You have made Dr. House go "Blearghhh." That doesn't bode well.

We're learning all sorts of fun stuff about the Senate Republicans' exciting new bill to kill Obamacare and many of the people on it. For instance, it's full of wishful math, promising to use the exact same money for several different purposes. It also makes sure whatever horrors the bill unleashes on plans in the individual marketplace, Congress's healthcare will not be affected by the New Cruelty. After all, they're important people, unlike the losers and takers who'll be subject to higher prices or penalties for having preexisting conditions.

The "I Got Mine" Amendment

[wonkbar]<a href=""></a>[/wonkbar]Over at Vox, Sarah Kliff explains that what's good for the voters is not good for Congress, because why should Congress have to suffer just for writing an incredibly bad healthcare bill? The brand new version of the "Better Care Resolution Act" sneaks in a provision that was laughed out of the House version of the bill, exempting congressional health insurance from Ted Cruz's plan to let insurers drop the Affordable Care Act's essential health benefits:

Insurers can offer plans without these benefits — unless they’re selling coverage to members of Congress and their staff, who are required to buy coverage on the health law marketplaces. The exemption says this part of the law still applies to any plans sold to Congress.

Now, here's the weird part: Kliff says the rule appears not to protect members of Congress from the new rules allowing insurers to charge people with preexisting conditions higher premiums, or to reject them altogether, according to policy expert Timothy Jost of Washington and Lee University, who says it's not clear how that would actually work in practice:

The Senate draft ... would still allow insurers to charge higher prices to those with preexisting conditions — when selling to Congress as well as to the rest of the public. This could create an odd scenario where the plans that Congress is eligible for have to cover a wide array of benefits but can also deny coverage or charge more to those expected to have higher costs.

Also, as with several other parts of the current draft, it's possible the provision exempting Congress from its own healthcare fuckery will violate the rules governing reconciliation, the method Republicans are using to kill Obamacare. The bill can only address policies that fall under the jurisdiction of the Senate's Budget Committee and the Health, Education, Labor, and Pensions Committee. A Senate aide told Kliff that congressional insurance coverage is the bailiwick of the Senate Finance Committee, so the congressional exemption may have to be stripped to avoid subjecting the bill to a filibuster, assuming it's not removed thanks to public shaming. Then again, if Senate Republicans were capable of feeling shame, they'd already be running away from this mess of slime as fast as they could.

You Cannot Spend The Same Bribes Four Times!

Maine Senator Susan Collins, who along with Kentucky's Rand Paul makes up all of the committed "no" votes the Senate plan can handle, noticed something really dumb in the new draft of the Senate bill, something even dumber than Ted Cruz's amendment to return us to the good old days of higher costs and outright denials of insurance for preexisting conditions. The new draft of the bill includes some beautiful additional spending meant to make Republican "moderates" happy, or at least willing to vote for the bill, but it's actually a shell game.

The Cruz amendment, again, would create a two-tier individual market -- cheap crappy plans that don't cover much of anything, but will supposedly attract all the younger, healthier buyers, and then plans that meet the Obamacare standards but will mostly be bought by people who actually need to use health services.

It's a recipe for turning the individual insurance market into one big high-risk pool, so the idea is that the new Senate plan would supposedly offset that market instability by not repealing a couple of the taxes in the ACA, which would then be allocated to states to "assist such health insurance issuers in covering high risk individuals.” Ah, but here's where Collins noticed the fuzzy math, as Talking Points Memo explains:

[There] is no additional money. Instead, the amendment takes money already appropriated in the bill for other needs and says it can be used for these payments to insurers under the Cruz Amendment.

“It seems to me you’re using that money over and over again,” she said. “It’s supposed to relieve the cost of high premiums. It’s supposed to solve the problem with deductibles being unaffordable. It’s supposed to be available for high-risk or reinsurance pool. It’s supposed to be available under the Cruz Amendment to help prevent a huge increase in rates for people with pre-existing conditions.”

That assessment was confirmed by Matthew Fiedler of the Brookings Institution, who agrees there's double-dipping going on in the bill:

“The overall bill adds $70 billion to the stability fund,” he said. “But the Cruz amendment then redirects that same money to make payments to insurers designed to mitigate the problems that the Cruz amendment would create in the ACA-compliant market.”

“That funding will, of course, not be available to serve the stability fund’s other purposes,” he added.

Presumably, the Congressional Budget Office will notice that when they score the thing, too. In addition to stabilizing the individual market, that same $70 billion (plus another $112 billion from the first draft) is supposed to help subsidize tax credits for people booted off Medicaid so they can buy insurance, help lower-income folks set up health savings accounts, and reduce deductibles and premiums for people in high-risk pools. (Which will be everyone buying real insurance on the exchange.) That money might not go that far!

But what about all the economic growth that will be stimulated by the tax cuts, and also the magic pixie farts from all the people working harder because now they'll be Taking Responsibility For Themselves? Seriously, these "experts" have no idea how Republican Math works.

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[Vox / TPM]

Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.


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