Senate Votes for $141 Billion in More Debt to Cover Medicare Patch

The Republican-led Senate passed legislation Tuesday night that would increase the national debt by an estimated $141 billion over the next decade, and would use the borrowed money to avoid a steep cut in reimbursement rates for Medicare doctors.

Senators approved the bill in an easy 92-8 vote, a margin that showed most Republicans were fine with the idea of borrowing to pay for the policy change. In the final vote, only eight Republican senators voted against the bill to protest an increase in the national debt: Ted Cruz (Texas), Mike Lee (Utah), David Perdue (Ga.), Marco Rubio (Fla.), Ben Sasse (Neb.), Tim Scott (S.C.), Jeff Sessions (Ala.), and Richard Shelby (Ala.).

Both the House and the Senate have passed a Medicare patch that will cost $141 billion over the next decade. The bill does not offset this new spending.

The vote followed consideration of several amendments, including some GOP amendments that would have required spending offsets to fully pay for the so-called permanent "doc fix." However, all of these proposals failed, either because a 60-vote majority was needed, or because not enough Republicans supported the idea of finding a spending offset.

For example, Sen. John Cornyn (R-Texas) offered an amendment to pay for the bill by repealing Obamacare's individual mandate. But Senate leaders decided 60 votes would be needed to pass that proposal — a sure way to guarantee its failure — and it predictably went down in a 54-45 vote, even though a clear majority supported it.

Another amendment from Sen. Mike Lee (R-Utah) would have required the new spending to be paid for in some way, and would have required across-the-board cuts to make up for the $141 billion. Lee's amendment only needed a simple majority to pass.

But that amendment also went down after a dozen Republicans voted against it. Lee's proposal failed 42-58.

Dan Holler of Heritage Action, which urged Republicans to support Lee's language, expressed surprise that so many Republicans would vote against the idea of finding offsetting funds for the bill.

Ayotte, Capito, Collins, Graham, Hatch, Heller and Perdue are among those voting against @SenMikeLee's amendment. #unreal

— dan holler (@danholler) April 15, 2015

voters didn't give Republicans a majority in the Senate to ignore any semblence of fiscal responsibility. but that is what just happened.

— dan holler (@danholler) April 15, 2015

A third GOP amendment, from Sen. Tom Cotton (R-Ark.), would have saved $10 billion over the decade by altering the Medicare reimbursement formula, but that also failed due to an almost total lack of GOP support. A simple majority was needed, but it failed 11-89.

Just before the final vote, Sen. Jeff Sessions (R-Ala.) raised a budget point of order, essentially arguing that the entire bill violates the budget agreement by raising spending without any offsets. Sessions said that with interest, the $141 billion would balloon to $174 billion in more debt.

But in response, Sen. Orrin Hatch (R-Utah) called on the Senate to waive Sessions' complaint. Sixty votes were needed to waive the budget rules, and Hatch's motion easily won in an 71-29 vote, with the help of nearly 20 Republicans.

Along the way, the Senate also rejected three Democratic amendments, including one that would have boosted funding for women's and children's health programs.

Ironically, Republicans actually raised a point of order against that amendment, arguing that it was not paid for. The Senate upheld that point of order, which defeated that Democratic proposal, even though Republicans conspired to ensure the doc fix bill itself would not have to be paid for.

The Senate killed two other Democratic amendments in the same way.

The doc fix bill has been hailed by Republican leaders in the House and the Senate as a final, permanent way around a problem that has plagued Congress for years. In 1997, Congress passed legislation that required cuts to the Medicare reimbursement rate, but Congress routinely decided to dodge those cuts, and periodic legislation was needed to officially avoid the reduction in payments.

Some of those bills offset the new spending, and conservative Republicans have said they oppose the permanent fix precisely because it isn't paid for.

The House passed the same bill in late March, less than a day after the House passed a resolution calling for a balanced budget after a decade. That budget proposal would have resulted in a $50 billion budget surplus in the ninth and tenth years of the plan, but the doc fix bill would wipe out that savings completely.

Without congressional action, Medicare reimbursement rates are set to fall Wednesday, but passage of the bill Tuesday night should allow President Barack Obama to sign the bill quickly and avoid any significant disruption in these payments.