Sahil Kapur

Sahil Kapur is TPM's senior congressional reporter and Supreme Court correspondent. His articles have been published in the Huffington Post, The Guardian and The New Republic. Email him at sahil@talkingpointsmemo.com and follow him on Twitter at @sahilkapur.

Articles by Sahil

While Democrats will claim victory in the impending deal to extend the payroll tax cut through 2012, Republicans have also won some fodder for their base on a key issue: They've managed to slice off a piece of the health care reform law -- albeit a fairly small piece.

A summary of the deal circulated to allies and insiders by House GOP leadership boasts that they've extracted concessions worth $11.6 billion from the Affordable Care Act in negotiations with Democrats. The cuts hit the prevention fund and provider reimbursements -- it's not a big chunk of the nearly $1 trillion law, but it's a salient political win for Republicans after Democrats repeatedly resisted efforts to cut the ACA in the Super Committee and December deal.

The Republicans may also have won on what could become an important matter of principle: whether savings from the projected wind-down of war spending could count as offsets. Democrats had wanted the cutbacks from the "Overseas Contingency Operation" (basically, the wars in Iraq and Afghanistan) to be able to be used as offsets for the so-called "doc fix." Republicans had been under immense pressure to cave on that as well. However, many argued that since these operations had been scheduled to wind down anyway, then they did not count as real savings. Furthermore, some feared that if they allowed this maneuver for the "doc fix" then Dems would try to use it to bankroll their pet infrastructure projects.

Here's the relevant except from the GOP-written Wednesday document, obtained by TPM and the numbers confirmed by Democratic and Republican leadership aides:

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After indicating that they were placated by President Obama's tweaked birth control regulation, Maine Republican Sens. Olympia Snowe and Susan Collins appear to be hedging on it, speaking late Tuesday to Jonathan Riskind of the home-state Portland Press Herald.

They appeared to dance around the issue, not taking a stance but saying they aren't fully with Obama.

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After indicating that they were placated by President Obama's tweaked birth control regulation, Maine Republican Sens. Olympia Snowe and Susan Collins appear to be hedging on it, speaking late Tuesday to Jonathan Riskind of the home-state Portland Press Herald.

They appeared to dance around the issue, not taking a stance but saying they aren't fully with Obama.


Snowe said today that the White House “certainly has made some critical adjustments, but we haven’t seen the final rule so I think it is important to see the final rule to make sure that we understand exactly what it will do. I see there are still some concerns within the Catholic Church, and hopefully the president can continue to work through those issues.”


“I thought that the president’s announcement on Friday was a step in the right direction, but as I indicated at that time, I needed more information about the details,” Collins said today. “A very important issue is how the administration would treat self-insured Catholic institutions. And I haven’t been able to get an answer from the administration on that issue. They have ducked the issue and said that it remains to be seen, that they are working on it and that it could take as long as a year to come up with an answer. That’s very disappointing and undermines what I thought was a sincere attempt initially to deal with the issues that have been raised not only by the Catholic Church but by other faith-based organizations.”

The two senators told Riskind they support the bill by Sen. Marco Rubio (R-FL) that would permit any employer to deny contraceptive services in their health plans, but neither are backing the measure by Sen. Roy Blunt (R-MO) that would let any employer deny any service they morally object to.

It's an awkward issue for Snowe and Collins, who in 2001 championed legislation that would have established a very similar mandate as Obama's. The context of their hedging is a concerted GOP push to roll back the regulation in its entirety, an affort that isn't helped by divisions within the party.

Negotiators on the payroll tax cut package are mulling a range of cuts to Medicare providers and some reductions to Affordable Care Act spending to override the reimbursement cuts to Medicare doctors set to take effect March 1.

The deal isn't finalized yet but negotiators struck an accord on the broad parameters Tuesday night. The following are the proposed health care cuts in the mix, according to multiple sources familiar with the discussions.

--Cuts to the Affordable Care Act's prevention fund totaling up to $5 billion

--Cuts to Medicare bad debt payments for hospitals and some nursing homes

--Cuts in Medicaid reimbursements to hospitals with a high percentage of low-income patients

--Coding changes to Medicare reimbursements for clinical laboratories and home health services

The policies have all been floated in earlier deficit-reduction efforts, although House Dems aren't happy about the cuts to the health law.

According to The Hill, Speaker John Boehner (R-OH) told his GOP members Wednesday that he will delay a House vote on his transportation and infrastructure bill that was originally slated for this week.

Keith Laing and Ian Swanson report:

"Given the volume of amendments and the need for a full, fair, open and transparent process, we may not finish energy/infrastructure this week," Boehner told his conference, according to a source in the room. "If we need more time to debate and consider amendments, that's perfectly fine with me. It's more important that we do it right than that we do it fast." 

The GOP bill would pay for road and transit projects over the next five years and reauthorize the collection of the federal gas tax. It also authorizes expanded domestic oil and gas drilling, and projects revenue would be used to pay for some of the projects.  

Boehner has reportedly had trouble gathering the votes for the measure, which has been criticized by Republicans as a spending bill and by Democrats as a giveaway to the fossil fuel industry.

Top Democratic and Republican negotiators have struck a broad tentative agreement to extend the payroll tax cut, unemployment insurance and Medicare physician payment rates through the end of the year, aides from both sides who are familiar with the deal tell TPM. Some of the details have yet to be ironed out, but Congress appears to have had a critical breakthrough in negotiations to prevent the three provisions from lapsing.

The payroll tax cut will be extended through 2012 without an offset, at a cost of $185 billion. House Republicans paved the way for it this week by dropping their demand that continuation of the tax holiday be matched with equal spending cuts elsewhere.

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Sensing a political upper-hand in the brewing culture war, Senate Democrats had their guns blazing against the GOP's birth control amendment Tuesday, vowing to fight Republicans' best efforts to tack it on to the bipartisan highway bill and warning that the measure would take women's health in America back to the "dark ages."

"In 2012, I stand here in complete amazement," said Sen. Barbara Boxer (D-CA), "that in a country known for its medical breakthroughs and advancements, Republicans would have us go back to the medical dark ages." She said the energy and transportation bill otherwise has strong bipartisan support, and deemed the contraception amendment both a poison pill and irrelevant.

The amendment by Sen. Roy Blunt (R-MO) purports to focus on contraception, but it goes well beyond that. As written, it would permit all employers to deny any health services in their insurance plans that aren't in accordance with their "religious beliefs and moral convictions." The measure states no limitations or criteria, which means employers have free rein to decide what medical care their employees may or may not receive.

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Massachusetts Senate candidate Elizabeth Warren (D) tore into her rival Sen. Scott Brown (R-MA) for supporting a GOP amendment that would permit any employer to deny coverage of birth control or other services they deem morally objectionable in their health insurance plan.

"I am shocked that Senator Brown jumped in to support such an extreme measure," Warren told The Washington Post's Greg Sargent in an interview. "This is an all new attack on health care. Any insurance company could leave anyone without health care, just when they need it most."

“This is an extreme attack on every one of us,” Warren added. “It opens the door to outright discrimination. It would let insurance companies and corporations cut off pregnant women, overweight guys, older Americans, or anyone — because some executive claims it’s part of his moral code. Maybe that wouldn’t happen, but I don’t want to take the chance.”

Scott Brown's spokesman pushed back in an email to Sargent.

"It’s elitist for Elizabeth Warren to dictate to religious people about what they should believe and how they should act. She wants to use the power of government to force Catholics to violate the teachings of their faith," Brown spokesman Colin Reed emailed. "That is wrong. This issue deals with one of our most fundamental rights as a people — the freedom of religion. Like Ted Kennedy, Scott Brown supports a religious conscience exemption in health care." 


Nothing is final, but aides and insiders say that a deal for year-long extensions of the payroll tax cut, unemployment insurance and Medicare physician payment rates could be near. The payroll tax cut is set to be extended without offsets, while UI and the "doc fix" are poised to be paid for.

The situation remains fluid, but as of now, the roughly $35 billion "doc fix" is expected to be offset with health spending cuts elsewhere in the budget, health care insiders tell TPM. They include cuts to the Affordable Care Act's prevention fund as well as reductions in Medicare payments to hospitals (including bad debt and pay bumps for hospitals with lots of low-income patients) and nursing homes.

At a cost of $20-25 billion, extension of unemployment compensation is likely to be paid for in part with cuts to federal employee retirement benefits and spectrum auction, an aide said.

That's what's being discussed now. We'll be following as the story develops.