Senate health bill includes budget tricks

November 21, 2009, Gannett News Service: Analysis, By BILL THEOBALD

WASHINGTON -You could hear the sighs of relief last week from Senate Democratic leaders when the Congressional Budget Office reported that their health care bill wouldn't increase the federal deficit.

The nonpartisan CBO said the legislation would reduce the deficit by $130 billion from 2010-2019, a finding that will be key to selling the idea to the public and to complying with a no-red-ink mandate from President Barack Obama.

But peel back the numbers in the CBO report, and you find the sort of bookkeeping shenanigans that wouldn't pass muster around most kitchen tables in Tennessee.

The first gimmick has to do with something commonly referred to as the "doctor fix." Back in 1997, Congress set up a system to automatically cut Medicare reimbursements to doctors if program costs rose too quickly.

Every year since then, costs have indeed risen. But just as the reimbursement cuts are about to kick in, Congress always steps in and "fixes" (i.e., nullifies) them. Some call this kowtowing to doctors, but policymakers fear that cutting reimbursement rates would cause many doctors to drop their Medicare patients.

The Senate health care proposal assumes Congress would approve its standard doctor fix only in the first year the reforms take effect. The amount paid to doctors serving Medicare patients would be cut sharply after that.

Total savings: about $200 billion.

So does that mean doctors' Medicare reimbursement rates would really be cut? Nope. On Thursday, the House voted to perform the same doctor fix it always has, but in a measure separate from the health care reform bill.

The next bit of financial sleight of hand relates to a proposed long-term care insurance program called the Community Living Assistance Services and Supports Act.

CBO officials looked at how much the program would cost only during the health care bill's 2010-2019 budget window. Over that period, the program would be taking in lots of premiums but would be spending very little on health services because most people enrolled in it would be too young to need those services.

The result: $72 billion in savings.

A final bit of fiscal finagling comes from delaying by one year the date when people would start getting federal subsidies to buy health insurance. Earlier proposals called for the subsidies to begin in 2013. The current Senate bill specifies 2014.

Total savings: about $15 billion.

Eliminate all these dubious accounting tricks from the health care bill, and you end up not with a deficit reduction, but with a deficit increase of more than $150 billion over the decade.

"It shows the tremendous lack of respect Congress has in dealing with the American people," Republican Sen. Bob Corker said. "It's almost beyond belief."

Bill Theobald covers Tennessee issues at Gannett News Service's Washington bureau. E-mail him at wtheobal@gannett.com. Copyright ©2009

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