Doc fix deal (?)

From Politico:

Senate leaders have reached a tentative, one-year deal on the Medicare “doc-fix,” sources close to the negotiations say.

The deal pays for the must-pass patch to prevent a deep cut in Medicare doctors’ payments with changes in the tax subsidy program that some consumers will use after 2014 to buy health insurance on the new exchanges. […]

The deal on the table would change how much money consumers would have to repay if their income status changes mid-year, pushing them out of the eligibility bracket. For instance, someone who qualified for a subsidy because he was unemployed in the first half of the year may have to repay a large portion of that subsidy if he finds a job. Few additional details were available Monday night.

Though that doesn’t strike me as such a bad deal, I’d have rather seen it go another way. First, it’s not bad because the tweaks to subsidy eligibility serve to make it more fair and are the type of things I would have expected to see happen as the program was implemented anyway. Put another way, if mid-year income corrections had already been in the ACA it would not have surprised me.

But I would have preferred to keep the whole deal within Medicare. The doc fix is about increasing physician pay under Medicare. Medicare has a spending problem. Therefore, I would have liked to see Congress figure out how to keep changes to the program budget neutral rather than take money out of the hide of a new program for low-income working-age adults and their families.

I know why it went down this way and not my preferred way though. One one side of the aisle the whole point is to use every possible means to nibble away at the ACA. That being the goal, I’m surprised they got so little in this deal. But the deal isn’t done yet.

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