And who determines what constitutes "remaining budget neutral"? And if (in the EXTREMELY UNLIKELY event) it is determined that HHS violated "budget neutrality", what is going to be done about it, and by whom?
This was a disastrous idea poltiically.
The Democrats had owned Obama-Care.
You break it, you fix it — now the ‘G’ OP owns it. Their caving had been a perpetual and tacit acceptance of Obama-care, but now with the ‘G’ OP as the super-villains.
Gee, ‘thanks’, Paul Ryan. You will cave on this after you are blamed for killing patients. You need a new drastic plan, and fairly soon.]
I can’t answer your specific questions, but I can tell you that the same language has already worked last year. The insurance companies only got 12.6% of what they asked for. This is a huge blow to companies that had been assured by HHS/Obama that they would reimburse them (if not 100%, then close to it) for their losses. The original Obamacare bill calls for the companies making a profit to pay into the risk corridor “pool”. Those companies losing money would be reimbursed for their losses from this pool. Only money paid in by the insurance companies was to be used ... obviously, 12.6% was not “sufficient” to reimburse losses. The Obamacare business model is failing (despite the lies to the contrary you hear daily) & to keep the insurance companies from bolting Obamacare, reimbursement above & beyond the pool monies was going to be made out of taxpayer funds. Rubio’s language restricting it to Obamacare’s original intent (bailout only to the extent of monies in the pool) rather than letting HHS use other funds, caused havoc last year (UnitedHealth Group just announced they expect to lose $700 million in the Obamacare exchanges and are seriously considering withdrawing from the program in the coming year - this language for a 2nd year in a row will assure they withdraw) and is going to cause a further stampede of companies to flee the Obamacare market.
Several most excellent articles on the subject at this link - last 3 in particular:
http://healthpolicyandmarket.blogspot.com/