Jonathan Cohn

No, Obamacare’s Cost Didn’t Just Double. Sigh.

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Sorting through the deceptive attacks on health care reform gets old, even for me. But on Wednesday the Republicans and their allies made a claim so obviously misleading that they, and the media outlets parroting them, must have known they spreading false information.

The basis for the claim is the Congressional Budget Office’s latest projections for the Affordable Care Act, which critics (and I!) like to call Obamacare. When Congress first passed the law, in the spring of 2010, CBO made official estimates of how much the law would cost, how many people would get insurance as a result, and so on. It updated that estimate one year later and has, now, updated it one more time.

The CBO distributed its report in the morning and, by 11 a.m., Republican offices on Capitol Hill were spitting out press releases about it. According to the Republicans, CBO had discovered that Obamacare was going to cost $1.76 trillion over the next ten years. “The CBO’s revised cost estimate indicates that this massive government intrusion into America’s health care system will be far more costly than was originally claimed,” Tom Price, chairman of the House Republican Policy Committee, said. Within a few hours, both Fox News and the Washington Times were carrying online stories making the same claim. According to the Fox News account, CBO was “showing that the bill is substantially more expensivetwice as much as the original $900 billion price tag.” 

If CBO had truly determined that health care reform’s cost will be twice the original estimates, it would be huge news. But CBO said nothing of the sort.

To figure out the cost of health care reform, CBO looks at each of the law’s component parts and, for accounting purposes, groups them into different categories. It calls one category “gross cost of coverage expansions”that’s the amount of money the federal government will spend to help people get insurance, mostly by offering Medicaid to more people or giving people subsidies they can use to help offset the cost of private insurance. Last year, CBO estimated that the gross cost of coverage expansion from 2012 through 2021 would be $1.445 trillion. Now CBO thinks the gross cost will be $1.496 trillion. The number shifted, in part, because the CBO has changed its projections for economic growth. (MSNBC’s Tom Curry has a nice explanation of this.) But, in the context of such a large a budget projection, that’s barely any difference at all.

In the this latest estimate, CBO extends its projection out one more year, to capture the expenses from 2012 to 2022, in order to capture a full decade. In 2022, CBO says, the gross cost of coverage expansion will be $265 billion. Add that to the $1.496 and you get (with rounding) the $1.76 trillionthe one in the press releases and the Fox story.

But there is nothing new or surprising about this. It’s only slightly more money than the previous year’s outlays. The ten-year number seems to jump only because the time frame for the estimate has moved, dropping one year, 2011, and adding another, 2022. Obamacare has virtually no outlays in 2011, because the Medicaid expansion and subsidies don’t start up until 2014, which means the shifting time frame drops a year of no implementation and adds one of full implementation.

Still, doesn’t that just validate what the law’s critics have always said, that the administration was playing games to hide the program’s true impact on the deficit? Hardly. Remember, this is just the raw cost of expanding insurance coverage we’re talking about herein other words, the money the federal government is sending out the door. The new law also calls for new revenue, in the form of taxes and penalties. It also reduces spending, mostly through Medicare, to help offset the cost of the coverage expansion. When the Affordable Care Act became law, CBO estimated that the net result of all these changes, taken together, would be to reduce the deficit. Now, with this revised estimate, CBO has decided the law will reduce the deficit by even more money.

Yes, you read that right: The real news of the CBO estimate is that, according to its models, health care reform is going to save even more taxpayer dollars than previously thought.

I want to be clear about something. The Affordable Care Act has flaws: Among other things, it reaches fewer people and provides less financial protection than I would prefer. The revised CBO report actually suggests this problem will get mildly worse, since it also expects slightly fewer people to end up with insurance. That’s one reason why the law will cost less; it’s helping fewer people. Another reason is that more employers pay penalties for not offering insurance and more people pay penalties pay penalties for not obtaining it. That’s obviously not great, either.

The report also had one finding that give us at least a little pause: CBO now projects the number of people with employer-sponsored insurance will drop by 4 million people, on net. It’s still a small effect, representing less than 2 percent of the total population with employer-sponsored coverage. That’s well within the margin of error of these models. It’s also difficult to tell why CBO thinks this will happenwhether it’s fewer employers offering insurance, fewer employees accepting coverage, or workers moving into firms that are less likely to provide benefits. Any of those would be consistent with lower economic growth, as CBO now expects. Still, the issue merits attention. (If I can get a more detailed explanation of why CBO thinks this will happen, I’ll update this item.)

But these aren’t the nuanced claims Republicans and their allies are making. Nor are their complaints consistent with this general point of view. On the contrary, if they had their way, health care reform would reach even fewer people and provide less protection. 

Meanwhile, the bottom line about Obamacare really hasn’t changed. Notwithstanding these latest adjustments, CBO still thinks it will mean about 30 million additional people get insurance, that insurance will become more secure for those who have it, that the law will more than pay for itself in the first ten years, and that, over the long run, the law will reduce the deficit.

But why admit those things when you can dissemble about them and when outlets like Fox and the Washington Times will let you get away with it?

Update: David Hogberg, of Investor’s Business Daily, noted via Twitter that one reason CBO predicts greater deficit reduction is that more employers and individuals will pay penalties. That’s true and I’ve added a sentence to that effect, although, again, the overall effect here is pretty small.

follow me on twitter @CitizenCohn

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