2016 GOP Hopefuls Split as Senate Sends Doc-Fix Bill to Obama

Cruz and Rubio oppose the Medicare-reform bill that’s set to become law.

WASHINGTON, DC - SEPTEMBER 27: U.S. Senator Ted Cruz (R-TX) (C), Senator Mike Lee (R-UT) (R), and Senator Marco Rubio (R-FL) (L) speak to members of the media after a vote on the Senate floor September 27, 2013 on Capitol Hill in Washington, DC. The Senate has passed a continuing resolution 54-44 to fund the government through November 15 with the exclusion of defunding the Obama care in which the provision was passed in the House.
National Journal
April 14, 2015, 6:39 p.m.

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.

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