New Obama Administration Health Care Guru: Double Counting? What Double Counting?


Is Donald Berwick, the controversial new head of the Centers for Medicare and Medicaid Services, standing by the Obama administration's double counting of savings in the new health care law? At a Senate hearing this morning, he declined to engage with official criticism of the administration's claim that the the Patient Protection and Affordable Care Act extends the Medicare Trust Fund.

Secretary of Health and Human Services Kathleen Sebelius has been pushing the line that the PPACA extends Medicare's solvency for a while, despite pushback from both the Congressional Budget Office and Medicare's chief actuary, Richard Foster. And now Berwick seems to be at least tacitly on board. I didn't get the exact quote (I'll update when I see a transcript), but when Republican Sen. Orin Hatch questioned Berwick about the conflict between what the administration has said and what Foster has said, Berwick's response was to suggest that the administration was simply using standard accounting methods.

At best, this is a way of not answering the question. But you can understand why he might not want to: Actually responding to the question would have required him to respond directly to statements by both Foster and the CBO that say that, in practice, the administration is wrong.

For those in need of a refresher, here's Medicare's actuary:

In practice the improved (Medicare hospital insurance) financing cannot be simultaneously used to finance other Federal outlays (such as the coverage expansions) and to extend the trust fund, despite the appearance of this result from the respective accounting conventions.

And here's CBO:

To describe the full amount of HI trust fund savings as both improving the government's ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings.

Sebelius has almost totally refused to engage with these statements except to either ignore or misrepresent them. At one point, she went so far as to claim that the CBO agreed with HHS that there was no double counting. Now Berwick seems to be dodging too. Is it now administration policy to just pretend these reports don't exist and keep saying that there's no double counting?