This morning I wrote a diary about the $8 Billion “pre-existing condition” amendment being slapped onto the AHCA in order to win over enough “moderate” GOP votes to cram the Trumpcare bill through. Please read it to understand what a crock of shit this is (on top of all the other ways the bill is horrific—Kicking 24 million off coverage, decimating Medicaid, etc etc).

However, it’s even worse yet.

When I titled this "The $8 Billion Scam", I was mostly looking for an excuse to use the cute "$6 Million Man" graphic. That is, I originally thought that it was "only" a scam in the sense that $8 Billion isn't nearly enough money to properly cover the number of people with pre-existing conditions it purports to.

HOWEVER, now that the actual language has finally been released (less than 24 hours before it's supposed to be voted on, I should add...so much for "transparency" and "Democrats rammed it down our throats" complaints), it looks very much like even the $8 billion itself is also a scam, in at least two ways.

First of all, I asked a few people today how the funding allocation works. After all, in theory up to all 50 states could request a pre-existing/community rating waiver which would require high risk pools for that $8 billion, right? But not every state will do so...some will, some won't, and the populations involved will vary widely. What happens if only, say, Wyoming (total population: 586,000) were to do so? Does the lowest-population state get the entire $8 billion?? What a windfall, especially since they'd likely only haver perhaps 20,000 people with pre-existing conditions on the entire individual market! That'd be $400,000 apiece! I assumed there was some sort of per-capita formula which would put a cap on how much each state could receive.

Well, no one seemed to know the answer...and now that I've seen the actual text, it turns out that the answers is...there is no formula whatsoever. Apparently HHS Secretary Tom Price can dole out the money however the heck he wants to:

AMENDMENT TO H.R. 1628 OFFERED BY MR. UPTON OF MICHIGAN, MR. LONG OF MISSOURI, MR. YOUNG OF IOWA, MR. VALADAO OF CALIFORNIA, MR. KNIGHT OF CALIFORNIA, MR. DENHAM OF CALIFORNIA, AND MRS. MCMORRIS RODGERS OF WASHINGTON Amendment drafted to H.R. 1628, as amended by self-executing amendments adopted by Rules Committee and Amendment offered by Mr. MacArthur In the section 2202(a) proposed to be added to the Social Security Act by section 132, strike ‘‘Subject to subsection (b)’’ and insert ‘‘Subject to subsections (b) and (c)’’. Add at the end of the section 2202 proposed to be added to the Social Security Act by section 132, the following: ‘‘(c) REQUIRED USE OF ADDITIONAL INCREASE TO CERTAIN WAIVER STATES TO PROVIDE FINANCIAL HARDSHIP ASSISTANCE.—A State shall use the additional allocation provided to the State from the funds appropriated under the last sentence of section 2204(a) only in accordance with such last sentence. Insert at the end of the section 2204(a) proposed to be added to the Social Security Act by section 132, the following: ‘‘The amount otherwise appropriated under this subsection shall be increased by $8,000,000,000 for the period beginning with 2018 and ending with 2023, to be allocated to States with a waiver in effect under section 5 2701(b) of the Public Health Service Act with respect to the purpose described in paragraph (1)(C) of such section, in accordance with an allocation methodology specified by the Secretary that takes into account the relative allocation of other amounts appropriated under this subsection 10 among such States, and to be used by (and made available under subsection (d), for any year during such period that such waiver is in effect, to) such States for the purpose of providing assistance to reduce premiums or other out-of-pocket costs of individuals who are subject to an increase in the monthly premium rate for health insurance coverage as a result of such waiver. In the section 2202(b) proposed to be added to the Social Security Act by section 132, strike ‘‘section 2204(b)’’ and insert ‘‘section 2204(a)’’. In section 214(b), strike ‘‘Section 1412 of the Patient Protection and Affordable Care Act is amended by adding at the end the following new subsection:’’ and insert ‘‘Section 1412(f) of the Patient Protection and Affordable Care Act, as added by section 202, is amended to read as follows:’’

That's it. That's the entire amendment.

Now, the ACA itself does already grant quite a bit of authoritative leeway to the HHS Secretary when it comes to deciding how to administer the law, which served Sylvia Burwell quite well when trying to deal with an obstructionist Congress, and which already grants Tom Price a similar amount of clout when it comes to bogging down or sabotaging the law. However, this may be along the same lines as that. I'm really not sure.

However, as former CMS Administrator Andy Slavitt just noted moments ago, there's a related issue which is far more disturbing:

This $8B targeted to take care of ppl w pre-existing conditions . . . doesn't have to be used for ppl w pre-existing conditions. 4 — Andy Slavitt (@ASlavitt) May 4, 2017

The number of times the words "pre-existing conditions" are used in the bill . . . Is ZERO. 5 — Andy Slavitt (@ASlavitt) May 4, 2017

Meanwhile, someone please count the times the words "pre-existing conditions" are in the GOP secretly obtained talking points. 6 pic.twitter.com/wAzcGVrDxw — Andy Slavitt (@ASlavitt) May 4, 2017

These are part of a longer thread; here's the other key points he makes: