Before Opposition, Price Sought Medicare Spending In Cures

Before House Budget Committee Chairman Tom Price opposed a bill that would increase funding for medical research, he proposed including some potentially costly changes to Medicare in the legislation, according to multiple sources. Those items aren’t in the final package, and now Price (R-Ga.) is leading the effort to kill the bill over spending concerns.

Price’s opposition is the latest in a complicated funding saga surrounding the bill known as CURES. The legislation, which has broad bipartisan support in the House, aims to bring drugs from research to market faster, in part by giving $9.3 billion over five years to the NIH and FDA for medical research. House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) said he wanted to get the bill through the House in June, but ran into trouble with the cost of the legislation.

A reworked version of the bill, which the Congressional Budget Office now says will reduce the federal deficit by $524 million over 10 years, came out after the July 4th congressional recess. It is scheduled to go in front of the House Rules Committee on Wednesday evening and get a vote on the floor later this week.

But it has run into opposition from the far right. Price is now actively lobbying against the new bill because it originates from the Energy and Commerce Committee, which technically makes the funding mandatory spending. Heritage Action joined Price on Tuesday by key voting the bill “no,” also because it creates a mandatory spending program.

“Chairman Price’s concerns with the new mandatory spending were conveyed to the Energy and Commerce Committee from the very beginning,” William Allison, a Budget Committee spokesman for Price, said in an email Tuesday. “That’s what this conversation has always been about and the chairman appropriately raised this issue so as to have a full and open debate.”

But some Republicans contend that the spending is mandatory in name only. That’s because it sets a date for the funding to automatically end. After five years, Congress will have to vote to extend the program. And in exchange for the $1.86 billion-per-year funding boost, Republicans get to cut an estimated $3.85 billion in Medicare and Medicaid, two of the biggest drains on the federal budget. In contrast, the Ryan-Murray budget agreement from 2013 cut less than $2 billion from Medicaid, and nothing directly from Medicare. The rest of the cost for CURES is made up by selling some oil from the Strategic Petroleum Reserve.

Neil Bradley, former deputy chief of staff to House Majority Leader Kevin McCarthy (R-Calif.), says CURES represents a unique opportunity for Republicans to effectively swap a permanent, mandatory cut to fund a time-limited program.

“Now some have argued that the increased spending for medical research is itself mandatory, and thus the proposal is just swapping one kind of mandatory spending for another. But this criticism misses the fact that, absent some type of mechanism like what is proposed in 21st Century Cures, there is no means in the normal federal budget process to cut mandatory spending and use the savings to fund a discretionary project,” Bradley wrote last month.

Having the Energy and Commerce Committee fund NIH with mandatory spending is unusual. The agency is traditionally funded with discretionary funds, which are doled out by the appropriations committees. It also means the funding is not subject to the spending caps put in place by the sequester, something Heritage Action emphasized. But House Appropriations Committee Chairman Hal Rogers (R-Ky.) supports the bill, in part because his panel will still have a role in determining exactly how the $1.86 billion research fund is spent each year it exists.

Before opposing CURES, Price lobbied to have several Medicare changes added, according to multiple sources on and off Capitol Hill. Those requests included changes to Medicare coding, delaying the ICD-10 coding rubric, and a bill he introduced to end Medicare’s “durable medical equipment” bidding program, which pays for expensive items like wheelchairs and respirators. All were potentially costly additions to the FDA and NIH bill.

Update: This article has been updated to include a statement from Price’s spokesman on the House Budget Committee.