The wordsmiths crafted clever names for some of the deals that got health reform through the Senate. There was the “Cornhusker Kicker” for Nebraska’s Sen. Ben Nelson’s Nebraska-only Medicaid payment rate, the “Louisiana Purchase” for Sen. Mary Landrieu’s cash infusion for Louisiana, and “Gator-Ade” for a provision for Sen. Bill Nelson from Florida. What about Sen. Bernie Sanders? He got more than the other three, perhaps even more than the other three combined. It took $11.1 billion to get his vote to get the bill through the Senate; now the fix-it budget reconciliation bill would up his take to $12.6 billion and more. What could his pot be called? Sanders’s Secret Sauce?
The first part of Sanders’s pot is good old fashioned pork. The University of Vermont wants a new hospital for its medical school. There’s a direct infusion of $100 million for that project in Section 10502 of the bill the president signed.
The second is additional money for two of Sanders’s favorite causes: community health centers and the National Health Service Corps. Courtesy of Section 10503, these programs get an add on, directly appropriated in the health-reform law, above their FY 2008 level. Community health centers provide health-care services. Their federal program began as part of LBJ’s Great Society and survived Ronald Reagan’s effort to block grant them (at a time when they cost one-tenth of what they do now). The FY 2008 appropriation was $2.1 billion. The Sanders add-on started at $.7 billion for FY 2010, and ramped up to $2.9 billion in FY 2014. Along with $1.5 billion for construction, the health centers would get $9.5 billion. The National Health Service Corps, funded at $155 million in FY 2008, would likewise double its money, thanks to Senator Sanders. Altogether, it would be $11.1 billion in additional spending.
But that’s not all. The House-passed reconciliation bill would further increase the amount for the community health centers by $1.5 billion over five years (the very last provision of the bill: Section 2303).
It’s a stretch of credibility to think that after FY 2014 the additional money would go away. If the FY 2014 spending continued for the second half of the ten-year budget window addressed by the reconciliation bill, that would be an additional $18.0 billion. That doesn’t show in the Congressional Budget Office’s estimate, but CBO’s job is to put a price tag on what Congress says — that the money would go away after FY 2014 — not to assess how believable it is that Congress will let that happen.
There’s plenty of deals in the health bills, one signed and one pending in the Senate. Would that they all get the attention they deserve, both from the wordsmiths and the broader public.
– Hanns Kuttner is a visiting fellow at Hudson Institute.