CBO: Health reform to cut deficit by $50 billion more than we thought... Republicans lie about health care. See them get busted.
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I’m getting a lot of e-mails quoting articles like this one, by John
Ransom, that say something like, “In a wholly predictable development,
it turns out the cost for Obamacare will end up being twice the original
price that the Democrats said.” Ransom also writes that I was
“w-w-w-wrong” to say, back in January 2011, that the law “cuts enough
spending and raises enough taxes to more than pay for itself.”
Actually, no, I wasn’t. That statement, in fact, is even truer today than it was then.
But let’s back up. The occasion for this dust-up is a set of updated
cost estimates for the coverage provisions of the health-care law. The
new estimates reflect a couple of factors. The Congressional Budget
Office lists them:
- An increase of $168 billion in projected outlays for Medicaid and CHIP;
- A decrease of $97 billion in projected costs for exchange subsidies and related spending;
- A decrease of $20 billion in the cost of tax credits for small employers; and
- An additional $99 billion in net deficit reductions from penalty payments,
the excise tax on high-premium insurance plans, and other effects on
tax revenues and outlays—with most of those effects reflecting changes
in revenues.
You’ll notice something about the above list: It appears to add up to a
net reduction in the cost of the health-care law. And, sure enough,
here’s CBO: “the insurance coverage provisions of the ACA will have a
net cost of just under $1.1 trillion over the 2012–2021 period—about $50
billion less than the agencies’ March 2011 estimate.” You would get the
opposite impression reading Ransom.
The problem for Ransom and others is that they didn’t read this analysis closely, or, if they did, they didn’t understand it.
Ransom quotes CBO saying “those provisions will increase deficits by
$1,083 billion,” but he either didn’t notice or didn’t choose to include
the CBO’s warning that this analysis does “not encompass all of the
budgetary impacts of the ACA because that legislation has many other
provisions, including some that will cause significant reductions in
Medicare spending and others that will generate added tax revenues.”
As it says right in the title, this is just a look at “the insurance
coverage provisions” of the Affordable Care Act. That is to say, it’s a
look at the spending side of the bill. So it doesn’t include the
Medicare cuts, or many of the tax increases, that pay for the
legislation. It’s like reading only the “outlays” side of the budget and
ignoring the “revenues” part. Of course that would make the deficit
look huge.
But those other parts of the bill aren’t a secret. They’re mentioned
right there in the analysis. Quoting again: “CBO and JCT have previously
estimated that the ACA will, on net, reduce budget deficits over the
2012–2021 period; that estimate of the overall budgetary impact of the
ACA has not been updated.”
It’s easy to do at least some of the update ourselves. This analysis
shows the net cost of the coverage provisions will be about $50 billion
less than previously estimated. That implies the law will cut more, not
less, from the deficit than previous estimates suggested. In other
words, this estimate says the bill is more, not less, fiscally
responsible than was previously reported.
One other thing that’s confused some people is that this estimate is
looking at a different timeframe than the original estimates. The CBO’s
first pass at the bill looked at 2010-2019. But years have passed, and
so now they’re looking at 2012-2021. That means they have two fewer
years of implementation, when the bill costs almost nothing, and two
more years of operation, when it costs substantially more.
But it also means that the included cuts and taxes, which grow with
time, are larger. That’s why, when House Republicans wanted to repeal
health reform in 2011, the estimated increase in the deficit was $230
billion, rather than the $130 billion that would have been expected from
the 2010-2019 analysis. As you extend the analysis, the bill both costs
more and saves more, and the savings grow more quickly than the costs.
There are a few other interesting things in the CBO report: It says, for
instance, that the bill is now expected to cover 30 million Americans,
rather than 33 million Americans. It doesn’t give a reason for the
revision.
