, they’re willing to let the cuts take place rather than work across the aisle to reach an agreement that can pass the Senate and be signed into law,” Stewart said. “That’s a position that’s difficult to understand.”