Saturday, March 20, 2010

CBO Score for Reconciliation Bill

Relevant top-line points from the CBO score and the JCT score, which is available online here:

  • The top line spending number on subsidies declined slightly, from $940 billion to $938 billion.  Again, however, this does NOT include the other various mandatory and discretionary spending in the Senate and reconciliation bills, which total about $1.2 trillion over the bill’s first ten years (2010-2019).
  • The overall deficit reduction is estimated at $124 billion over ten years for the health component, and $19 billion for the education portions of reconciliation.
  • 32 million individuals would be newly covered in 2019 – half of them through Medicaid.
  • Individuals enrolled in employer-based coverage would decline by about 3 million overall – 6-7 million would gain access to employer coverage, but 8-11 million would lose their offer of coverage and/or purchase a policy elsewhere.
  • Federal budgetary commitment to health care: Would rise by an additional $180 billion in the next ten years under the reconciliation bill; the reconciliation bill and H.R. 3590 combined would increase the federal budgetary commitment to health care by a total of $390 billion in the 2010-2019 period.
  • Like H.R. 3590, the reconciliation bill also contains unfunded mandates that would exceed the threshold levels in the Unfunded Mandates Reform Act (UMRA).

Marginal impacts of the manager’s amendment:

  • An additional $5 billion in spending on the “doughnut hole” provisions related to the changes in the true out-of-pocket growth rate;
  • An additional $3.8 billion in Medicare Advantage cuts related to the coding intensity changes;
  • $400 million in new spending on physician practice expense geographic practice cost index adjustment;
  • $400 million in new payments for qualified hospitals;
  • $300 million less revenues/savings due to the removal of Section 1304 (CMS-IRS data matching);
  • Insurance reforms cost $300 million less than original estimate;
  • Device tax scores the same ($20 billion tax increase) despite changes that reduced the overall rate (from 2.9 percent to 2.3 percent) while broadening the base of items subject to the tax.

Important caveats about the CBO analyses:

  • The long-term deficit projections “reflect an assumption that the key provisions of the reconciliation proposal and H.R. 3590 are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation.  For example, the sustainable growth rate mechanism governing Medicare’s payments to physicians has frequently been modified to avoid reductions in those payments, and legislation to do so again is currently under consideration by the Congress.”
  • “The reconciliation proposal and H.R. 3590 would maintain and put into effect a number of policies that might be difficult to sustain over a long period of time. Under current law, payment rates for physicians’ services in Medicare would be reduced by about 21 percent in 2010 and then decline further in subsequent years; the proposal makes no changes to those provisions. At the same time, the legislation includes a number of provisions that would constrain payment rates for other providers of Medicare services. In particular, increases in payment rates for many providers would be held below the rate of inflation (in expectation of ongoing productivity improvements in the delivery of health care).”