You may remember that the only way Congress was able to make the budget score for the Patient Protection and Affordable Care Act (PPACA) was to pretend that Medicare payments to doctors would fall 23 percent this year and continue falling according to the sustainable growth rate (SGR) schedule. Since the first cuts were supposed to take effect in 2002, Congress under Republicans and Democrats alike had always intervened, so the PPACA savings were fictional from the start. Making the “doc fix” permanent would have added $250 billion to the bill’s cost.

But Congress has found a way to pay for its most recent temporary fix without racing the cost of PPACA. The new bill, which passed both houses by large majorities, reduces the size of tax subsidies for people purchasing insurance through an ObamaCare exchange and moves them to a sliding scale. Community Catalyst is not happy about this because they worry it sets a precedent for cutting the bill’s spending to pay for other stuff. Sounds like a good start to me.