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"This is a hard run to the middle," said a former GOP aide who has worked on fiscal issues. "It's nothing more than a 100-plus billion-dollar hole in the deficit, if you're at all worried about a primary from the fiscal conservative side, which is still dominating the Republican Party."
"The interesting thing is how Paul argues this. His first big move from the committee is to allow 100-plus billion dollars in entitlement spending to go unpaid for?" the source continued.
In fact, Boehner, Ryan, and other leaders will argue that, if you look beyond the standard 10-year budget window, the deal is a win for Republicans. Only about a third of the up to $200 billion price tag will be paid for within 10 years—half of that by reforms to Medicare long sought by Republicans and the other half through costs imposed on hospitals and other Medicare service providers. But those Medicare reforms, leaders will argue, will save money in the long term.
The deal also removes a perennial sword of Damocles hanging over doctors who treat Medicare patients, as it repeals a policy that would raise their costs by more than 20 percent if it is allowed to lapse at the end of the month.
"We are working to develop a bipartisan framework that finally resolves the never-ending doc-fix problem while putting in place responsible reforms that would strengthen the Medicare program for seniors," Boehner spokesman Kevin Smith said.
Meanwhile, House Democrats have agreed to the policy without insisting on tax increases in return. What they get instead is a two-year reauthorization of the Children's Health Insurance Program at levels agreed to in the Affordable Care Act. And even that is a relief for GOP leaders; CHIP not only splits the Republican Party, but it expires in September, just as government spending is set to run out. Amid another potential shutdown jam, GOP leaders would also likely have to deal with Democrats to get it passed then or concoct their own policy and suffer attacks from Democrats accusing them of endangering or making draconian cuts to children's health care programs.
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All that is enough, aides said, for Boehner to make the decision to deal with Democrats up front. Not to mention, the last doc-fix patch was so controversial, GOP leaders sneakily voice-voted it without giving dissenters a chance to object, surprising even Ryan. That has left residual hard feelings, and Boehner does not want to replicate that move.
"Boehner's biggest priority these days is just to get the place working again," said a House GOP aide familiar with leaders' thinking. "I think Boehner's been through so many of these things and knows how much they disrupt getting anything you want to do done. He wants to resolve it once and for all."