The House released their version of a year-end bill to extend unemployment benefits, a payroll tax cut and a “doc fix” to avoid a 27% cut in Medicare reimbursement. A look at the various elements of the bill make clear that Republicans have little interest in passing anything through Congress.

The somewhat good news here is that the seamless coverage regulations proposed by the Department of Health and Human Services have been widely praised. They are designed to do all those calculations backstage, so that the consumer need only to visit one portal to figure out which program they slot into. And it sets up a process for annual eligibility review, so individuals are not responsible for flagging their increase in income. Individuals who end up making too much for Medicaid will get to keep their coverage until they get a new plan on the exchange.

The somewhat bad news is that because of the new rules, the tax credits just got less affordable.

I thought the President was pretty clear yesterday – he thinks we’ve cut the domestic and defense budgets to the bone, and any future savings must come out of a combination of tax revenues and so-called “modest adjustments” to health care programs. So you can forget about that defense-heavy trigger being fired, and even if it is, the defense lobby will have all of 2012 to come up with a substitute for the cuts. And some of the potential areas for cuts in that trigger include some of the best spending in the Affordable Care Act, for community health centers.

Some Democrats took a look at the automatic cuts and thought they were tough, but probably better than a bad agreement that would slash the safety net and in all likelihood do little on revenues. After all, Medicaid, Social Security and programs for the poor were protected in the agreement, and Medicare would only see a provider haircut. And half of the automatic cuts would hit the Pentagon. What’s the forcing mechanism for the left?

Turns out, that would be the exchange subsidies from the Affordable Care Act:

The Senate has passed this bill a half-dozen times, sometimes attached to other bills, and more recently as a standalone. The pay-for that the Senate uses differs from the House’s. But instead of a House-Senate conference, the Senate, unbelievably, will vote on the House bill today.

There’s a lot I object to in Hendrik Hertzberg’s judgment of those opposed to the Senate health bill as “pathetic.”