CBO Score of Extenders Substitute
CBO has released its score of the House substitute for the “extenders” package (HR 4213). As with the tables released last night, the score does not include detailed provisions for each of the health sections, but does state the following:
- The overall bill would raise the deficit by $166.8 billion over five years, and $136.5 over ten.
- The health subtitle would increase the deficit by $93.4 billion over five years, and $84.4 billion over ten.
- The Medicaid FMAP extension would increase the deficit by $24.1 billion, largely in fiscal 2011.
- The SGR provisions will increase the deficit (under the PAYGO exemption) by $64.6 billion over five years, and $63.1 billion over ten. Note also that the SGR changes will result in a 35 percent cut in physician payments on January 1, 2014, and additional cuts of about 2 percent per year thereafter.
- CBO notes that it has not completed a table regarding compliance with statutory PAYGO “because there are a number of ambiguities regarding how to apply the specifications” included in the act. Specifically, CBO notes it is unclear how to apply the statutory provisions – which provide for a five-year freeze in the SGR provisions through 2014 – with the House substitute, which provides for payment increases through 2013, followed by a funding “cliff” in 2014. CBO says it is engaged in consultations with Chairmen Conrad and Spratt on how to resolve this discrepancy.
UPDATE: To follow up on my earlier missive, CBO has released tables giving a bit more detail on the spending provisions in the extenders package. Many of the health changes do not score, but the one-year extension of Section 508 hospital reclassifications costs $300 million, and the adjustment to Medicare payment localities provides a $400 million windfall explicitly designated to the state of California (didn’t President Obama say he opposed backroom deals that benefit one specific state?). Section 525, which relates to the 3-day payment window for bundled reimbursements and has received some attention in recent days, saves only $100 million according to the CBO score; however, this section also includes a $3.95 billion transfer to the Medicare Improvement Fund, so the savings would appear to be higher in reality. (It also begs the question: Why can’t this nearly $4 billion be used to offset the cost of other deficit spending in the bill, rather than being parked in a Medicare “slush fund” to finance more spending in the future?)
Also FYI, JCT has completed its analysis on the COBRA subsidy provisions and the CMS-IRS data match, both of which involve tax code interactions; the full score can be found here. The COBRA subsidies will raise the deficit by $7.8 billion over ten years (designated emergency spending for PAYGO purposes), and the data match section saves $425 million over ten.