The idea of tying the doc fix to a partial health reform repeal has legs because it comes with a clear rhetorical message: Congress should not start creating new entitlements without the necessary funding to uphold existing ones.And the Republicans have found the part of ObamaCare that they want to exchange for the doc fix.
Sen. Orrin Hatch (R-Utah), who will serve as ranking member on the Finance Committee next session, would not comment on specific budgeting but he did indicate that the committee would not move forward with a doc fix that was not fully funded.
"Ensuring that Medicare reimbursement rates aren't slashed is important, but so too is making sure that we stop adding to our already sky-high deficit," Hatch told POLITICO in a statement. "Over the next month, I'll be working with my colleagues to accomplish a longer-term fix that's paid for and doesn't add to the deficit."
The prospect of Republicans yanking reform funds puts major pressure on the Democrats to come up with a yearlong patch before the lame-duck session ends. But so far, Democrats have been unable to find the necessary $19 billion in offsets to finance a yearlong fix.
One aide said health reform's preventive health spending is one of the "top three" offsets in the law that congressional Republican staffers are eyeing, with the idea that a few moderate Democrats facing tough races in 2012 could eventually be brought on board.
As for which part of the health reform law to pull funds from, Republicans have long derided the multibillion Prevention and Public Health Fund as wasteful spending, scoffing at its investment in bike paths and farmers' markets. One Republican Senate aide quipped that it was a "slush fund for jungle gyms."Obama would probably veto such a plan, but watch out for more brinkmanship on this question.
The fund, which began this year with $500 million, will grow to a $2 billion per year allocation by 2015. Totaling $15 billion over the next 10 years, the fund would be nearly enough to offset an entire, yearlong doc fix.