Senate Approves Budget Proposal That Includes Cuts to Health Spending

On Saturday, the Senate voted 50-49 to approve a $3.7 trillion fiscal year 2014 budget proposal that includes $275 billion in health care reductions and calls for nearly $1 trillion in tax increases over the next decade, AP/Modern Healthcare reports (Daly, AP/Modern Healthcare, 3/25).

The vote marks the first time in four years that the Senate has adopted a budget proposal (Wasson, "On The Money," The Hill, 3/23).

About the Proposal

The Senate Democratic proposal (S. CON. RES. 8) -- written by Senate Budget Committee Chair Patty Murray (D-Wash.) -- would reduce the federal deficit by $1.85 trillion. Murray's proposal would lower the federal budget deficit to an amount equal to 2.2% of gross domestic product by 2023 through an equal mix of new tax revenues and spending cuts, including a $265 billion reduction to Medicare and a $10 billion cut to Medicaid.

In addition, Murray's budget proposal would replace the $1.2 trillion mandated cuts under sequestration, including a 2% cut to Medicare reimbursement rates, with a mix of targeted spending cuts and new tax revenue (California Healthline, 3/22).

Four Democrats -- Sens. Max Baucus (Mont.), Mark Begich (Ala.), Kay Hagan (N.C.) and Mark Pryor (Ark.), all of whom are up for re-election in 2014 in Republican-leaning states -- joined the entire GOP caucus in voting against the budget ("On The Money," The Hill, 3/23).

The Senate budget proposal offers a stark contrast to House Budget Committee Chair Paul Ryan's (R-Wis.) House-approved FY 2014 budget proposal, as lawmakers prepare to open discussions on how to deal with reducing the federal deficit (Montgomery, Washington Post, 3/23).

Although it is extremely unlikely either budget will take effect, congressional committees could work on a reconciliation bill if House and Senate negotiators can come to an agreement for overhauling the tax code and federal entitlement programs, such as Medicare, according to the New York Times.

Both Republicans and Democrats have expressed a desire to reduce the federal deficit. President Obama has been pushing for a deficit-reduction deal that would include a combination of tax increases and spending cuts.

However, GOP leaders -- who are seeking significant reductions in Medicare and other federal entitlement programs -- say they will not consider raising taxes (Weisman, New York Times, 3/23).

Obama is expected to release his own 2014 budget next month, which could provide some insight into his willingness to engage Republicans in negotiations, according to AP/Modern Healthcare (AP/Modern Healthcare, 3/23).

Senators' Amendments

During a debate prior to the vote, senators proposed more than 400 amendments, including about 80 health care-related amendments, The Hill's "Healthwatch" reports. Nearly 30 of those proposals were designed to modify the Affordable Care Act, while three were aimed at curbing abortion rights policies (Vibeck, "Healthwatch," The Hill, 3/22).

However, only 103 amendments -- 28 of which were related to health care -- made it to the floor for a full vote (Khimm, "Wonkblog," Washington Post, 3/23).

Among the proposals that reached the floor for a vote was a measure to repeal the ACA's medical device tax, which passed in a 79-20 vote, and an amendment to repeal the entire ACA, which failed in a 45-54 vote (Cox, "Floor Action Blog," The Hill, 3/22).

The Senate also voted to approve measures by:

Sen. Richard Burr (R-N.C.) to fund the Biomedical Advanced Research and Development Authority and the Bioshield Special Reserve Fund;
Sen. Ben Cardin (D-Md.) to establish funds to improve dental health care for children with Medicaid coverage ("Wonkblog," Washington Post, 3/23);
Sen. Tom Coburn (R-Okla.) to reduce the hospital matching rate for the ACA's Medicaid expansion ("Healthwatch," The Hill, 3/22);
Sen. Susan Collins (R-Maine) to change the ACA's definition of a full-time employee ("Wonkblog," Washington Post, 3/23);
Senate Majority Whip Dick Durbin (D-Ill.) to increase NIH funding for biomedical research ("Healthwatch," The Hill, 3/22);
Sen. Orrin Hatch (R-Utah) to promote innovation and preserve jobs for manufacturers of medical devices and medical treatments;
Sen. Mike Johanns (R-Neb.) to repeal a $2,5000 federal limit on flexible spending accounts and the requirement that individuals first obtain a prescription before using such accounts to purchase over-the-counter drugs;
Sen. Mary Landrieu (D-La.) to change the deficit-neutral reserve fund for service members and veterans to include leases of major Department of Veteran Affairs' medical facilities ("Wonkblog," Washington Post, 3/23);
Sen. Joe Manchin (D-W.Va.) to draw more attention to the fight against prescription drug misuse ("Healthwatch," The Hill, 3/22);
Sen. Bob Menendez (D-N.J.) to reaffirm current law banning undocumented immigrants who later gain citizenship from receiving federal health benefits (Cox, "Floor Action Blog," 3/23);
Sen. Bernie Sanders (I-Vt.) to protect benefits of disabled veterans and their family members ("Wonkblog," Washington Post, 3/23);
Sen. Jeanne Shaheen (D-N.H.) to protect women's health care coverage and employer-provided contraceptive coverage under the ACA ("Floor Action Blog," The Hill, 3/22);
Sen. Debbie Stabenow (D-Mich.) that would establish a fund "to protect Medicare's guaranteed benefits and to prohibit replacing guaranteed benefits with the House-passed budget plan to turn Medicare into a voucher program" (AP/Modern Healthcare, 3/23);
Sen. John Tester (D-Mont.) to extend health care coverage to veterans' children until age 26 ("Healthwatch," The Hill, 3/22);
Sen. Mark Udall (D-Colo.) to increase veterans' access to health care in rural areas; and
Sen. Ron Wyden (D-Ore.) to ensure chronic illness is addressed as part of national efforts to improve health care ("Wonkblog," Washington Post, 3/23).

Meanwhile, the Senate voted to reject measures by:

Sen. Mike Crapo (R-Idaho) to repeal the ACA's tax increases on individuals ("Floor Action Blog," The Hill, 3/22);
Sen. Ted Cruz (R-Texas) to completely repeal the ACA and encouraged patient-centered reforms to reduce costs;
Cruz that would have banned taxpayer dollars from funding United Nations members that force citizens to undergo involuntary abortions;
Sen. Deb Fischer (R-Neb.) to establish funds aimed at protecting women's access to health care;
Sen. Ron Johnson (R-Wis.) that would have required Congress to guarantee the solvency of Medicare and Social Security programs ("Wonkblog," Washington Post, 3/23);
Sen. Pat Roberts (R-Kan.) that would have banned funds from being used to promote or market the ACA;
Sen. Jeff Session (R-Ala.) that would have banned undocumented immigrants who later gain citizenship from qualifying for health care coverage under the ACA or Medicaid (Cox, "Floor Action Blog," 3/23); and
Sen. Pat Toomey (R-Pa.) that would have repealed the ACA's tax increase on catastrophic medical expenses ("Wonkblog," Washington Post, 3/23).

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