‘Fuzzy math’ could drive health bill cost higher

The official $1.1 trillion price tag for the House Democrats’ health care bill excludes dozens of unfunded programs that could drive up costs when future congresses look to fund them.

Republicans said the health care bill includes two dozen programs whose funding is listed as “such sums as may be necessary.” That amounts to legislative jargon, they said, for “We’ll bill you later.”

The list of projects ranges from the “No child left unimmunized against influenza” project to 10 programs in the Indian health care system. There are also programs to encourage people to go into nursing and to spur states to restrain medical-malpractice lawsuits.

The tactic is far from new and has been used for years by Republicans and Democrats alike. The health reform examples are just the latest of what has become known as “fuzzy math” - the sort of budgeting that has been drawing extra scrutiny as the economy sputters, federal spending balloons and deficits deepen.

Republican leaders said leaving appropriations for a later date meant lawmakers were voting blind this weekend on health reform in the House. “How can members of Congress cast informed votes on a bill when there is no way to know the true cost to the American taxpayer?” said Rep. Jerry Lewis of California, the top Republican on the House Appropriations Committee.

But Democrats said leaving spending decisions up to future congresses is standard operating procedure under both parties and is the only way to let the appropriations committees weigh priorities. They said authorizing a program doesn’t mean it will get money, and they pointed to a host of programs that have never gotten off the ground because Congress has never funded them properly.

“If you’re calling these fuzzy math, then every authorization bill is fuzzy math,” said a Democratic aide, who requested anonymity. “It’s not fuzzy math at all. It’s not math. That’s the way Congress works. You authorize a program, and the appropriators appropriate for it.”

Until Saturday’s late-night health vote, much of the criticism for fuzzy calculations has been aimed at the administration’s calculation of jobs “saved or created” by the $787 billion stimulus package.

Late last month, Vice President Joseph R. Biden Jr. seemed to stumble over the math, touting that 1 million jobs have been created so far - but immediately adding that those calculations can’t be expected to be “100 percent accurate.”

The official tally is 650,000 jobs saved or created by stimulus investment, but Mr. Biden said the indirect effect of the spending means the real number is much higher.

It is in Congress, though, where bills get written, that creative math is elevated to an art.

Douglas Holtz-Eakin, former director of the Congressional Budget Office and chief policy adviser for Sen. John McCain’s presidential campaign, said that’s true of the health care bills winding their way through the Capitol.

He said Democrats are counting on spending cuts that “are political fiction,” adding that by imposing a new surtax but not indexing for inflation they’ve invented yet another budget boondoggle future congresses will have to adjust every year.

“The Senate and House health bills are exercises in budget gimmicks,” he said.

Congressional Republicans said one problem lies in the holes left by the “such sums as may be necessary” language.

The Congressional Budget Office, the lawmakers’ official scorekeeper, said it hasn’t yet completed a cost estimate for the programs “subject to future appropriations.” But, the CBO says, it’s tough to imagine the cost would be substantial compared with the trillion-dollar price tag already made public.

In using many of these tactics, Democrats are merely following the lead of Republicans who, when they controlled Congress and the White House, splashed red ink across the budget but hid some of it behind gimmicks. For example, where President Obama this year projected long-term war costs and then cut them to show savings, President George W. Bush left the costs out almost entirely.

Mr. Bush, who popularized the term “fuzzy math” during his 2000 campaign debates with Vice President Al Gore, also began producing a five-year budget rather than the usual 10-year document, which obscured skyrocketing costs in the later years.

And Republicans in Congress during Mr. Bush’s tenure also played with the timing of his tax cuts to shoehorn them into the budget. This has created an ongoing headache for budgeteers in the years since.

“Everything they wanted to do, they didn’t pay for. Obviously, the tax cuts, 2001 and 2003, Medicare prescription drugs. It’s a whole lot easier to do these policy things, tax cuts, expand Medicare and not to pay for it,” said James R. Horney, director of federal fiscal policy at the Center on Budget and Policy Priorities.

Mr. Obama vowed to do away with those gimmicks in his first budget, which he released in the spring.

He went back to a 10-year budget window and included a 10-year fix to the alternative minimum tax, which Congress traditionally adjusts every year to avoid having it penalize upper-middle-class taxpayers.

Following through on his budget, Mr. Obama has demanded a health care bill that’s paid for, Mr. Horney said.

That’s led both houses of Congress to propose tough choices on tax increases and spending cuts, but both chambers are working on bills that will reduce, not increase the deficit - as long as Congress follows through on the cuts that are called for.

On Monday, Mr. Obama told ABC News that he would veto any bill that tries to undo those cuts in the future.

Still, Mr. Holtz-Eakin, who is a fellow at the Peterson Institute for International Economics, said the key test for Mr. Obama is still to come in his next budget, which will be his first full blueprint.

Some of the ideas Mr. Obama included in his 2010 budget, such as assuming $640 billion in revenue from auctioning off carbon emissions under a cap-and-trade climate change plan, have been roundly rejected by Congress. Mr. Obama was counting on that money to fund continuation of his make-work-pay tax cuts.

“I’m not here to defend how it went for the Bush administration, because they included tax policies that never were going to fly. This crowd claims to have set a higher standard,” he said.