A letter from the Congressional Budget Office to Republican Senators on Wednesday raised fresh questions about whether the health bill from Democrats will really reduce the federal deficit as advertised.

The explanation is a bit difficult, and we struggled up in the Press Gallery yesterday to get our heads around it when GOP Senators released a note from CBO Chief Doug Elmendorf. 

Basically, any money raised for the Medicare Trust Fund has to be used for that and not for other items.  So when Democrats talk about savings, "they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs," said Elmendorf.

"To describe the full amount of (Medicare) trust fund savings as both improving the government's ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement in the government's fiscal position," he added.

I could almost feel the gut punch of the phrase "double-count" - that's not something you want on the public record when there are already questions about how legitimate the cost estimates are on the health care bill.

"What's happening here is a scam," said Sen. Judd Gregg (R-NH), a former Chairman of the Senate Budget Committee.

"A pure and simple scam on the American people and especially on the seniors," Gregg thundered on the Senate floor.

But while the letter gave Republicans some sharper talking points on the final full day of debate, it just sort of felt like the issue fell with a thud in the snow outside the Capitol, whereas two weeks ago, it might have added fuel to the fire against the bill.

You can read the Elmendorf letter at http://bit.ly/8YbG0t .

Republicans say the bottom line is that Democrats cannot say this bill would lower the deficit, that it actually would raise the deficit, because Medicare money is set aside from the regular budget.

It's an argument that we will certainly hear more about in the coming weeks.