TIME Congress

Fiscal Conservatives, Defense Hawks Square Off On Spending

John Boehner
J. Scott Applewhite—AP Speaker of the House John Boehner responds to reporters about the impasse over passing the Homeland Security budget because of Republican efforts to block President Barack Obama's executive actions on immigration, at the Capitol in Washington on Feb. 26, 2015.

The House GOP budget cuts $5.5 trillion over 10 years

House leaders introduced a budget Tuesday that could spark a fight between the pro-military and anti-deficit wings of the Republican Party.

The proposed House Republican budget largely keeps across-the-board spending caps known as sequestration in place while setting aside an additional $94 billion to fight terrorism overseas over the next fiscal year.

That amount is $36 billion more than President Obama’s request for emergency funds to fight terrorism, which could help bring on board the 70 or so defense hawks in the House who have said they’ll only support a budget that has at least as much spending as the president’s budget.

But the proposal also risks losing support in the Senate, where Republican Sens. John McCain, Lindsey Graham and Tom Cotton have said they will not support a budget that leaves in place the sequestration cuts. Spending increases in future years could also cause concern among fiscal conservatives in both chambers.

The proposal would balance the federal budget in 10 years by cutting $5.5 trillion, mostly from domestic programs, particularly in health care. As in past budgets, Republicans propose repealing the Affordable Care Act and creating a Medicare premium support model for seniors beginning in 2024. It would also give states more flexibility to adapt their Medicaid programs.

“It is a plan that balances the budget in less than ten years, secures and strengthens vital programs – like Medicare – provides our military men and women with the resources they need to protect American families, and would make Washington more efficient, effective and accountable to hard-working taxpayers,” said House Budget Chairman Tom Price in a statement.

To be sure, the House proposal is more of a political chit than an actual working budget. But many Republicans in Congress hope to pass the first regular budget since 2006 as a sign of party unity and a show of legislative progress. In addition, since a budget needs only a simple majority, it would be a good way to get around opposition from the Democratic minority in both chambers.

There is one other incentive for the Republican-led Congress to pass a budget. A spending blueprint would allow Republicans to make use of a maneuver, known as reconciliation, to clear certain bills through the Senate with a simple majority, instead of needing to overcome the 60-vote hurdle posed by a filibuster.

GOP leaders haven’t specified what they might like to use the procedural end-run to accomplish — and Senate Finance Chairman Orrin Hatch already said one big priority, tax reform, will not be subject to the move this year. But it remains a powerful tool. Democrats used it in 2010 to secure the Affordable Care Act’s final passage after losing their filibuster-proof majority in the Senate.

President Obama ripped the Republican budget proposal on Tuesday following a meeting with Irish Prime Minister Enda Kenny in the Oval Office, saying it is “not a budget that reflects the future.”

“I was hoping for a little luck of the Irish as the Republicans put forward their budget today,” President Obama said. ” Unfortunately, what we are seeing right now is a failure to invest in education and infrastructure and research and national defense – all the things that we need to grow, to create jobs, stay at the forefront of innovation and keep our country safe.”

With reporting by Tory Newmyer

TIME Congress

Republicans to Renew Call for Obamacare Repeal in 2016 Budget

Rep. Diane Black takes her seat for the House Budget Committee hearing on "The Congressional Budget Office's (CBO) Budget and Economic Outlook" on Jan. 27, 2015.
Bill Clark—CQ Roll Call/AP Rep. Diane Black takes her seat for the House Budget Committee hearing on "The Congressional Budget Office's (CBO) Budget and Economic Outlook" on Jan. 27, 2015.

"We can start over with health care reforms that protect the doctor-patient relationship and expand access to quality affordable health care"

Republicans will again call for a full repeal of President Obama’s signature health law in the House’s 2016 budget proposal to be released on Tuesday.

“Our proposal repeals all of Obamacare so we can start over with health care reforms that protect the doctor-patient relationship and expand access to quality affordable health care,” said Rep. Dian Black of Tennessee in a two-minute video previewing the budget. Previous budgets authored by the House’s former Budget Committee Chairman Paul Ryan also called for repeal of the healthcare act.

The New York Times reports the budget plan will also make substantial cuts to Medicaid spending and essentially create vouchers for private insurance for future Medicare recipients. The White House said Monday the Affordable Care Act had provided coverage to 16.4 million previously uninsured peopl.

Members of the House Budget Committee previewed the broad strokes of their budget plan, which they say “balances the budget” and “lays the foundation for new jobs,” in a video released on the YouTube channel of Budget Committee Chairman Rep. Tom Price. The budget would also simplify the tax code and expand energy production under its plan for creating new jobs. It would also increase defense spending, Fox News reports.

“Our country faces massive challenges, but with positive solutions like these we will overcome them and create an America that is more secure, stronger, and full of opportunities,” said Price.

Full details of the budget will be released Tuesday morning.

TIME Congress

Mikulski ‘No Passing Fad’ After Three Decades in Senate

Sen. Barbara Mikulski, D-Md., the longest-serving woman in the history of Congress, speaks during a news conference announcing her retirement after her current term, in the Fells Point section of Baltimore on March 2, 2015.
Steve Ruark—AP Sen. Barbara Mikulski, D-Md., the longest-serving woman in the history of Congress, speaks during a news conference announcing her retirement after her current term, in the Fells Point section of Baltimore on March 2, 2015.

No B.S. BAM Retires After 30 Years

Long-serving Sen. Barbara Mikulski has not yet taken a side in the race to replace her among Maryland Democrats. But she made clear this week that the key to her heart will be pay equality.

That doesn’t necessarily mean a female Senator, either. Asked if she would like to see a woman take her seat, Mikulski was noncommittal.

“I would hope that Marylanders would pick someone who is a very strong advocate for them and their day-to-day needs, knows how to listen to them and convert [those needs] into national policy,” she told TIME. “And of course to be a big supporter of making sure that the rights guaranteed in the Constitution are lived out in the workplace.”

The race for Mikulski’s open seat in Democratic-leaning Maryland will be brutal. Reps. Chris Van Hollen and Donna Edwards have both announced runs for the Democratic nomination already. Other Deocratic heavy hitters such as Baltimore Mayor Stephanie Rawlings-Blake, Rep. Elijah Cummings, former state delegate Heather R. Mizeur and former Maryland Lt. Gov. Kathleen Kennedy Townsend are all considering a run.

Whoever wins will have big shoes to fill. Mikulski, 78, is considered the “dean” of the 20 female senators. She holds “power workshops” for freshmen — Maine GOP Sen. Susan Collins still remembers her invitation and cram course in the appropriations process in 1997 — and organizes dinners every month or so.

“We have relationships now today because she and [former North Carolina Sen.] Kay Hagan were so adamant about keeping that up,” says Washington Democratic Sen. Maria Cantwell.

During Mikulski’s 1986 bid for Senate, President Reagan said the “wily liberal” would meet a similar fate as the hula hoop and the all-asparagus diet.

“Well I’ve never used a hula hoop; I did try the asparagus diet,” she said. “I turned out to not be a passing fad.”

Mikulski reminisced about how much has changed for women in politics from when Mikulski first began as a Baltimore City Councilwoman in 1971.

“You know, there was the central casting: the gray hair and the distinguished person,” said Mikulski, who’s 4’11’’ and believes her colleagues’ “little general in pearls” description is accurate, although that’s not what she would call herself. Mikulski, who’s middle name is Ann, is referred to as “BAM” by her staff.

“I just laughed when they said I didn’t look the part, I just said this is what the part looks like,” she said. “I just squared my shoulders, put my lipstick on and kept on going door to door, kept on knocking on doors, kept on getting elected to open the doors for other women.”

She’s done that both legislatively and in the Senate, a boy’s club only surpassed in exclusivity by the one informally practiced by presidents.

While in office, Mikulski pushed for years for equal pay for equal work, culminating in the 2009 Lilly Ledbetter Fair Pay Act, which was the first bill President Obama signed in office. She added expansive provisions in the Affordable Care Act related to women’s preventative health and wrote a major bill helping spouses avert poverty while trying to pay for nursing home care. Her influence has been broad—her office notes her fierce support of the Hubble space telescope, which is managed in Maryland—and she has broke gender barriers, becoming the first female Democratic Senator elected in her own right in 1987 and the first Chairwoman of the Appropriations Committee in 2012.

“I think of a fighter,” said Maryland Democratic Sen. Ben Cardin of his colleague. “I can tell you of meetings in our caucus where the health care bill came up and didn’t have strong provisions on women’s health care. Sen. Mikulski got up and within a matter of an hour the health care bill was changed.”

Cantwell and Collins, who talked to TIME while walking together in the underground tunnels of the Capitol, happily rattled off a number of decades-old Mikulski sayings, including “square my shoulders,” the bipartisan group of female senators are a “force not a caucus,” and that senators should talk “not only in macroeconomics but in macaroni.” When asked if she was effective because “everyone’s afraid of her”—as Senate Democratic Leader Harry Reid once said—Mikulski objected, recalling another oft-repeated phrase: “insistent and persistent.”

But Mikulski’s impact in the Senate is much larger among her female colleagues than inspirational tongue twisters, she also broke down sexist rules, including one that forbade walking on the Senate floor in 1993 with pants. She later told CNN it was such a “seismographic event” that she had to tell the West Virginia Sen. Robert Byrd, the Democratic leader.

“When Senator Mikulski decided that she was going to wear pants while casting her votes, it was the rule that had to change, not her,” said Washington Democratic Sen. Patty Murray in a statement.

For now, Mikulski seems content to let the next stage of the fight play out without making waves publicly.

“I want Maryland to decide who they think is best to represent them now,” she told TIME. “I was the bridge that brought them over from the twentieth century into the twenty first, being the strong advocate for social justice, but certainly for jobs and promoting really the kind of jobs that would be a part of the innovation economy as we said goodbye to some of the others.”

TIME White House

The Meanest Tweets Obama Didn’t Read

You ain't seen nothing yet

Correction appended, March 13

Keeping with a tradition on the “Jimmy Kimmel Live” show, President Obama read mean tweets about himself Thursday night. But compared to what he’s gotten from Congress, the tweets were fairly tame.

Obama himself made that point.

“I have to say, those weren’t that mean,” he told Kimmel after the segment. “I’ve gotta tell you, you should see what the Senate says about me all the time.”

For example: After the Charlie Hebdo terror attacks in France, Obama was criticized for not going there to show his support.

Texas Republican Rep. Randy Weber tweeted: “Even Adolph [sic] Hitler thought it more important than Obama to get to Paris (For all the wrong reasons.) Obama couldn’t do it for right reasons.” Weber later deleted the tweet and apologized.

But it wasn’t the first time. In a series of other tweets from January 2014, Weber called Obama the “Kommandant-in-Chief,” a “socialist dictator” and suggested that POTUS stands for “Poor Obama Trashed U.S.”

Some of the tweets aren’t so much mean as they are cutting in good sport. After Obama joked during the White House Correspondents Dinner in 2013 that Republican Sen. Mitch McConnell wouldn’t be a good drinking buddy, McConnell tweeted a picture of himself having a beer with an empty chair for Obama, complete with a glass of red wine and the message “Greetings from Coal Country!”

And sometimes the mean tweets are friendly fire. Democratic Rep. Marcy Kaptur once jokingly tweeted (and deleted) as the stock market hit a now high that Obama was the “worst socialist ever.”

Still, most of the meanest tweets come from off Capitol Hill. Businessman Donald Trump is a serial offender when it comes to saying mean things about Obama. Here he is blaming Obama for a bad call in the Super Bowl:

And there’s this:

And this:

Even KitchenAid, a company that makes kitchen appliances, accidentally tweeted something mean about Obama. In 2012 someone tweeting for the company posted about the president’s grandmother, who died before he took office, “Obamas gma even knew it was going 2 b bad! ‘She died 3 days b4 he became president’. #nbcpolitics.” The company swiftly apologized for the tweet.

Correction: The original version of this story incorrectly described a series of tweets by Texas Republican Rep. Randy Weber. The tweets were sent in January 2014 and they are still online.

TIME Crime

Ferguson Community Shocked at Cop Shootings, Senator Says

Senator Claire McCaskill says protestors are "disappointed" by shooting of two police officers

The Ferguson community has “come together” in outrage and disappointment a day after two officers were shot in a demonstration in front of the city Police Department, Missouri Sen. Claire McCaskill said Friday.

“Many of the protest community have spoken out in very dramatic terms about how disappointed they are that some thug would come to a peaceful protest site and commit a violent criminal act like this against police officers who are doing their jobs,” she said, echoing Attorney General Eric Holder, who called the at-large perpetrator, a “damn punk.”

The shootings came the morning after the town’s chief of police, Thomas Jackson, resigned following a Department of Justice report that found widespread racial bias among the city’s police. The city manager and a judge have also resigned after the damning report ordered by Holder after the killing of unarmed black teenager Michael Brown by a white police officer in August.

Ferguson remained calm overnight Thursday despite the shootings. A few hundred protesters gathered peacefully outside the police department and no fights broke out, as they had before the shootings, according to the Associated Press. The AP reports that the two officers, who were released from the hospital Thursday, were the first shot in more than seven months of protests in Ferguson.

McCaskill said Friday that the racial tension enraging Ferguson isn’t unique. “This is a bigger issue than Ferguson,” she said on the Today show. “We have a disconnect between some communities in this country and law enforcement. And law enforcement only works if the people of this country believe in it. So we’ve got to back to the drawing board [and] get back to community policing models. There is healing going on in Ferguson and there is reform going on in Ferguson. And that needs to be happening in many communities across this country.”

McCaskill’s office said she was drafting legislation to address these issues, prioritizing federal resources for body cameras for police officers and providing more oversight of federal grant and equipment programs that critics claim have militarized the nation’s police force.

TIME Foreign Policy

Obama ‘Embarrassed’ for GOP Senators on Iran Letter

U.S. President Barack Obama speaks at the National League of Cities annual Congressional City Conference in Washington on March 9, 2015.
Pool—Getty Images U.S. President Barack Obama speaks at the National League of Cities annual Congressional City Conference in Washington on March 9, 2015.

President expressed his discontent in an interview with Vice News

President Obama said he’s “embarrassed” for the 47 Republican Senators who sent a letter to Iranian leaders earlier this week making a case against a pending deal on nuclear weapons.

“For them to address a letter to the Ayatollah, who they claim is our mortal enemy, “ Obama says in a trailer for an interview with Vice News. “And their basic argument to them is ‘Don’t deal with our president cause you can’t trust him to follow through on an agreement.’ That’s close to unprecedented.”

The President’s statements are among the many that have come out in the wake of the letter organized by freshman Sen. Tom Cotton of Arkansas. Iranian Foreign Minister Javad Zarif called it a “propaganda ploy.” Vice President Joe Biden returned fire with a scathing letter to Congress released late Monday, saying in part “the decision to undercut our President and circumvent our constitutional system offends me as a matter of principle.”

Seven Republican Senators did not sign the letter: Sens. Bob Corker and Lamar Alexander of Tennessee, Susan Collins of Maine, Jeff Flake of Arizona, Dan Coats of Indiana, Lisa Murkowski of Alaska, and Thad Cochran of Mississippi.

The President sat down with Shane Smith, the founder of Vice News on Tuesday while in Atlanta for an event with the Democratic National Committee and a speech at Georgia Institute of Technology. The wide-ranging interview will be released in full next Monday, but a trailer for the conversation was released Friday morning.

TIME Congress

How a Human Trafficking Bill Became a Debate About Abortion

Sen. John Cornyn
Bill Clark—CQ-Roll Call/Getty Images Sen. John Cornyn, R-Texas, on Tuesday, Feb. 10, 2015.

Language to block funding for abortions has Democrats ready to filibuster

In February, the leading anti-trafficking organization Polaris praised the Senate for taking up their cause. On Wednesday, the group’s tone had changed dramatically, as it was now urging that same group of lawmakers to pass the same bill.

What happened? Two words: Abortion politics.

Until Tuesday, the bill was set to easily pass the Senate with bipartisan support. Now, it’s in jeopardy due to the inclusion of language that would limit women’s access to abortions.

“The bipartisan support to address modern slavery should not be held up by a separate debate on partisan issues,” said Brandon Bouchard, a spokesperson for Polaris.

The Alliance to End Slavery and Trafficking, another anti-trafficking advocacy group, expressed similar sentiment: “We urge all members of the Senate to turn away from this divisive debate and find a bipartisan approach to this new initiative to protect and serve the needs of survivors,” it said in a statement.

Introduced by Sen. John Cornyn of Texas in January, the Justice for Victims in Trafficking Act would establish a fund for victims using fines collected for trafficking crimes. Democrats and Republicans supported the bill, which passed out of the Senate Judiciary Committee with ease in late February. And on Monday, Senators seemed excited to move forward on the legislation.

That changed Tuesday, when Democrats cried foul over language in the bill they say was slipped in under the radar that would restrict the use of any funds collected from the trafficking punishment for abortions. Democrats say the abortion restrictions were not included in a list of changes to the bill that was circulated when it was introduced. Because of that, Democrats said they were unaware of any such provision when they decided to support it. Plus, they say adding it to this legislation goes too far.

Cornyn, however, says that doesn’t make sense. “I don’t believe for a minute they would have missed a reference in this legislation to a restriction on spending on funding taxpayer-provided abortions,” he said in an impassioned floor speech on Tuesday. “There are no shrinking violets in the United States Senate.”

Cornyn also said when he offered Democrats the option of offering an amendment they rejected it. “When we offered them an opportunity to offer an amendment to change that, they said: ‘No, we don’t want an amendment. We don’t want to change it by a vote of the Senate. We just want to block the bill,’” Cornyn said Wednesday. “And that’s what, unless something changes between now and the time we vote on cloture on the bill, is going to happen. Because they don’t want to amend the bill.”

But Democrats gave Republicans two options on Wednesday: remove the language or risk having the bill blocked.

“This bill has been hijacked by an issue completely unrelated to human trafficking,” Senate Minority Leader Harry Reid said in a floor speech on Wednesday. “I would suggest to the Majority, take it out.”

The whole ordeal is endemic of the partisan gridlock plaguing Washington, with both sides reluctant to cede any ground even though both agree on the fundamentals. Stuck in the middle of it all: the victims of trafficking and the organizations that were hoping greater protections and resources were on the horizon.

With reporting by Alex Rogers

 

TIME World

Obama’s Credit Crunch

Bremmer is a foreign affairs columnist and editor-at-large at TIME.

Congress weakens the U.S. by playing politics abroad

The Obama administration and negotiators from Britain, France, Germany, Russia and China are pushing for an agreement with Iran that would freeze the Islamic Republic’s nuclear program. On March 9, 47 Republican Senators sent an open letter to Iran’s leaders to warn them that the U.S. Congress had the power to rip up any deal signed with the Obama Administration. It was a clear bid to undermine the President’s credibility before any agreement could be signed.

Some of these lawmakers probably believed that urgent steps were needed to prevent a bad deal that would threaten U.S. national security. Others may simply have wanted to score political points off a President they and their constituents dislike. It’s doubtful that this letter will kill a deal that remains improbable for a host of other reasons. Obama can likely bypass the Senate by submitting any pact as an executive agreement, not a formal treaty. But there’s more to it. This move undermines the credibility of future Presidents, Democrats and Republicans, by raising fears abroad that America’s political polarization means no one is empowered to negotiate in good faith on behalf of the U.S. government.

The White House complained about the Republican letter, but the risk cuts both ways. The President has used Congress in the past in ways that have directly undercut U.S. credibility. In August 2012, Obama warned Syria’s Bashar Assad that the use of chemical weapons against his country’s rebels would cross a red line that would “change my calculus” on the use of American force in Syria. Several months later, Assad used these weapons. His bluff called–the President had shown little appetite for intervening in Syria–Obama argued that a military response was warranted but that Congress should vote to approve any air strikes.

This was disingenuous–Obama has ordered military action without congressional approval multiple times. When it appeared that Congress might not provide the authorization Obama sought, the President asked for a delay, then signed on to a Russian plan in which Assad agreed to dismantle his arsenal if Washington held its fire. Assad crossed the President’s red line, and Obama turned to Congress for political cover that lawmakers refused to provide. U.S. credibility sustained lasting damage.

A successful superpower foreign policy depends on more than just superior force and the willingness to use it. It demands deep reserves of credibility, the primary currency of power politics. If Washington asks a foreign government to compromise or to accept new costs and risks, leaders of that government must have confidence that the President can and will keep his promises. If the President’s representatives negotiate a deal, everyone at the table must know that Washington will keep up its end.

The Constitution is clear: the President sets foreign policy. Congress provides “advice and consent” for the ratification of treaties. Lawmakers should not undermine the President’s proper authority, but neither should the President cede that authority for temporary political advantage. The President and Congress score points off each other every day, but if their gamesmanship undermines Washington’s credibility, the national interest will suffer.

This trend is all the more dangerous at a time when other governments know well that the wars in Iraq and Afghanistan have sapped support for any long-term commitment of U.S. troops. That sharply reduces American negotiating leverage before the talking even begins.

With fewer means at Washington’s disposal to get the outcomes it wants, credibility is a resource that no U.S. elected official can afford to squander.

Foreign-affairs columnist Bremmer is the president of Eurasia Group, a political-risk consultancy

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME 2016 Election

South Carolina Presidential Straw Poll Leaves Out Lindsey Graham

Sen. Lindsey Graham
Bill Clark—CQ Roll Call/Getty Images Sen. Lindsey Graham speaks during a news conference in Washington D.C., March 26, 2014 .

Sen. Lindsey Graham is the Rodney Dangerfield of the 2016 Republican presidential primary: He can’t get no respect.

Almost two months after the South Carolina Republican announced that he was “definitely” looking at a presidential run, an online straw poll from his home state’s party still did not include him.

To make the oversight hurt just a little more, the straw poll had 25 names on it, including such unlikely candidates as former Godfather’s Pizza CEO Herman Cain, former Alaska Gov. Sarah Palin and former Secretary of State Condoleezza Rice. It even listed the state’s junior senator, Tim Scott. When asked if Scott was interested in running for president, spokesman Sean Smith said: “Easy answer: nope.”

Graham fans could still fill out a box for a write-in candidate, however.

South Carolina GOP party chairman Matt Moore was notified of Graham’s absence when TIME emailed him about it Wednesday. He said that the poll was created before Graham became more publicly vocal about a run, although he had floated the possibility last fall.

“That straw poll was done late last year before the New Year,” said Moore. “So it’s no reflection upon him. It was just a poll we put together last year and I expect we’ll be adding Sen. Graham pretty soon. In other words, take a look today again.”

“You raised a good point,” he added. ”He’s been in recent polls so people can end up choosing him.”

By Wednesday afternoon, the poll had been updated to include Graham’s name.

But there may be little appetite for a Graham run in his own home state. A week ago, a Winthrop Poll found that 60 percent of South Carolinians and two thirds of the state’s registered voters think he should not run for president in 2016.

MONEY Medicare

Why the Bill to Fix Medicare Keeps Soaring

150311_RET_MedicareCosts
Getty Images

Congress must act to prevent a big cut in fees to Medicare doctors. But a short-term solution now will mean soaring costs for older Americans later.

A perennial congressional battle over Medicare is about to erupt. And the result is likely to be a steep increase in the program’s long-term costs—with older Americans eventually paying many of those bills.

As of April 1 fees paid by Medicare to participating doctors will be slashed by a steep 21%. This cut is the result of a 1997 budget formula, called the Sustainable Growth Rate (SGR), which should have been junked years ago. Physicians have already been complaining about Medicare’s low level of reimbursement, and if the cut happens, there could be a mass exodus of physicians from the program.

Congress has had plenty of opportunities to reset the the SGR formula to permit fair fees and annual adjustments but instead has opted for short-term fixes 17 times. Last year lawmakers agreed on a long-term plan to set physician rates—a so-called “doc fix”—and this consensus proposal has been reintroduced in the new Congress. But the long-term price tag for the adjustment threatens to make it a non-starter.

How much would a long-term doc fix cost? The Congressional Budget Office (CBO) estimated the 10-year budget hit of a permanent reform at $138 billion in early 2014. A year later, the 10-year bill has risen to nearly $175 billion. For perspective, the agency’s latest 10-year price tag for the Affordable Care Act is “only” $142 billion.

It’s hard to believe that Congress will be able to find $175 billion in spending offsets in the next couple of weeks, or that Republicans would agree to boost the deficit in order to pay the long-term tab. So expect another one-year fix—number 18. It would cost an estimated $6 billion, which would not have much of an immediate impact on consumers.

If Congress doesn’t vote in a fix, higher Medicare costs would slam older Americans and their families. As a new Kaiser Family Foundation analysis points out, under current law beneficiaries would automatically absorb their share of Part B Medicare costs if the formula is changed. That out-of-pocket price tag would be nearly $60 billion over 10 years, Kaiser estimates.

That’s just for physician fees. Consumer out-of-pocket costs are likely to rise even higher once other effects of the change are factored into Part B premiums and co-insurance payments. “One option under discussion would require beneficiaries to assume a portion of the $175 billion federal price tax, above what they will automatically pay in premiums and cost-sharing,” the Kaiser analysis says.

Other major Medicare service providers, including insurers and drug companies, could also be asked to take a haircut to finance high doctor payments. Of course, those costs are likely to be passed along to consumers eventually.

Paying higher Medicare costs is asking a lot of most older Americans. Half of all Medicare recipients live on incomes of about $23,500 or less. And seniors already spend triple the amount of money on health care, as a percentage of their household budgets, compared with younger households.

Still, a permanent doc fix has to happen at some point. And Kaiser’s report notes that Congress has been getting closer to a serious response to the problem.

So if you depend on Medicare, you would do well to set aside what savings you can to meet those inevitable health care bills. And at the very least, expect a big increase in Washington rhetoric over Medicare.

Philip Moeller is an expert on retirement, aging, and health. He is the co-author of “Get What’s Yours: The Secrets to Maxing Out Your Social Security,” and a research fellow at the Center for Aging & Work at Boston College. Reach him at moeller.philip@gmail.com or @PhilMoeller on Twitter.

Read next: The New Rules for Making Your Money Last in Retirement

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