The Congressional Budget Office is out with its analysis of the House Democrats’ health care bill. The headline number — likely to be widely cited in media accounts — is that the bill costs $894 billion over 10 years. But in reality, the CBO says that the gross cost of the bill will be $1.055 trillion. The $894 billion number reflects the taxes being paid by individuals who don’t have insurance and employers who don’t provide insurance.
In addition, the bill relies on some of the same budgetary gimmicks as the Senate Finance Committee’s bill. Once again, we see that the Democrats backload the spending provisions into the final six years of the CBO’s 10 year budget window to make it appear cheaper. Specifically, the CBO says the bill’s gross spending will be $60 billion in the first four years, and $995 billion in the next six years (or 94 percent of the total).
Also, while the CBO says that the bill will reduce deficits by $104 billion over 10 years and keep reducing the deficit (albiet slightly) beyond that, it cautions that these estimates assume that proposed budget cuts will actually get enacted by future members of Congress. “These longer-term projections assume that the provisions of H.R. 3962 are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation,” the CBO director Douglas Elmendorf wrote. “The long-term budgetary impact of H.R. 3962 could be quite different if those provisions generating savings were ultimately changed or not fully implemented.”
The CBO estimate doesn’t include the more than $200 billion it will cost to prevent scheduled cuts to doctors’ payments under Medicare, which Democrats intend to pass through separate legislation.
The bill would also add 15 million people to the Medicaid rolls, costing states an additional $34 billion over 10 years.
Another thing to keep in mind is that the CBO report doesn’t say anything about whether the bill actually bends the health care cost curve. To be clear, while it estimates — with caveats — that the bill will reduce deficits, that isn’t the same thing as reducing national health care expenditures, which is how people derive all those statistics about how high of a percentage of GDP we spend on health care compared with other countries. If you hike taxes high enough, you can get the CBO to say it reduces deficits on paper, but that’s a lot different from bringing down the actual costs of health care to our nation.