You're never gonna believe what else is in Trump's budget...

Healthcare reporter extraordinaire Margot Sanger-Katz has been picking through the horror show known as Donald Trump's proposed annual federal budget, and it's every bit as awful as you might expect:

The first one I already wrote about this morning...

The White House’s preferred Obamacare replacement now appears to be Graham-Cassidy.

— Margot Sanger-Katz (@sangerkatz) February 12, 2018

In a surprise to no one, Planned Parenthood would appear to be defunded...

This would be a big policy change.

Prohibits Certain Abortion Providers from Receiving Federal Funds. The Budget includes provisions prohibiting certain abortion providers from receiving Federal funds from HHS, including those that receive funding under the Title X Family Planning program and Medicaid, among other HHS programs

— Margot Sanger-Katz (@sangerkatz) February 12, 2018

But here's the one which makes me roll my eyes and slam my head into my desk:

Surprise! The budget would fully fund CSRs and risk corridor payments for Obamacare plans.

Provide Appropriation to Pay Cost-Sharing Reductions
This proposal provides a mandatory appropriation for Cost-Sharing Reduction payments for FY 2018 through the end of calendar year 2019. [No budget impact]

Fully Fund the Risk Corridors Program
This proposal provides a mandatory appropriation to fully fund the Risk Corridors Program, including exempting the program from sequestration. [Budget Impact: $812 million in FY 2018]

— Margot Sanger-Katz (@sangerkatz) February 12, 2018

Yup, after all that fuss and drama over the issue last year, Donald Trump's proposed federal budget would include a mandatory 2-year CSR reimbursement payment appropriation for 2018 and 2019...five months after doing so would be a net positive. Making the payments now, after the 2018 individual market premiums have been locked in and after the open enrollment period is over would make no sense whatsoever for 2018...and would actually end up hurting more people than it helps if reinstated starting in 2019, since those earning between 250 - 400% of the federal poverty line would lose the additional tax credits they're getting this year.

And again, doing so in the middle of the 2018 calendar year would just cause even more chaos and confusion, since premium rates are locked in for the full calendar year, which I assume means they'd end up double-dipping for this year (the CSR load on premiums and the CSR reimbursement payments), which in turn means they'd have to pay the extra money back in the form of rebate checks due ot the ACA's 80/20 Medical Loss Ratio rule...gah!


The budget would also apparently include PAYING OUT THE RISK CORRIDOR FUNDS which have been legally owed to dozens of insurance carriers since 2015.

YES, THAT'S RIGHT: Over three years after Marco Rubio pulled his stupid #RiskCorridorMassacre stunt which helped lead to the collapse and liquidation of over a dozen Co-Ops, put several hundred people out of work and kicked 800,000 people off of their healthcare policies in a shameless attempt to help make himself look good for his ill-fated Presidential run, the Trump Administration has now decided to go ahead and make the payments of several billion dollars (and which, again, have been legally owed for years now) after all.

Which might have been useful if it had been done at the time they were due, back in 2015.

Unfortunately, those dozen-plus Co-Ops (as well as at least one private insurance carrier which was caught in the wake) are now long dead and buried. The damage from the sabotage was done in 2015. A handful of others stuck it out through 2016...except the payments owed them weren't paid then either, taking down a few more.

Paying them back now is tantamount to writing a check to someone you owe money to and placing it on their headstone 3 years after they died.

But hey, at least their creditors will be paid off, so there's that, anyway.

(sigh) Yes, as it happens, I've called for both of these things to be fact, they're the very first and second items on my "If I Ran the Zoo" wish list...but aside from the situation being completely different today, the hypocrisy/chutzpah factor is off the charts, not that this has ever made a damned bit of difference to the Republican Party...

I was made to believe that cost sharing reductions and risk corridors were insurance company bailouts.

— Colin B (@colinb1123) February 12, 2018