House and Senate budget talks target Affordable Care Act

On Monday afternoon, House and Senate members gathered on Capitol Hill to hash out their differences on a budget blueprint for the next decade. But there was little debate over specific discrepancies between the House and Senate plans.

Instead, the two-hour hearing was devoted to speeches by conference committee members rehashing familiar partisan tropes.

“Repealing the president's healthcare law would pave the way to starting over on patient-centered healthcare reform, where patients and families and doctors are making medical decisions, not Washington, D.C.,” said Rep. Tom Price (R-Ga.), chair of the House Budget Committee.

“America is the only major country on earth that doesn't guarantee healthcare to all of its people,” countered Sen. Bernie Sanders (D-Vt.), the ranking member of the Senate Budget Committee. “Despite the modest gains of the Affordable Care Act, 35 million Americans continue to have no health insurance.”

The lack of detailed spending discussions is indicative of the fact that the budget process is a largely symbolic exercise. Congressional Republicans plan to pass a budget that abolishes the Affordable Care Act and eliminates deficit spending within a decade.

House and Senate Republicans differ on some significant details when it comes to healthcare policy. Most notably, the House wants to move Medicare to a “premium support” model starting in 2024, whereby beneficiaries would receive subsidies to purchase coverage through an exchange. The Senate budget blueprint simply calls for reducing Medicare spending by $423 billion over a decade, the same level as in the president's budget, but provides no details.

But whatever the negotiators settle on, those proposals aren't going to be enacted anytime soon. That's because they're anathema to President Barack Obama and most Democrats, and Republicans don't have anywhere close to the majorities needed to override vetoes.

“Frankly, a budget resolution, even a joint resolution, doesn't really bind anybody to do anything,” said Joe Antos, a health policy expert at the conservative American Enterprise Institute.

Christopher Condeluci, a former top GOP Senate Finance staffer, said the point is to show the public that the GOP majorities aren't dysfunctional. “The Republicans can indicate to the American public that they came to Congress to get things done, unlike what has occurred over the past however many years when a budget has never been reported out,” Condelucci said.

Once Republicans settle on a budget resolution, it will be up to committees to fill in the fine print. The real discussion about 2016 appropriations will occur as the close of the fiscal year approaches at the end of September and the possibility of another government shutdown begins to loom.

Perhaps more interesting in the coming weeks will be whether Republicans opt to pursue significant policy changes through the budget reconciliation process. That path is enticing because it allows passage through the Senate with just a majority of votes. Some Republicans want to use it to repeal the Affordable Care Act, even though it would be certain to draw a presidential veto. But there's also talk of using reconciliation for an overhaul of the tax code. And some would like to reserve it as a means to respond if the U.S. Supreme Court strikes down subsidies in up to 37 states in the King v. Burwell case. A ruling is expected by the end of June.

But it's uncertain if Republicans will use reconciliation at all. Condelucci isn't convinced that they're serious about attacking major issues through that process.

“They will slow-walk reconciliation and the calls for using it all the way through until the presidential campaign really heats up, and then they won't be able to use it at all,” he predicted. “The closer you get to the presidential election the less likely reconciliation will occur.”

Antos, meanwhile, said the reconciliation process would take too long to be an effective means of responding to a Supreme Court ruling eliminating subsidies, and he thinks it would be a waste of time to target a full repeal of the ACA.

“It's a lot of work that will go into something that will lead to nothing,” he said.

Another wrinkle in the budget process could be lingering fallout from the repeal of Medicare's sustainable growth-rate formula. While that legislation cleared both legislative chambers by overwhelming bipartisan margins, some conservatives are still chafing at the fact that only about a third of the $200 billion-plus package was offset by spending reductions.

Sens. Jeff Sessions (R-Ala.) and Mike Crapo (R-Idaho) both raised the issue during Monday's conference committee. They argued that it sends a contradictory message to the public at a time when Republicans are negotiating a plan to balance the budget within 10 years.

“We've got to find a way to offset the SGR vote,” Crapo said. “It was a good vote, but we need to offset it.”