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Funding bill skips measure to avert physician pay cuts, a blow to GOP Doctors Caucus

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The funding bill House Republican leaders released on Saturday does not avert cuts for doctors who treat Medicare patients — a blow to Republicans who had pushed for the changes that also could risk alienating members whose support will be needed to pass the legislation.

Rep. Greg Murphy (R-N.C.), who co-chairs the GOP Doctors’ Caucus, said in recent months that Republican leadership was open to including the policy in the bill to keep the government funded through September, and that Trump administration officials had assured it would be addressed. Five health industry lobbyists, granted anonymity to share details of private negotiations, were also anticipating it would be a part of the funding measure to avoid a shutdown after March 14.

Murphy said in an interview its inclusion would be a “line in the sand” necessary for his support. A Murphy spokesperson did not immediately respond to a request for comment about whether the lawmaker was still adhering to that position.

Speaker Mike Johnson can only afford to lose two votes on his side of the aisle if all Democrats band together and oppose the government funding bill, a position the minority party could ultimately take.

Two lobbyists aware of the closed-door negotiations said the patch for doctors was ultimately not included amid broader concerns among Republican leadership that adding more than standard extensions of programs would open the door to more demands for other policies to be attached.

But the legislation released Saturday, which would hold most current spending levels through the end of the fiscal year, is far from “clean“: It would boost spending for illegal immigrant deportations while cutting — and in many cases completely zeroing out — money for a variety of non-defense programs. It’s not clear how leadership will justify the exclusion of one policy provision when other priorities are getting addressed.

The doctors’ pay fix would have prevented further cuts from going into effect that would slash deeply into salaries for doctors providing Medicare services based on an outdated formula. It was part of a larger health care overhaul package set to pass as part of a year-end government funding bill in December. Then-President-elect Donald Trump and Elon Musk complained that bill was overly broad, and the package got scrapped.

Members of both parties warn the stakes are high for not addressing this issue quickly: Decades of payment reductions in Medicare have put physician practices in difficult financial straits, doctors groups say — meaning they could be forced to close their practices and reduce access to care.

But while though there is no relief for doctors, the stopgap funding bill would — as expected — include an extension of eased telehealth rules until September, avoiding a potential disruption in access to care if adopted.

Those relaxed telehealth rules were first introduced by the Center for Medicaid Services during the Covid-19 pandemic when physical doctor offices were closed. Congress has extended those telehealth rules several times, but a permanent solution has remained elusive.

The stopgap bill would also extend hospital-at-home waivers that enable facilities to offer more care at home. It would, as well, extend funding for community health centers, alongside a delay in funding cuts to safety-net hospitals.

The Affordable Care Act called for such cuts, expecting such hospitals wouldn’t have to offer less care without getting paid as millions more got covered through the law, but Congress has never let them go into effect.

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Congress

Chuck Schumer is in a real shutdown mess. Can he lead Democrats out of it?

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Two days out from a government shutdown, Chuck Schumer and Senate Democrats find themselves in a serious jam. But some of them are starting to hint at how they might get out of it.

Publicly, the Senate minority leader and many of his fellow Democrats are vowing they won’t provide the votes to allow a House GOP funding bill to pass, while demanding a vote on a Plan B. Privately, though, Senate Democrats appear to be moving toward that potential offramp: Securing a vote on their preferred 30-day stopgap bill in exchange for helping the House bill, which funds government through September, clear the 60-vote filibuster hurdle — even if they ultimately oppose it on final passage.

The emerging strategy comes as Schumer has convened his caucus for a string of meetings that have grown so boisterous at times that they’ve been overheard outside the room where Senate Democrats have huddled.

It’s a significant moment for Schumer: He’s trying to bridge disagreement within his caucus over how hard to fight amid fears from some of his members that a shutdown would only empower President Donald Trump and Elon Musk. Meanwhile, outside groups — and even their Democratic colleagues across the Capitol — are pressuring them to reject the House GOP funding bill even if it means shuttering the government.

Where Democrats end up will say a lot about how they intend to navigate the weak position in which they find themselves, with Republicans in control of both chambers of Congress and the presidency. They’re under immense pressure from the left to use the scant leverage they have to slow down Trump’s early-term blitzkrieg. But the party is wary of a shutdown that could be pinned on them — and exacerbate their political woes.

The first test for Schumer and Senate Democrats will come on Friday, when Republicans have teed up the first vote on advancing the House GOP bill. Democrats will need to either back up their statement that the House GOP bill can’t get the 60 votes needed to advance or Senate leaders will need to reach an agreement that Democrats can live with.

Publicly and privately on Wednesday, Schumer sought to unify his caucus with a demand for a short-term spending patch, while pulverizing the House GOP bill. After giving his members the same message at a Democratic caucus lunch, Schumer took to the Senate floor and declared that Republicans do not currently have the 60 votes needed to advance the House GOP bill.

“Our caucus is unified on a clean April 11 CR that will keep the government open and give Congress time to negotiate bipartisan legislation that can pass. We should vote on that. I hope … our Republican colleagues will join us to avoid a shutdown on Friday,” Schumer said from the Senate floor after his caucus meeting.

But behind the scenes, after days of listening to the disparate voices in his ranks, Schumer appears to be ready to help steer his caucus away from unilateral shutdown brinkmanship. Instead, he’s making a demand that will let his members take a unified vote and, they hope, peel off a few Republicans unhappy with a seven-month stopgap. It’s all a sign that even as Democrats are enjoying their first instance of potential legislative leverage in the Trump era, they might not all be willing to live with the political consequences of playing hardball.

“[Our] strategy kind of emerged after he heard everybody out yesterday,” said Sen. Tim Kaine (D-Va.) of Schumer.

He said that Schumer started the closed-door meeting on Wednesday by saying, “‘I listened to y’all yesterday’” and that he believed the emerging strategy “would seem to unify a lot of us.”

“And I think it was a productive discussion. I think it was a good idea,” Kaine continued, adding that Schumer has been good at letting the caucus air their opinions and “not starting to put his thumb on the scale.”

Nothing is finalized. Schumer notably did not say publicly that, if Republicans give them a vote on the 30-day stopgap, Democrats would help get the House bill to the finish line. Senate Majority Leader John Thune (R-S.D.) told reporters he did not believe Senate Democrats had made an offer, though he said “we’re open to those conversations and discussions.”

But Kaine spelled out the strategy after the closed-door Senate Democratic lunch. And Sen. Richard Blumenthal (D-Conn.) added that his understanding was that the vote on a short-term funding extension would be taken as an amendment to the underlying bill. “I think we would have 60 votes” for advancing the House GOP bill, Blumenthal said, if Republicans agreed to give Democrats a vote on their alternative as an amendment.

The maneuvering came amid clear misgivings about the damage a government closure could do.

“If you shut down the government,” Sen. John Hickenlooper (D-Colo.) told reporters, “[Trump] will decide, without any safeguards, what gets reopened, what doesn’t. Who knows how long he’ll want to keep the government shut down so that he has total control. … The president gets immensely more authority.”

Added Sen. Mark Kelly (D-Ariz.): “Especially in this environment when we have an unelected billionaire that’s already shutting down parts of the government, the president could certainly give him the authority … where Elon Musk gets to decide what gets opened back up.”

But Kelly, Hickenlooper and a handful of their other colleagues who have warned that they could unintentionally empower Musk or Trump are being met with growing pressure from progressives. They include House Democrats across the Capitol who almost unilaterally opposed the House Republican bill. Democratic leaders hoped that would give senators political cover to oppose the legislation, too.

Rep. Ted Lieu (D-Calif.), vice chair of the House Democratic caucus, said whoever votes to fund the government owns whatever bad things come next from Trump and Musk, “so we’re asking Senate Democrats to vote ‘no.’”

“We’re standing on the side of working families,” Democratic Whip Katherine Clark said. “That’s why our message to the Senate is also stand with us on that side.”

Katherine Tully-McManus, Jennifer Scholtes, Nicholas Wu and Mia McCarthy contributed to this report.

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‘Be careful about this’: Warnings abound as GOP considers writing off tax cuts

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It’s the accounting maneuver that could break the Senate, upend the federal budget process and explode the national debt.

That’s according to critics of a fiscal tactic that congressional Republicans are now seriously considering as they struggle to figure out how to deliver on all of President Donald Trump’s policy demands.

Adopting the “current policy baseline,” as it’s called, could be the only way for the GOP to make Trump’s 2017 tax cuts permanent and avoid painful cuts to federal programs, as well as pile on new income tax exemptions for tips, overtime and Social Security. Trump is expected to discuss the move with members of the tax-writing Senate Finance Committee at a White House meeting Thursday.

If lawmakers adopt the change, it would essentially make it appear as though extending current tax rates, set to expire at the end of the year, would cost nothing rather than the roughly $4 trillion over 10 years that nonpartisan scorekeepers estimate.

But while some Republicans argue that continuing current tax rates shouldn’t be counted toward the deficit, critics of the maneuver — including prominent GOP budget experts — say that it would be a recipe for disaster, a fiscal Pandora’s box that once opened could be used to forever excuse huge ongoing deficits.

“I would caution my friends, my Republican friends and senators up there, be careful about this,” said Bill Hoagland, the former GOP staff director for the Senate Budget Committee. “Someday you may be in the minority.”

The tactic is so tempting because it would solve a very difficult political problem for Republicans. Budget hawks in the House who do not want the party-line domestic policy bill adding to federal deficits want to ensure that planned tax cuts are closely tied to the amount of spending cuts Republicans can achieve.

Even then, the $4.5 trillion upper limit the House put on tax cuts does not leave enough room for a permanent extension of expiring tax cuts, in addition to all the other tax-related asks Trump has made.

For instance, adding on Trump’s other tax-related asks, such as income tax exemptions for overtime, tips and Social Security benefits, could add up to another $5 trillion, according to the nonpartisan Committee for a Responsible Federal Budget.

Critics say members of either party could use the maneuver to disguise trillions of spending through tax policies. Democrats argue that if Republicans move forward, they would be doing away with decades of precedent — and reneging on decades of anti-deficit rhetoric — to enact tax cuts for the wealthy.

Massachusetts Sen. Elizabeth Warren called it “magic math” in an interview and said going in that direction would end the congressional budget process as it has existed for more than 50 years.

“They can’t repeal the underlying reality, a $4.7 trillion giveaway to billionaires and giant corporations will cost $4.7 trillion,” she said, referring to how much the tax cut extensions are estimated to cost with interest.

Said Sen. Mark Warner (D-Va.), who signed onto a recent letter with Warren questioning the GOP’s strategy, “If this was done in the accounting world, you wouldn’t be an accountant for very long.”

Meanwhile, the leading advocate of moving to a current policy baseline, Senate Finance Chair Mike Crapo (R-Idaho), argued that it would rectify budget scoring rules that favor higher spending over keeping taxes low.

“If you’re not changing the tax code, you’re simply extending current policy, you are not increasing the deficit,” Crapo said on Fox Business in January. “We’ve got to get some kind of sensibility into the way that we score.”

Sen. John Kennedy (R-La.), a Budget Committee member, brushed off the idea that Republicans were undermining the budget procedures in place since 1974 — but also acknowledged that turnabout could be fair play when Democrats get their next governing trifecta.

“They will probably use current policy themselves in the future when they’re back in the majority,” he said.

Besides being controversial from an accounting perspective, the current policy baseline represents a major political gamble for Republicans, with the fate of potentially all of Trump’s tax agenda hanging in the balance.

That’s because the GOP might not know for weeks, if not months, if the maneuver will pass muster with the Senate’s parliamentarian. With a permanent extension of the expiring tax cuts moving toward the center of the Republican must-do list, an adverse ruling could create a huge hole in the GOP’s math.

“It would complicate making the tax cuts permanent,” said Sen. Lindsey Graham (R-S.C.), who chairs the Budget Committee.

That could create pressure for Republicans to overrule or even fire the parliamentarian — a move that would upend the delicate balance senators of both parties have adhered to for decades: Only bills that comply with strict fiscal rules aimed at reducing deficits can be exempted from the chamber’s 60-vote requirement for ending debate and moving to a final vote.

“As far as I’m concerned, that might as well give away the filibuster in the Senate,” Hoagland said.

Republicans, for their part, say they aren’t doing anything out of compliance with the longstanding budget rules. And there’s widespread skepticism inside the Senate GOP that they would ever vote to overrule the longtime parliamentarian, Elizabeth MacDonough.

We can say “it’s a $4 trillion deficit that we’re going to add into this, or we can say it’s current policy, but everyone knows it’s the exact same the next day,” said Sen. James Lankford (R-Okla.) in an interview. “So it’s nomenclature.”

Key GOP staff are already quietly meeting with the parliamentarian to try to get informal vibe checks on what she is thinking. Though senators won’t get a formal ruling until they go through what’s called a “Byrd bath” — when the reconciliation bill is vetted to make sure it complies with the rules that allow them to pass it by a simple majority — they can and frequently do have conversations with the parliamentarian’s office before that as they try to game out their procedural strategy.

“We think the law is pretty clear … but these things are all subject to discussion and arguments made in front of the parliamentarian,” Senate Majority Leader John Thune said in a brief interview, while cautioning that they were a long way away from that point.

But there’s skepticism from former longtime congressional staff and budget experts that the Senate GOP plan will fall within the rules of reconciliation. Sen. Jeff Merkley (D-Ore.), the top Democrat on the Budget Committee, predicted the parliamentarian won’t green-light the GOP strategy because it “seems like a pretty big stretch” of the rules.

George Callas of Arnold Ventures, who served as former Speaker Paul Ryan’s top tax aide during the drafting of the 2017 law, said adopting the current policy baseline would amount to a “huge gimmick.”

“My understanding is that the Senate parliamentarian gives a great deal of weight to the existing rules and the precedents and takes a skeptical look at just expedient reinterpretations of those rules for political reasons,” he said.

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How many GOP senators ‘support DOGE’? Rand Paul pushes to vote on it.

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Sen. Rand Paul wants to force the Senate to vote on codifying President Donald Trump’s cuts to foreign aid, a potential hitch for Republican leaders working to pass a bill to prevent a government shutdown Friday night.

Paul wants the Senate to vote on an amendment that would cut foreign aid grant funding by 83 percent, which would enact the reductions Secretary of State Marco Rubio and the president’s Department of Government Efficiency are already making. The Kentucky Republican predicts that about half of Republican senators would oppose the amendment, putting them on record against the Trump administration’s work.

“My vote will be an example of how many people support DOGE,” Paul told reporters on Wednesday. “No Democrats, obviously. But on the Republican side, how many people actually would cut any money from foreign aid? I think you’ll be surprised, or maybe you won’t.”

Paul has a reputation for sticking with his threats to drag out debate on funding bills if he doesn’t get his way. He spurred a brief government shutdown in 2018 because Republican leaders denied him a vote to tweak a budget agreement. But he won’t say whether he’d go to the same lengths this week, as GOP leaders try to speed up final passage of the seven-month funding patch House Republicans sent over Tuesday night.

“That’s top-secret,” Paul said.

The Kentucky Republican plans to vote against the funding measure, along with droves of Senate Democrats, who oppose the measure for completely different reasons than the fiscal hawk. Also threatening to drag out debate, Senate Democrats are demanding a vote on a four-week stopgap funding bill as an alternative to the Republican-led measure that would cut non-defense funding by about $13 billion while boosting defense budgets by roughly $6 billion.

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