One way or another

Republicans and Democrats in Congress are still worlds apart on taxes and spending, as they showed in budget blueprints that launched a new round of debate on the federal deficit. They agree, though, that Congress should find billions in federal healthcare spending to cut over the next decade.

In a 22-17 vote, the House Budget Committee passed Committee Chairman Paul Ryan's proposal to balance the federal budget in 10 years. Mirroring ideas he has put forward in the past two years, the Wisconsin Republican's plan once again recommends a premium-support model for Medicare, which would allow those born in 1959 or later to have a choice between private health plans or traditional fee-for-service Medicare starting in 2024. The House GOP plan would shift Medicaid to a block-grant program for states similar to the Children's Health Insurance Program. Providers and patient advocate groups decried the proposal and the more than $750 billion in Medicaid cuts to providers over 10 years that would result from it.

Ryan's budget also aims to repeal the Patient Protection and Affordable Care Act—although his plan keeps the billions in Medicare cuts that the 2010 law included. “Those cuts would continue, but not to offset coverage—but for deficit reduction,” said Tom Nickels, senior vice president for federal relations at the American Hospital Association. The budget panel approved Ryan's plan, setting the stage for a full House vote this week.

Meanwhile, the Senate Budget Committee introduced—and passed in a narrow 12-10 vote—its own budget proposal, the first spending plan that Senate Democrats have released in four years. The plan introduced by Committee Chairman Patty Murray

(D-Wash.) would end the $1.2 trillion in federal spending cuts resulting from the 2011 Budget Control Act's sequester that kicked in March 1, which includes 2% in Medicare cuts to providers after April 1. It would also cut federal healthcare spending by $275 billion over the next decade.

In a budget hearing, Murray said the billions in healthcare cuts would not harm seniors or families. “There are no sacred cows, we put everything we can on the table, but we do it in a responsible way that preserves, protects and strengthens the programs like Medicare and Medicaid that the American people strongly support.”

The upper chamber is expected to vote on the Senate Budget Committee's plan this week. Meanwhile, President Barack Obama is expected to release his fiscal 2014 budget the week of April 8.