After significant backroom negotiating, Congressional leaders released the proposed omnibus budget bill last night. (here) This is the inclusive federal budget that funds the government through September. It totals $1.3 trillion. Both the U.S. House and Senate have until early Saturday morning to vote on the bill or risk a government shut-down.

From a health care standpoint, more money is allocated to the Health and Human Services Department, to the opioid crisis, research through the National Institute of Health, and various other smaller projects.

Missing from the bill is money to bail-out health insurance carriers in the Obamacare exchanges. There were potentially two sources of money for the insurance companies.

Last year the Trump Administration stopped paying the cost-reduction subsidies in the exchanges. These were subsidies given to low-income people in addition to the basic taxpayer subsidies in the exchanges. Congress never allocated funding for these payments, although the Obama Administration continued them through a loop hole using Treasury Department funds.

The second source of money was through the “risk corridors.” These were established to spread financial risk to all health insurance companies participating in the exchanges and ran from 2014 through 2016. The Affordable Care Act states that these risk corridors needed to be claims-based and revenue neutral. In other words, the insurance companies that made money in the exchanges had to share their profits with the carriers losing money in the exchanges.

There was bi-partisan support in the Senate to include these payments in the budget. Both parties are concerned about rising health insurance premiums just before the 2018 mid-term election.

There are two potential scenarios that will now happen with Obamacare. Without these payments, premiums may indeed rise. However, increasing premiums will also increase the taxpayer subsidies. Out-of-pocket costs for individuals in the exchanges may not increase at all. The second scenario is that losing these payments, coupled with the elimination of the individual mandate in the January tax reform bill, will hasten the collapse of the Obamacare exchanges.

There will be a lot of finger pointing and blaming of the other party as the 2018 elections approach and premiums go up. Because or perverse financial incentives, Obamacare was never going to be sustainable without massive infusions of more taxpayer dollars.