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113th Congress, Vote 177; House of Representatives #96

Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024.

Official Title: Establishing the budget for the United States Government for fiscal year 2015 and setting forth appropriate budgetary levels for fiscal years 2016 through 2024.

H.Con.Res 96: Paul Ryan’s budget for 2015 fiscal year
Passed by the House April 10, 2014, 219-205 (8 abstaining).

Synopsis: In April 2014, Rep. Paul Ryan (R, Wisconsin) published The Path to Prosperity, his fiscal year 2015 budget resolution. It was generally regarded as a symbolic measure, more a declaration of Conservative fiscal values than a genuine attempt at a bipartisan budget proposal. And Senate Democrats had clarified that they didn’t plan to pass a budget for the 2015 fiscal year, as they had already reached a two-year spending agreement in late 2013.

Ryan’s budget would cut about $5.1 trillion in government spending over a decade, and healthcare would account for more than half of the overall savings. The overall implications of the budget proposal are far-reaching, but this synopsis looks at the impact on Medicare if H.Con.Res. 96 were to be enacted:

  • Starting in 2024, Medicare would switch to a "premium support" model for new enrollees, providing a fixed government contribution that seniors could use to purchase traditional fee-for-service Medicare or a private option via a Medicare exchange. If the enrollee selects a plan that costs more than the government’s contribution, the enrollee would pay the difference. Premium support payments would be made directly to the insurance carriers. Wealthy seniors would have to pay a larger share of their own premiums, while low-income seniors would receive additional help covering out-of-pocket costs.
  • Starting in 2024, the eligibility age for Medicare would gradually increase from 65 to 67.
  • Starting in 2024, traditional fee-for-services Medicare would have a single deductible (currently, there’s a deductible for Part A and another deductible for Part B).
  • Part B and Part D premiums are already higher for higher-income beneficiaries, but H.Con.Res 96 would expand this until 25 percent of Medicare beneficiaries are paying increased premiums based on their incomes.
  • The ACA would be repealed, including the sections that pertain to Medicare beneficiaries.

Why supporters pushed for this bill

  • Balancing the budget over the coming decade is a primary component of H.Con.Res 96, and supporters of reduced government spending liked that aspect of the budget proposal.
  • Those who prefer a privatized approach to Medicare were generally supportive of Ryan’s proposal. Free-market proponents noted that the premium support stipends would drive competition and innovation in the private Medicare market.
  • Changes to the Medicare system wouldn’t take effect until 2024, so people who are 55 or older in 2013 would still be covered under traditional Medicare once they reach age 65 (although they’d be allowed the option to join the new premium support program outlined in H.Con.Res 96). This helped to avoid controversy among current Medicare beneficiaries and those who will age into the program in the next few years.

Why opponents tried to stop the bill

  • Repealing the ACA is a key component of H.Con.Res. 96. The ACA has been closing the donut hole in Medicare Part D, and has also provided free preventive care and annual wellness exams for Medicare enrollees. These benefits would disappear if the ACA were to be repealed.
  • The Center on Budget and Policy Priorities noted that transitioning to Ryan’s proposed "premium support" Medicare model would result in reduced access to traditional fee-for-service Medicare in areas where private plans are less expensive than traditional Medicare. This could make it more difficult for seniors to keep their doctors, since private plans tend to have narrow networks (as opposed to traditional Medicare, which includes 96 percent of providers who offer Medicare-covered services).
  • Premium support payments could be used for private plans or traditional Medicare, but the former would be more likely to attract healthier enrollees, thus gradually driving up costs for traditional Medicare.
  • The National Committee to Preserve Social Security and Medicare strongly opposed H.Con.Res 96, stating that the budget "ends traditional Medicare and achieves savings for the federal government by shifting costs to Medicare beneficiaries" in a variety of ways, including the loss of coverage for 65- and 66-year-olds once the Medicare eligibility age is increased.
  • But among fiscal conservatives – including some members of congress – Ryan’s budget resolution didn’t go far enough. It wasn’t scheduled to reach a balanced budget until 2024, and fiscal conservatives wanted more swift action towards a balanced budget.
04/10/2014 Status: House passed

More: select a member to see his or her other key Medicare votes.

Yes (219)
R Don Young AK
R Robert Aderholt AL
R Spencer Bachus AL
R Mo Brooks AL
R Bradley Byrne AL
R Martha Roby AL
R Mike Rogers AL
R Tom Cotton AR
R Tim Griffin AR
R Steve Womack AR
R Trent Franks AZ
R Paul Gosar AZ
R Matt Salmon AZ
R David Schweikert AZ
R Ken Calvert CA
R John Campbell CA
R Paul Cook CA
R Jeff Denham CA
R Duncan Hunter CA
R Darrell Issa CA
R Doug LaMalfa CA
R Kevin McCarthy CA
R Tom McClintock CA
R Howard McKeon CA
R Gary Miller CA
R Devin Nunes CA
R Dana Rohrabacher CA
R Edward Royce CA
R David Valadao CA
R Mike Coffman CO
R Cory Gardner CO
R Doug Lamborn CO
R Scott Tipton CO
R Gus Bilirakis FL
R Vern Buchanan FL
R Ander Crenshaw FL
R Ron DeSantis FL
R Mario Diaz-Balart FL
R John Mica FL
R Jeff Miller FL
R Richard Nugent FL
R Bill Posey FL
R Thomas Rooney FL
R Ileana Ros-Lehtinen FL
R Dennis Ross FL
R Steve Southerland FL
R Daniel Webster FL
R Ted Yoho FL
R Doug Collins GA
R Tom Graves GA
R Tom Price GA
R Lynn Westmoreland GA
R Rob Woodall GA
R Steve King IA
R Tom Latham IA
R Raúl Labrador ID
R Michael Simpson ID
R Rodney Davis IL
R Randy Hultgren IL
R Adam Kinzinger IL
R Peter Roskam IL
R Aaron Schock IL
R John Shimkus IL
R Susan Brooks IN
R Larry Bucshon IN
R Luke Messer IN
R Todd Rokita IN
R Marlin Stutzman IN
R Jackie Walorski IN
R Todd Young IN
R Tim Huelskamp KS
R Lynn Jenkins KS
R Mike Pompeo KS
R Kevin Yoder KS
R Garland Barr KY
R Brett Guthrie KY
R Harold Rogers KY
R Ed Whitfield KY
R Charles Boustany LA
R Bill Cassidy LA
R John Fleming LA
R Steve Scalise LA
R Andy Harris MD
R Justin Amash MI
R Dan Benishek MI
R Kerry Bentivolio MI
R Dave Camp MI
R Bill Huizenga MI
R Candice Miller MI
R Mike Rogers MI
R Fred Upton MI
R Tim Walberg MI
R Michele Bachmann MN
R John Kline MN
R Erik Paulsen MN
R Sam Graves MO
R Vicky Hartzler MO
R Billy Long MO
R Blaine Luetkemeyer MO
R Jason Smith MO
R Ann Wagner MO
R Gregg Harper MS
R Alan Nunnelee MS
R Steven Palazzo MS
R Steve Daines MT
R Howard Coble NC
R Renee Ellmers NC
R Virginia Foxx NC
R George Holding NC
R Richard Hudson NC
R Patrick McHenry NC
R Mark Meadows NC
R Robert Pittenger NC
R Kevin Cramer ND
R Jeff Fortenberry NE
R Adrian Smith NE
R Lee Terry NE
R Rodney Frelinghuysen NJ
R Scott Garrett NJ
R Leonard Lance NJ
R Christopher Smith NJ
R Stevan Pearce NM
R Mark Amodei NV
R Joseph Heck NV
R Chris Collins NY
R Michael Grimm NY
R Richard Hanna NY
R Peter King NY
R Tom Reed NY
R John Boehner OH
R Steve Chabot OH
R Bob Gibbs OH
R Bill Johnson OH
R Jim Jordan OH
R David Joyce OH
R Robert Latta OH
R James Renacci OH
R Steve Stivers OH
R Patrick Tiberi OH
R Michael Turner OH
R Brad Wenstrup OH
R Jim Bridenstine OK
R Tom Cole OK
R James Lankford OK
R Frank Lucas OK
R Markwayne Mullin OK
R Greg Walden OR
R Lou Barletta PA
R Charles Dent PA
R Michael Fitzpatrick PA
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R Mike Kelly PA
R Tom Marino PA
R Patrick Meehan PA
R Tim Murphy PA
R Scott Perry PA
R Joseph Pitts PA
R Keith Rothfus PA
R Bill Shuster PA
R Glenn Thompson PA
R Jeff Duncan SC
R Trey Gowdy SC
R Mick Mulvaney SC
R Tom Rice SC
R Marshall Sanford SC
R Joe Wilson SC
R Kristi Noem SD
R Diane Black TN
R Marsha Blackburn TN
R Scott DesJarlais TN
R John Duncan TN
R Stephen Fincher TN
R Charles Fleischmann TN
R David Roe TN
R Joe Barton TX
R Kevin Brady TX
R Michael Burgess TX
R John Carter TX
R K. Conaway TX
R John Culberson TX
R Blake Farenthold TX
R Bill Flores TX
R Louie Gohmert TX
R Kay Granger TX
R Jeb Hensarling TX
R Sam Johnson TX
R Kenny Marchant TX
R Michael McCaul TX
R Randy Neugebauer TX
R Pete Olson TX
R Ted Poe TX
R Pete Sessions TX
R Lamar Smith TX
R Steve Stockman TX
R Mac Thornberry TX
R Randy Weber TX
R Roger Williams TX
R Rob Bishop UT
R Jason Chaffetz UT
R Chris Stewart UT
R Eric Cantor VA
R J. Forbes VA
R Bob Goodlatte VA
R H. Griffith VA
R Robert Hurt VA
R Edward Rigell VA
R Robert Wittman VA
R Frank Wolf VA
R Doc Hastings WA
R J. Herrera Beutler WA
R C. McMorris Rodgers WA
R David Reichert WA
R Sean Duffy WI
R Thomas Petri WI
R Reid Ribble WI
R Paul Ryan WI
R F. Sensenbrenner WI
R Shelley Capito WV
R Cynthia Lummis WY
No (205)
Our pick
D Terri Sewell AL
R Eric Crawford AR
D Ron Barber AZ
D Raúl Grijalva AZ
D Ann Kirkpatrick AZ
D Ed Pastor AZ
D Kyrsten Sinema AZ
D Karen Bass CA
D Xavier Becerra CA
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D Lois Capps CA
D Tony Cárdenas CA
D Judy Chu CA
D Jim Costa CA
D Susan Davis CA
D Anna Eshoo CA
D Sam Farr CA
D John Garamendi CA
D Janice Hahn CA
D Michael Honda CA
D Jared Huffman CA
D Barbara Lee CA
D Zoe Lofgren CA
D Alan Lowenthal CA
D Doris Matsui CA
D Jerry McNerney CA
D Grace Napolitano CA
D G. Negrete McLeod CA
D Nancy Pelosi CA
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D L. Roybal-Allard CA
D Raul Ruiz CA
D Linda Sánchez CA
D Loretta Sanchez CA
D Adam Schiff CA
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D Jackie Speier CA
D Eric Swalwell CA
D Mark Takano CA
D Mike Thompson CA
D Juan Vargas CA
D Maxine Waters CA
D Henry Waxman CA
D Diana DeGette CO
D Jared Polis CO
D Joe Courtney CT
D Rosa DeLauro CT
D Elizabeth Esty CT
D James Himes CT
D John Larson CT
D John Carney DE
D Corrine Brown FL
D Kathy Castor FL
D Theodore Deutch FL
D Lois Frankel FL
D Joe Garcia FL
D Alan Grayson FL
D Alcee Hastings FL
R David Jolly FL
D Patrick Murphy FL
D D. Wasserman Schultz FL
D Frederica Wilson FL
D John Barrow GA
D Sanford Bishop GA
R Paul Broun GA
R Phil Gingrey GA
D Henry Johnson GA
R Jack Kingston GA
R Austin Scott GA
D David Scott GA
D Tulsi Gabbard HI
D Colleen Hanabusa HI
D Bruce Braley IA
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D Tammy Duckworth IL
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D Bobby Rush IL
D Janice Schakowsky IL
D Bradley Schneider IL
D Peter Visclosky IN
R Thomas Massie KY
D John Yarmuth KY
D Cedric Richmond LA
D Michael Capuano MA
D Katherine Clark MA
D William Keating MA
D Joseph Kennedy MA
D Stephen Lynch MA
D James McGovern MA
D Richard Neal MA
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D Elijah Cummings MD
D John Delaney MD
D Donna Edwards MD
D Steny Hoyer MD
D C. Ruppersberger MD
D John Sarbanes MD
D Chris Van Hollen MD
D Michael Michaud ME
D Chellie Pingree ME
D John Conyers MI
D John Dingell MI
D Daniel Kildee MI
D Sander Levin MI
D Gary Peters MI
D Keith Ellison MN
D Betty McCollum MN
D Richard Nolan MN
D Collin Peterson MN
D Timothy Walz MN
D Wm. Clay MO
D Emanuel Cleaver MO
D Bennie Thompson MS
D George Butterfield NC
R Walter Jones NC
D Mike McIntyre NC
D David Price NC
D Ann Kuster NH
D Carol Shea-Porter NH
D Rush Holt NJ
R Frank LoBiondo NJ
D Frank Pallone NJ
D Bill Pascrell NJ
D Donald Payne NJ
D Albio Sires NJ
D Ben Luján NM
D M. Lujan Grisham NM
D Steven Horsford NV
D Dina Titus NV
D Timothy Bishop NY
D Yvette Clarke NY
D Joseph Crowley NY
D Eliot Engel NY
R Christopher Gibson NY
D Brian Higgins NY
D Steve Israel NY
D Hakeem Jeffries NY
D Nita Lowey NY
D Daniel Maffei NY
D Carolyn Maloney NY
D Sean Maloney NY
D Carolyn McCarthy NY
D Gregory Meeks NY
D Grace Meng NY
D Jerrold Nadler NY
D William Owens NY
D Charles Rangel NY
D José Serrano NY
D Louise Slaughter NY
D Paul Tonko NY
D Nydia Velázquez NY
D Joyce Beatty OH
D Marcia Fudge OH
D Marcy Kaptur OH
D Tim Ryan OH
D Earl Blumenauer OR
D Suzanne Bonamici OR
D Peter DeFazio OR
D Kurt Schrader OR
D Robert Brady PA
D Matthew Cartwright PA
D Michael Doyle PA
D Chaka Fattah PA
D David Cicilline RI
D James Langevin RI
D James Clyburn SC
D Steve Cohen TN
D Jim Cooper TN
D Joaquin Castro TX
D Henry Cuellar TX
D Lloyd Doggett TX
D Pete Gallego TX
D Al Green TX
D Gene Green TX
R Ralph Hall TX
D Rubén Hinojosa TX
D Eddie Johnson TX
D Beto O’Rourke TX
D Marc Veasey TX
D Filemon Vela TX
D Jim Matheson UT
D Gerald Connolly VA
D James Moran VA
D Robert Scott VA
D Peter Welch VT
D Suzan DelBene WA
D Denny Heck WA
D Derek Kilmer WA
D Rick Larsen WA
D Jim McDermott WA
D Adam Smith WA
D Ron Kind WI
D Gwen Moore WI
D Mark Pocan WI
R David McKinley WV
D Nick Rahall WV
Not Voting (8)
D George Miller CA
D Ed Perlmutter CO
D John Lewis GA
D André Carson IN
R Vance McAllister LA
R Jon Runyan NJ
D Allyson Schwartz PA
D Sheila Jackson Lee TX