From here. The Medicare actuary shed light on this so-called “double counting” last year in an April 22 memo.  “In practice,” he wrote, “the improved Part A financing cannot simultaneously be used to finance other Federal outlays (such as the coverage expansions under the PPACA) and to extend the trust fund, despite the appearance of this result from the respective accounting conventions.”

“There is an issue here on the budget because your own actuary has said you can’t double-count,” Shimkus said. “You can’t count — they’re attacking Medicare on the CR when their bill, your law, cut $500 billion from Medicare.”

He continued: “Then you’re also using the same $500 billion to what? Say your funding health care. Your own actuary says you can’t do both. … What’s the $500 billion in cuts for? Preserving Medicare or funding the health-care law?

“Both,” Sebelius replied.

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