Final Doc-Fix Compromise To Take Money Out Of Health Law Establishes A Poor Precedent

The final details of the one-year doc fix are in and it looks like both parties have agreed to pay for the patch — which would prevent a 25% cut in reimbursement rates to physicians — by taking some money out of the health care law. Here’s how:

Short version is that the ACA specified that if your income rose during the year such that your end of year income was higher than was projected (which is how amount of subsidy/tax credit was figured), then the maximum amount an individual had to pay back to the government was $250 for individual or $400 for family coverage. Now there is a sliding fee scale based on how much your income turns out to be, with much larger pay backs in force. If your income is 200% poverty, you have to repay up to $600, if it is 450-500% of poverty, you have to repay up to $3,500, with sliding scale in between.

The Congressional Budget Office has just released its estimate of the measure here, and while the pay fors are certainly not the kind of “defunding” that Republicans are talking about, it’s hard to escape the fact that Democrats are still taking money out of the law — before most of it even goes into effect.

That is, rather than drawing a line in the sand and refusing to even entertain the suggestion of tampering with their signature legislative accomplishment, the Democrats are setting a precedent that says, ‘yes, there is too much money in the health care law.’ Why one would open that door just as Republicans are gearing up to completely defund the measure, is unclear. After all, Democrats are indicating that they’re willing to compromise on reform and I suspect the GOP will press them to give even further. If the law becomes the go-to pay-for, that doesn’t bode well for the law or its affordability standards.