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

Rep. Paul Ryan's (R-WI) budget unveiled Tuesday indicates a new, albeit somewhat minor, area of agreement with President Obama on Medicare: How much money it should spend per beneficiary. But they completely disagree on what to cut in order to get there.

Ryan's budget -- which replaces Medicare with subsidized insurance exchange where seniors can buy into a private plan or a public option -- limits the value of the subsidies to per-capita GDP+0.5 percent. In other words, it makes cuts on the beneficiary side.

President Obama's plan, as enacted under the Affordable Care Act, is to let 15 Senate-confirmed experts find the best way to hold down Medicare costs to the same level -- but only by cutting reimbursements to providers, without touching benefits. Its existing mandate is GDP+1 percent, but Obama last year supported reducing that to GDP+0.5 percent.

The contrast in broader visions remains stark as ever, however, with Obama and his party wanting to keep Medicare alive as an insurance plan with a coverage guarantee, and Ryan and the GOP pushing to replace that with a "premium support" or voucher system.

The House of Repesentatives is set to vote on a measure Thursday to repeal the Medicare cost-cutting Independent Payment Advisory Board (IPAB) enacted by the Affordable Care Act. The $3.1 billion cost will be offset by medical malpractice reform legislation the GOP has been sitting on.

The bill is likely dead on arrival in the Senate, and the White House issued a veto threat Tuesday.

The vote underlies battles over the future of Medicare as well as a right-wing split over whether federal caps on medical liability are constitutional. The pay-for is expected to cost the votes of Dems who want to repeal the board.

(Correction: An earlier version of this post mistakenly said the vote is today. It's tomorrow.)

When the Supreme Court hears arguments on the Affordable Care Act next week, the central question the justices will consider is whether the federal government has the authority to require Americans to buy health insurance.

The Obama administration will argue that it's an acceptable use of federal power to regulate interstate economic activities, backed by decades of judicial precedent. The 26 Republican-led states and other stakeholders challenging the law will decry it as an abuse of federal power that exceeds the limits of the Constitution's Commerce Clause.

Experts on both sides of the ideological divide say the ruling will come down to whether the justices rule with an eye toward precedent. If they do, they'll uphold the law. An ideology-driven move to strike down the mandate, a central component of the law, would mark a rare, swift departure from precedent.

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House Republicans aren't all sold on Rep. Paul Ryan's new budget.

Seven conservative House Republicans hosted a panel late Tuesday afternoon at the Heritage Foundation, none of whom committed to voting for the blueprint unveiled earlier in the day. One of them -- a member of the House Budget Committee -- said he's unequivocally opposed.

"I will be voting no," said Rep. Tim Huelskamp (R-KS). "It's not good enough."

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House Republicans aren't just reigniting battles over domestic spending and Medicare in their new budget resolution. They're also instigating a war over military funding by seeking to replace automatic defense cuts both parties agreed to in the bipartisan debt limit deal to with major cuts to programs that benefit low- and middle-income Americans, such as food stamps and health care.

Democrats on the Hill and at the White House consider this a violation of the agreement they struck with Republicans last summer. The debt-limit legislation included a mechanism to force both parties to strike a balanced deal to reduce federal budget deficits: deep, automatic, across-the-board cuts to both domestic and national security programs. When the Super Committee failed in November, thanks largely to the GOP's refusal to back significant new tax revenues, it armed that bomb -- those cuts are now scheduled to take effect on Jan. 1, 2013.

Instead of reconsidering their anti-tax absolutism, Republicans want to go back on their end of the deal.

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House Minority Whip Steny Hoyer on Tuesday rebuked House Republicans from essentially walking away from the debt limit deal by cutting beneat the agreed-upon spending levels in the accord last August.

"We understand it abandons the agreement that was reached among Republicans and Democrats in order to pass the Budget Control Act that was essential to keep our country from defaulting," Hoyer told reporters at his weekly press conference. "There is no doubt that everybody at the table thought there was a deal, an understanding, an agreement."

"Senator Reid's right," he added. "It's going to be hard to negotiate with people and try to come to an agreement in a democratic process if the other side simply says, well, yeah we agreed on that some months ago but we're abandoning it now."

Hoyer flatly rejected the notion expressed by Speaker John Boehner that the agreement was simply an upper limit on spending as opposed to an agreed-upon figure for federal outlays.

"What kind of deal is that?" he said. "That's like saying we'll sit down on a contract and say, okay, I'll pay $100 for whatever service or good you're going to give me. And then I come back and say, no I'm only going to pay you $92 because that was just a top limit of what I was going to pay you. Who believes that? Nobody."

House Minority Whip Steny Hoyer laid down the Democrats' marker Tuesday by declaring that the new Paul Ryan Medicare plan is basically the same as his old one that ignited a firestorm of controversy.

"We think it's more of the same, essentially," Hoyer told reporters at his weekly press conference. "While he's tweaked the Medicare [plan], it will in fact do what his last budget did, and that is force people off Medicare, as it will increase the price of Medicare. We believe also that the guarantee, which allegedly is a change is, as a practical matter, is not a change."

The new plan replaces Medicare with a subsidized insurance exchange, as the old one does, but it includes traditional Medicare as an option among private plans that seniors can buy into. The value of the vouchers is slightly higher than his earlier plan.

The right is giving House GOP leaders a collective headache.

They were already under fire from conservative members for taking a piecemeal approach to repealing the health care law. Now conservative activists are after them for abandoning Tea Party principles at the same time.

Caught in the middle of these related attacks is President Obama's Medicare cost-cutting panel -- the Independent Payment Advisory Board (IPAB), which was created by the health care law.

The House is poised to vote this week to repeal IPAB. A small but vocal contingent of dissatisfied, all-or-nothing Republicans worries that this strategy is too timid, and will lead the public to conclude that some parts of the law are acceptable.

But Tea Party activists are upset about something else entirely. GOP leadership has opted to fund the $3.1 billion cost of repealing IPAB with legislation written by Rep. Phil Gingrey (R-GA) that would reform medical malpractice laws. That's a problem not just for the handfuls of House Democrats who want to scrap IPAB, but also for conservatives who believe federal malpractice award caps are unconstitutional.

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President Obama may have the power to circumvent the Senate and recess-appoint members to his Medicare cost-cutting Independent Payment Advisory Board (IPAB) once it takes effect, two physicians turned Republican senators warned in a new report Tuesday.

As part of an all-out GOP assault on the Affordable Care Act on the week of its two-year anniversary, a 38-page report released Tuesday by Sens. Tom Coburn (R-OK) and John Barrasso (R-WY) runs the gamut of Republican messaging points against the law -- and expresses the fear that their party may not be able to stop Obama from implementing IPAB, which was enacted under the ACA.

"According to the CRS, there are no legal restrictions on the White House’s ability to bypass Congress and install politically-connected czars as members of this highly controversial panel," the senators' report reads. "'We do not see why,' CRS said, 'should the normal conditions for a recess appointment occur, the President could not recess appoint a majority of the 15- member Board with individuals of his choosing as long as those appointments complied with the other limitations established in that section.' The White House could effectively nominate political allies, bypass the Senate’s constitutional role to confirm these Presidential appointees."

Senate Republicans had already tipped their hand by suggesting they might refuse to confirm anyone to the board. And the new warning flag from Coburn and Barrasso about a possible work-around for Obama only reaffirms clear GOP appetite for using their clout to scale back, if not neuter, IPAB's effectiveness, in the event that they're unable to repeal it.

When top House Republicans advanced a bill this month aimed at repealing one of the most contentious parts of President Obama's health care law, they didn't see much downside. More bad press for health care reform, a splintered Democratic House minority and a consolidated Republican Party. They didn't look hard enough.

Not only have they managed to alienate some Democratic allies on the bill, slated for a floor vote this week, they're also facing heat from the right for targeting just the one provision of "Obamacare," instead of the law in its entirety.

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