Jonathan Chait devotes a long, detailed post today towards arguing, once again, that Republicans are wrong to consider the "doc fix" a real cost of ACA.
He is, in my view, correct.
But he's missing a larger point.
The Republican argument to including the doc fix as a cost of ACA last year boiled down to: this is a serious problem, the Democrats know it's a serious problem, the Democrats intend to continue to do a doc fix, but they're artificially ducking the cost of the problem by omitting it from the bill. Therefore, the doc fix should count as a budgetary cost of enacting ACA. I don't agree, but that's the argument.
However, we're no longer debating the fiscal effects of passing ACA.
We're now debating, or at least the House is debating, repeal.
Repeal, as the House Republicans define it, does not include the doc fix.
Republicans know it's a serious problem. Republicans intend to continue to do a doc fix. They are, however, by their own logic, artificially ducking the cost of the problem by omitting it from their repeal bill.
I've said this before: if we listen to what the Republicans are actually saying, then doc fix should be scored as a cost, and certainly not a savings, of repeal. If Chait and the Democrats want to spin this properly, they should forget about re-arguing the original case, and simply point out any time the GOP raises doc fix that Dems would be glad to buy the argument as long as Republicans agree to be consistent, and charge the doc fix against repeal. Which means that by their own logic, repeal would really increase the budget deficit over the next decade by about twice as much as CBO says.
And if anyone can figure out the case for including the doc fix as a savings of repeal, I'd love to see it. That's the claim that Republicans are pushing now, and all the mumbo jumbo in the world about how ACA should have been scored last year seems to me to either be irrelevant to that claim or thoroughly undermine it.
The original, SGR-necessitated doc fix is not and should not be considered part of the cost of PPACA. But PPACA creates a new doc fix of its own with scheduled cuts in reimbursement rates. The jury is obviously still out on whether this will play out in the same way.
ReplyDeleteOne specific scheduled cut is in Medicaid. The majority of the coverage expansion in the bill is through Medicaid. But reimbursements are so low that the majority of primary care docs won't accept new Medicaid patients. To fix this they increased Medicaid reimbursements up to Medicare levels for the first 2 years, after which they revert back to the lower level. They designed it this way because keeping the reimbursements higher would increase the cost of the bill. One of two things will happen, the doctors will stop taking Medicaid patients again, making the coverage expansion somewhat useless, or Congress will step in and prevent the cuts from happening, blowing up the cost projections.