I think I've finally figured out what's behind the kerfuffle that has stirred up a hornet's nest against Senate Republicans, on the surface voting against and/or blocking the PACT Act, The story behind the PACT Act on its merits has to do with veterans who got presumably exposed to toxic chemicals (like the notorious Agent Orange in Vietnam) during their years of service and have subsequently developed long-term health consequences. It seems that the real issue is that the VA basically put the burden of proof on the veteran to prove his ailment is caused by service exposure before the VA takes responsibility for related healthcare coverage.
This issue has been simmering in Congress for years before finally getting approval votes on (different versions) in both chambers in Congress, including an 84-14 Senate vote in mid-June. Note that one of the 14 nay's is retiring Sen. Toomey (R-PA).
Now before going into the soap opera with the House before Toomey's recent move getting nuclear heat, let's point out why some Republicans opposed the initial bill, which seems quixotic since the GOP considers military conservatives part of their core constituencies. It has to do with some inside baseball and fiscal conservatives.
But one of the things that must be made absolutely clear: it has NOTHING to do with the merits of funding veteran healthcare. While comedian Jon Stewart goes on his partisan rant and veteran groups are blasting the Republicans blocking the second vote, let's be clear: the funding will eventually be approved. It's just the timing and specifics. Toomey has admitted he doesn't have an issue with the estimated 280-400B price tag over the coming decade.
It has to do with the divide between mandatory and discretionary spending. Mandatory spending, which includes items like senior entitlements, is not subject to annual discretionary appropriations, including Defense and other normal government operations. VA spending has generally been included under discretionary spending. For fiscal hawks like Toomey, their only leverage is over spending on the discretionary side, subject to certain caps.
So the inside story is apparently transferring the VA funding to the mandatory side of the ledger, Toomey fears, will open up maybe up to $40B/year spending slack on the discretionary side that Dems will fill as sort of a political slush fund. Toomey wants relevant budgetary safeguards. Tester (D-MT) rages, "How dare you not trust the appropriators!" and then he revives a version of Grayson's argument that the GOP plan for healthcare is to "hurry up and die! You, Toomey, are responsible for all the vets dying while we deal with your delay!" Cry me a river, Tester!
Now to the kerfuffle. Although his fellow Republicans agreed with Toomey on the budget issue, most still supported the PACT Act as indicated above. So what happened?
Apparently, the Senate bill includes a buyout clause for provider contracts for purposes of staffing employment in rural areas. The Senate wanted this to be tax-free in the legislation. The problem is constitutionally revenue-bearing items must start in the House, something the House discovered in reviewing the Senate bill. So we have a blue slipping issue. There are a variety of workaround fixes, like the Senate striking the provision and the House restoring it in the reconciled version, etc.
Tester had tried to get unanimous consent for an "engrossment correction" before the July Fourth recess to resolve the blue slip problem created by the tax provision. But Sen. Patrick J. Toomey, R-Pa., one of 14 Senate Republicans who voted against the bill, objected because he did not like that the bill would shift a significant chunk of veterans’ health funding, which is currently subject to discretionary spending caps, to the mandatory side of the spending ledger
So what happened to the failed closure vote on the relevant House amendment:55-42?
I suspect it is probably GOP blowback to the recent Schumer/Manchin reconciliation agreement (Inflation Reduction Act), which includes climate change and tax provisions that Republicans (and myself) oppose. (Budget reconciliation is exempt from the filibuster.)
How does this get resolved? Toomey wants the mandatory/discretionary matter resolved in the bill. Schumer regards the change as a poison pill and all he seems prepared to do is to allow a Toomey amendment under the same cloture rules--which would probably win few, if any necessary Dem votes. For Republicans, especially those are in the hot spot of explaining changing their votes on PACT itself, it may be enough to put themselves and Dems on the record on the Toomey amendment. They already implicitly accepted the mandatory spending shift in their earlier vote. So I think the Toomey vote fails closure, the second PACT closure vote passes, and the PACT act finally passes and goes to POTUS.
This is all political gamesmanship. I think the Democrats could easily push through the buyout provision through ordinary reconciliation, ignore the Senate bill faux pas, pass it intact and send it to the President.
