Medicaid vote an obstacle for GOP

As the Republican leadership in both chambers prepares to move toward final action on the fiscal year 2006 budget resolution, the path toward passage remains treacherous.

In a move that suggests cautious optimism that a deal can be struck on mandatory spending decreases, a conference committee meeting tentatively has been scheduled for today. A House Republican aide indicated that negotiations are proceeding well enough to justify the conference sit-down.

Moreover, Democratic aides said the GOP leadership had agreed to permit a high-profile motion to instruct the budget conferees to side with the Senate and move a budget that does not call for reduced Medicaid spending and the creation of a yearlong commission to study systemic changes to the healthcare program for the poor.

Such a vote ordinarily would take place in conjunction with a motion to send a measure to conference and designate conferees — steps the House had yet to take. The Senate named its conference committee members April 4.

Senate Majority Leader Bill Frist (R-Tenn.) has maintained that he wants to begin debating a conference agreement this week.

Budget Chairman Judd Gregg (R-N.H.) declined to speculate whether a deal was imminent yesterday. Asked by reporters whether the Senate leadership and House Budget Committee Chairman Jim Nussle (R-Iowa) can agree to an approach to mandatory spending reductions, Gregg simply said, “I don’t know.”

The pressure to get a conference agreement this week appears to be real. “We need to reach an agreement soon,” Gregg said. “Otherwise it’ll be hard to do it this week.” If a deal is not made this week, he added, “the time may have passed.”

The House and Senate are significantly far apart on mandatory spending. “There are gaps,” Gregg observed.

The chief sticking point is Medicaid: the Senate budget resolution would not require the Finance Committee to produce any savings from the program, while the House version obligates the Energy and Commerce Committee to cut $20 billion in mandatory programs under its jurisdiction.

Gregg’s mark of the budget would have demanded $14 billion in Medicaid reductions, but Sen. Gordon Smith (R-Ore.) led a group of moderates to join Democrats against the language. Smith has insisted that he does not want to stand in the way of an agreement and by doing so has made himself a player in the negotiations.

Medicare also is on the table, but Finance Committee Chairman Chuck Grassley (R-Iowa) steadfastly has maintained he does not want to tackle Medicare this year.

A compromise on mandatory spending can be reached without Medicare, Gregg said.

The House action slated for yesterday presented a delicate challenge for the GOP leadership. Though motions to the instruct conferees are not binding, a loss on the floor would be seen as an embarrassment.

The Democrats have some reasons to hope for success. Rep. Heather Wilson (R-N.M.) led a group of more than 40 Republicans who signed a letter opposing the Medicaid language. A spokeswoman for House Minority Leader Nancy Pelosi (D-Calif.) remarked, “I would assume that a member who had signed the letter … would vote for the motion.”

The Republican leadership may have no choice but to expose itself to a small loss to move ahead on the budget. A failure to pass a congressional budget resolution would be perceived as a more egregious defeat. A Democratic win on Medicaid in the House also would suggest a lack of support from Republican centrists on the budget resolution itself.

But a deal that wins over Smith and the Senate and forestalls GOP defections in the House on the Democratic motion likely would displease House conservatives who have made absolutely clear they cuts to mandatory programs as essential to reining in the budget deficit.

The House Energy and Commerce Committee is gearing up to tackle Medicaid on its own. The Health Subcommittee, chaired by Rep. Nathan Deal (R-Ga.), has scheduled a hearing today on Medicaid and long-term care.

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