How much pain will far-right conservatives cause the GOP leadership on Capitol Hill before Congress reaches a deal to fix this year’s Medicare funding shortfall?
The Tea Party caucus has a lot more skin in this game than in earlier funding fights. Any damage to Medicare has direct, personal impact on the Tea Party's core political base — people over 65, mostly white, and heavily Southern and rural.
The members of Congress representing this Tea Party base ultimately folded in their battle to halt President Obama's immigration reform. They let Speaker John BoehnerJohn BoehnerTrump, GOP fumble chance to govern ObamaCare gets new lease on life Ryan picks party over country by pushing healthcare bill MORE (R-Ohio) use Democrats to pass a clean funding bill for the Department of Homeland Security. Now the GOP infighting goes to a higher level.
The politics of Medicare reform is as personal as it gets for those stalwart Republican seniors who voted for Tea Party candidates.
This is not about the groups that some Tea Party backers see as “those people”: immigrants, the poor, the blacks and the young people. It is about themselves.
The debate on the future of Medicare is therefore a key stress test for the already large fissures inside the House Republican caucus. It is a preview of coming pressure on Republicans to deal with other issues, including those pertaining to the federal budget and defense spending.
Two of the three states with the largest number of Medicare beneficiaries, Florida and Texas, each have a prominent Tea Party Republican senator among their congressional delegations: Sen. Marco RubioMarco RubioSenators introduce new Iran sanctions Senate intel panel has not seen Nunes surveillance documents: lawmakers With no emerging leaders, no clear message, Democrats flounder MORE of Florida and Sen. Ted CruzTed CruzHow 'Big Pharma' stifles pharmaceutical innovation AIPAC must reach out to President Trump Under pressure, Dems hold back Gorsuch support MORE of Texas. (California has the largest number of people on Medicare.)
But leading conservative groups, such as Club for Growth and Heritage Action, are demanding that Congress and Tea Party politicians cut overall spending on Medicare as part of their assault on entitlements, deficits and big government.
The outside groups’ opposition is aimed at the top proposed deal for reform now being considered by the two major parties. Under the deal, Republicans will have to agree to an extension for state health insurance for children. In exchange, Democrats will have to consent to a GOP proposal for the first dose of means-testing for seniors using Medicare.
For seniors, the key to any deal is the quality of care and the ease of finding a doctor. On that point, the reform deal offers the doctors a higher level of pay for providing better overall care to Medicare patients — very different from the current, and often criticized, fee-for-services schedule.
That change, in line with ObamaCare provisions that reduced the rate of growth in annual Medicare spending, has support from leading Republicans and Democrats on the committees with oversight of Medicare, as well as congressional leadership on both sides of the aisle.
But Heritage Action is telling far-right voters, including seniors, to oppose the deal:
“Americans don’t hand Republicans a historic House majority to engage in massive deficit spending,” Dan Holler, a spokesman for the group told a reporter.
Such sentiments pressure Tea Party politicians to support the traditional but makeshift “doc fix” — a one-year increase in pay to doctors — for one more year so long as there are cuts elsewhere in the Medicare program to off-set its cost.
"Some fiscal hawks are defending the [doc fix approach] because Congress often claims to offset the cost of higher physician payments with spending cuts elsewhere in Medicare," the Wall Street Journal's conservative editorial writers declared last week. "If [it] really did force Congress to reduce government [spending], that would be great. But the 'pay-fors' are usually fake — mostly the failed habit of fiddling with this or that price-control dial in Medicare.
“Conservatives are supposed to understand that price controls distort markets and don't work," the Journal concluded. "So much the better if reasonable Republicans and Democrats can agree to commit the Sustained Growth Rate [and the doc fix] to the glue factory."
But without GOP agreement on the reform all that is left is the prospect of another one-year "doc fix." And if the Democrats insist on the reform deal by refusing to sign on to another “doc fix” the result will be an uprising among the Tea Party's most faithful supporters: American seniors faced with less access to doctors.
There is an even bigger danger for all those over-65 Republicans, too – higher out of pocket costs for medical care if nothing is done. If neither a "doc fix" nor the current reform proposal passes, seniors will be hit with new, higher rates for coinsurance and higher levels for deductible costs.
This is not in dispute. James Braid, the education coordinator at Heritage Action acknowledges that “this year, Medicare payments to physicians will be reduced 21 percent if no "doc fix" passes by March 31.”
If Congress fails to agree on reforms and opts for another "doc fix," it will only delay the inevitable increased costs and reduce access to doctors for a lot of people in the Tea Party base: Medicare patients.
That is a prescription for GOP political malpractice.
Juan Williams is an author and political analyst for Fox News Channel.