Doc fix could face up to four budget challenges

Senate Republicans on Monday will have a chance to offer up to four points of order against the "doc fix" bill up today, although it's not yet clear whether any of these challenges will be made.

Late today, senators will consider the doc fix bill, which would dodge a pending 24 percent cut to Medicare physician reimbursements for another year, through March 2015. The House passed this bill, H.R. 4302, last week.

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While the Senate is widely expected to pass the bill today, Senate Budget Committee staff has confirmed to other Senate offices that up to four budget points of order lie against the bill. If any of these points of order are raised, the Senate would need to muster 60 votes to overcome them.

One of the points of order that could come up is one that says the bill violates Senate "PAYGO" rules, which generally require new spending to be offset either with new revenues or spending cuts.

According to the Congressional Budget Office, the bill is technically paid for over the next 10 years. But it does so in part by shifting planned Medicare cuts from 2025 to 2024 — thus, it creates no real savings outside the 10-year budget window.

Another point of order that could come up is that the doc fix bill violates the top-line spending number in the recently passed Ryan-Murray budget deal.

Senators could also raise a point of order that the bill spends more than is allowed under the Senate Finance Committee's allocation. And last, the bill could be challenged because it includes language that the Senate Budget Committee has yet to approve.

Even if any or all of these challenges are raised, it seems likely that the Senate would simply waive these points of order in order to approve the doc fix bill. If the Senate fails to act tonight, the cuts to Medicare reimbursements take effect tomorrow.