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Quiet Win for Boehner? Bending the Entitlement Curve

Boehner is close to an elusive deal on a small piece of what allies are calling entitlement reform. (Bill Clark/CQ Roll Call)

If the phrase "sustainable growth rate" sounds like it might be useful in putting you to sleep, you might have missed it.  

Speaker John A. Boehner is quietly putting the finishing touches on a legacy item that generations of high school civics teachers insist is the third rail of politics: "entitlement reform." It's no accident most Americans haven't heard much about a potential deal eliminating SGR and making changes to Medicare. A long-term bill is still in question, and final details are still being hammered out. But every day without an uprising on SGR is a day closer to a deal.  

It looks increasingly likely lawmakers will agree to ditch the yearly fixes to the payment formula for Medicare doctors and pay for it — at least some of it — by making changes to private Medigap plans and by forcing wealthier seniors to pay more.  

“In budget after budget, Republicans have offered real, structural reforms to strengthen the Medicare program for seniors," Boehner said in a statement to CQ Roll Call Wednesday. "This is an important opportunity to start getting some of those reforms enacted into law for the benefit of generations to come.”  

Close Boehner-ally and fellow Ohio Republican Pat Tiberi told CQ Roll Call Boehner has always wanted to accomplish "big things."  

"This framework would certainly fall into that category," Tiberi said. "Speaker Boehner has made entitlement reform a priority over the years because he knows it would have the largest impact on solving our long-term fiscal problems. If the framework of this deal is enacted, Speaker Boehner would and should consider it a major win for taxpayers.”  

Yes, Boehner has long argued for an entitlement overhaul. He's been talking about it since he came to Congress in 1991. And it was a major part of his campaign to be majority leader in 2006. And yet there really hasn't been much movement on the issue since the '90s, when Congress passed a welfare overhaul in 1996 and the Balanced Budget Act of 1997. That's how difficult the issue is.  

Of course, the "fixes" being discussed now aren't the most ambitious changes ever. But they are "changes" adjacent to the word "Medicare." Sources close to the negotiations say most of the real savings would come from lowering income thresholds for aspects of Medicare that are already means-tested, such as prescriptions and doctor visits, or by increasing the percentage that these wealthier seniors have to pay for their premiums. Currently, means-testing on Medicare kicks in at $85,000 per year for individuals and $170,000 for couples.  

Democrats in recent years have insisted any real changes to entitlements be coupled with tax hikes, but they’ve dropped that demand with SGR. And that could be a breakthrough for future negotiations.  

Such negotiations aren't likely to happen while Boehner is speaker. And, of course, this deal could fall apart. But GOP leadership is pushing the yet-to-be-released bill as a win for conservatives, particularly when the long-term savings are considered. Leadership acknowledges the deal would add to the deficit over the next 10 years. But proponents say skeptics should look further out and measure the proposal's long-term savings against the fact that Congress typically doesn't pay for SGR anyway.  

Democrats have stayed mostly silent on the negotiations. Boehner and Ways and Means Chairman Paul D. Ryan told the GOP Conference Tuesday they'd been working with Minority Leader Nancy Pelosi to jam the Senate into taking the House-passed bill.  

That bipartisan angle may be part of the problem for conservatives, who would prefer Boehner try to pass legislation with all Republican votes before consulting Democrats.  

"He was sitting down with Nancy first," Tim Huelskamp, R-Kan., said of Boehner Tuesday, "and then he's going to come back to conference and say, 'Hey, we got the votes. I'm going to ram it through, and together, we're going to jam the Senate.'  

"No, it's to jam the House Republican conservatives."  

Huelskamp predicted a majority of the GOP conference wouldn't vote for the long-term deal. "But if he's got Pelosi and her crowd, and he's got 30 of the Tuesday group, he's got her done," he said.  

Expect a lot more than 30 Republicans to vote for a deal. The doctor's lobby has been all over Congress on this issue, hitting up Republicans and Democrats. And even some of the most conservative voices in the House see merit to a long-term deal.  

"This is one that I'm going to take the leap of faith," conservative Arizona Republican Paul Gosar told CQ Roll Call. "We got to do something."  

If Gosar is in, plenty more conservatives — not to mention the rank and file — could join him, even though the silence from Democrats might scare some Republicans.  

"Democrats aren’t stupid," Heritage Action Communications Director Dan Holler told CQ Roll Call in an email. "If they’re in on the deal, it is because it serves their long-term interests. Heck, a Democrat leadership aide is touting this as a 'very big accomplishment' for the minority!"  

Holler went on to say that if Republicans wanted to vote for $130 billion in new deficit spending, that was their decision. "But they shouldn’t pretend they’ll be sneaking something by Nancy Pelosi, Harry Reid and Barack Obama," he said.  

Indeed, Democrats could be waiting until the bill is passed before sending out a round of self-congratulatory press releases. Most of these changes were included in President Barack Obama's budget. And even the changes that could affect less-wealthy seniors, such as alterations to the supplemental coverage of Medigap, are pretty modest. Negotiators are discussing having seniors pay a deductible of less than $250 before their coverage kicks in. But the more significant changes — at least from a pay-for perspective — are the means-testing provisions.  

With years before many of those changes ever take hold, Democrats could be paying for the so-called "doc fix" for free if they're able to undo the modifications — or just delay them until Congress becomes accustomed to the idea of not doing it.  

Sort of like what happened with SGR in the first place.  

Melissa Attias contributed to this report. Related: Republicans Open to Potential ‘Doc Fix’ Deal ‘Doc Fix’ Is Latest Spending Battle for Conservatives Conservatives Still Fuming Over Secret ‘Doc Fix’ Voice Vote (Video) (Updated) The 114th: CQ Roll Call's Guide to the New Congress Get breaking news alerts and more from Roll Call in your inbox or on your iPhone.