The Republican senators angling to become the party’s next presidential candidate had the opportunity to vote on a major entitlement-reform bill Tuesday—and they were divided over it, opening the door for the issue to make an appearance in the primary campaign.
The Senate overwhelmingly approved the permanent Medicare doc-fix bill, 92-8, and the White House has indicated that President Obama will sign the bill, which would put an end to one of Congress’s most-hated rituals.
The nascent GOP primary field split evenly. Sens. Ted Cruz of Texas and Marco Rubio of Florida voted against the bill. Sens. Rand Paul of Kentucky and Lindsey Graham of South Carolina—who is the only one of the four not to formally announce his expected candidacy yet—voted for it.
The contenders didn’t seem eager to discuss the legislation; Cruz was the only one to issue a public statement before the vote. The other three senators’ offices did not respond to multiple requests for comment before or after the vote.
Cruz derided the bill for not being fully paid for, citing an estimate that it could add as much as $500 billion to the federal deficit in the next 20 years. According to the official Congressional Budget Office score, the bill is expected to cost about $210 billion in the next 10 years, with $70 billion directly offset through cuts to providers and beneficiaries.
“While I appreciate the work done by my colleagues in the House, I cannot support the Boehner-Pelosi bill, which institutionalizes and expands Obamacare policies that harm patients and their doctors while adding roughly half a trillion dollars to our long-term debt within two decades,” Cruz said.
Cruz, Rubio, and Paul all backed an amendment from Sen. Mike Lee, R-Utah, that would have required the bill’s full costs to be offset; Graham opposed it. The amendment, pushed by deficit hawks unhappy about the bill’s costs, failed.
All four senators voted for an amendment to pay for the bill by repealing Obamacare’s individual mandate, though it failed to reach the 60-vote threshold to pass.
The doc fix, negotiated by House Speaker John Boehner and Minority Leader Nancy Pelosi, permanently repeals the Medicare “sustainable growth rate” formula, which routinely threatened 20-percent pay cuts to doctors unless Congress fixed it once or twice a year. It also sets up a transition to performance-based Medicare payments to doctors.
The measure reforms Medicare in several other ways, enacting a deductible for Medigap plans and expanding means-testing for Medicare’s outpatient and drug programs. Cost became an issue during the congressional debate. Supporters assert it will pay for itself in the long term, but opponents argued that it would add even more to the deficit across a longer timeline.
Boehner touted the bill as the “first real entitlement reform in nearly two decades” after it passed the House with 392 votes last month.