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

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.

Senate Minority Leader Mitch McConnell (R-KY) on Tuesday refused to take a position on the House GOP's fallback plan announced yesterday to extend the payroll tax cut without offsets.

"I can understand why the House leadership is exasperated with the lack of progress in the conference and looking around at other alternatives," McConnell told reporters. "I don't have a view on it right now, but I certainly understand their feeling of frustration.

The Kentucky Republican resisted multiple efforts by reporters to say if he would support the legislation if the House decides to adopt it -- and took a shot at Democrats for letting it come to this.

"The difficulty we've had going back to December is getting our friends on the other side to cut any spending anywhere," McConnell said.

President Obama on Tuesday suggested that the House GOP's recent willingness to extend the payroll tax cut without offsets is "good news" but warned that it can't be taken for granted -- and capitalized by demanding an extension of the tax break and unemployment insurance without "ideological sideshows."

"The good news is over the last couple of days we've seen some hopeful signs in Congress that they realize that they've got to get this done. And you're starting to hear voices talk about how can we go ahead and make this happen in a timely way on behalf of the American people," Obama said at the White House. "That is good news."

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Sen. Roy Blunt (R-MO) told TPM Tuesday that he wants to attach his contraception amendment to a bill that President Obama has to sign -- which is probably the only way Republicans can get it passed.

"I'd like to get it on a bill the President has to sign," Blunt told TPM. "But I'd also like to see it debated and voted on, and so we'll just see how that goes."

He made the remarks after Senate Democrats tore into Republicans for trying to tack the measure on to the bipartisan highway bill. Senate Majority Leader Harry Reid (D-NV) indicated that he would allow a vote on the amendment.

Blunt's amendment goes well beyond his stated aim of letting religious employers refuse to pay for birth control coverage -- it lets any employer restrict access to any service they object to in their health insurance plan.

Treasury Secretary Tim Geithner told the Senate Finance Committee on Tuesday that Congress "must extend the payroll tax cut and unemployment insurance by the end of this month" or 160 million Americans will see their taxes rise and 5 million Americans will lose or be denied unemployment insurance -- which he said would cause a hit to the economic recovery.