A few days ago I noted that I had seriously misunderstood the Congressional Budget Office's individual market premium projections in the event the ACA's individual mandate is repealed: Yes, it'd be ugly, but not nearly as bad as I thought, although they still expect up to 13 million people to lose coverage as a result.
While I have my own doubts about some of the CBO's assumptions, there can be no doubt that premiums would increase substantailly, millions of people would end up without healthcare coverage, and the $25 billion in Medicare cuts do appear to be locked in if the GOP's bill were to become law:
Several regular commenters here at ACA Signups have been wondering why the Congressional Budget Office keeps using March 2016 as the "baseline" for projecting the net impact on healthcare coverage numbers under the GOP's Trumpcare bills (the House's AHCA and the Senate's BCRAP), as opposed to the more recent January 2017 baseline. After all, according to the March 2016 baseline, the CBO was projecting that under the ACA, the total individual market would have 25 million people as of 2026 (18 million on the exchanges plus another 7 million off-exchange), whereas under the January 2017 baseline, their projections are for the individual market to only be 20 million as of 2027 (13 million on the exchanges plus 7 million off-exchange). Taken at face value, this would seem to suggest a 5 million enrollee discrepancy. This drumbeat has been taken up more recently by GOP Senators, particularly Wisconsin Senator Ron Johnson.
CBO aims to provide preliminary assessment of Graham-Cassidy bill by early next week
CBO is aiming to provide a preliminary assessment of the Graham-Cassidy bill by early next week. That assessment, which is being prepared with the staff of the Joint Committee on Taxation, will include whether the legislation would reduce on-budget deficits by at least as much as was estimated for H.R. 1628, the American Health Care Act, as passed by the House on May 4, 2017; whether Titles I and II in the legislation would each save at least $1 billion; and whether the bill would increase on-budget deficits in the long term. CBO will provide as much qualitative information as possible about the effects of the legislation, however CBO will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks.
Well this was unexpected, although I suppose I should have expected it given all the insanity surrounding the impending deadlines for insurance carriers to sign contracts (Sept. 27th, I believe); the end of the fiscal year on Sept. 30th (which is also the last chance for the GOP to try and squeeze through the hideous Cassidy-Graham Hail Mary repeal/replace bill); and the start of Open Enrollment on November 1st.
The CBO has issued a 17-page report with their latest projections for the types of healthcare coverage and federal spending on healthcare programs including Medicaid, CHIP, ACA tax credits and so forth over the next decade. here's what they foresee:
The federal government subsidizes health insurance for most Americans through a variety of programs and tax provisions. In 2017, net subsidies for people under age 65 will total $705 billion, CBO and the staff of the Joint Committee on Taxation (JCT) estimate.
As has been obvious for some time now, the early projections by the Congressional Budget Office back in the pre-exchange days of 2010 - 2013, which foresaw ACA exchange enrollment heading into the 20-million-plus range by this point, obviously not only never came to pass, but are unlikely to do so anytime in the near future under the current legal/healthcare policy structure. There are several reasons for this ranging from legitimate problems with the structure of the ACA itself to Republican obstruction, but the two most obvious errors the CBO made in their projections were:
CONGRESSIONAL BUDGET OFFICE
Keith Hall, Director
Washington, DC 20515
August 3, 2015
Honorable Mike Enzi
Committee on the Budget
United States Senate
Washington, DC 20510
Re: Budgetary Effects of S. 1881
Dear Mr. Chairman:
Last week, CBO provided the following information in response to a request for an estimate of the budgetary effects of S. 1881:
S. 1881, which would prohibit federal funds from being made available to Planned Parenthood Federation of America or any of its affiliates, could affect direct spending for the Medicaid program; however, CBO has not determined whether the legislation would increase or decrease the program’s spending. Completing an estimate of such effects would take some time.