We Remember, With Great Fondness, Our First Post On Health Care’s CBO Score. This May Be The Last One.

Carrie Budoff Brown in Politico:

House Majority Leader Steny Hoyer (D-Md.) just released the first set of Congressional Budget Office numbers to reporters this morning.

The bill would cost $940 billion, and reduce the deficit by $130 billion over the first 10 years and $1.2 trillion in the second 10 years. The deficit numbers Democrats have been most worried about, and will be key to convincing moderates to coming on board with the bill.

Jacob Sullum at Reason:

1. The Medicare savings, which may not actually materialize because they depend on reimbursement changes Congress has been loath to maintain in the past, total about $500 billion during the first decade, compared to  total deficit reduction of $130 billion.

2. The reconciliation bill includes changes to student loan programs that CBO estimates will reduce spending by $19.4 billion during the first decade. By contrast, the “doc fix” that was originally envisioned as part of the health care package, since it deals with Medicare payments to physicians, was carved out and placed in a separate bill. It costs more than $200 billion.

3. CBO warns that it “does not generally provide cost estimates beyond the 10-year budget projection period” and that its projections for the second decade are subject to “an even greater degree of uncertainty” than its projections for the first 10 years. It estimates that the unmodified Senate bill “would have a total effect during that [second] decade that is in a broad range between one-quarter percent and one-half percent of gross domestic product.” The changes in the reconciliation bill, it says, would “further reduce federal budget deficits in that decade, with a total effect that is in a broad range between zero and one-quarter percent of GDP.” When the range of numbers in a projection includes zero, it seems fair to say the projection is not very helpful as a guide to policy decisions. Yet the Democrats have transformed these highly uncertain projections into a seemingly precise and reliable dollar figure: $1.2 trillion in deficit reduction during the second decade.

Ezra Klein:

The question people generally ask about the final health-care reform vote is, “Won’t it be politically difficult for many House Democrats to vote yes?” But with the release of the CBO report (pdf), I’d flip that question a bit: Won’t it be substantively difficult for many House Democrats to vote no?

If you’re a liberal House Democrat, here’s what you’d be voting against: Legislation that covers 32 million people. A world in which 95 percent of all non-elderly, legal residents have health-care coverage. An end to insurers rescinding coverage for the sick, or discriminating based on preexisting conditions, or spending 30 cents of each premium dollar on things that aren’t medical care. Exchanges where insurers who want to jack up premiums will have to publicly explain their reason, where regulators will be able to toss them out based on bad behavior, and where consumers will be able to publicly rate them. Hundreds of billions of dollars in subsidies to help lower-income Americans afford health-care insurance. The final closure of the Medicare Prescription Drug Benefit’s “doughnut hole.”

If you’re a conservative House Democrat, then probably you support many of those policies, too. But you also get the single most ambitious effort the government has ever made to control costs in the health-care sector. According to the Congressional Budget Office, the bill cuts deficits by $130 billion in the first 10 years, and up to $1.2 trillion in the second 10 years. The excise tax is now indexed to inflation, rather than inflation plus one percentage point, and the subsidies grow more slowly over time. So one of the strongest cost controls just got stronger, and the automatic spending growth slowed. And then there are all the other cost controls in the bill: The Medicare Commission, which makes entitlement reform much more possible. The programs to begin paying doctors and hospitals for care rather than volume. The competitive insurance market.

This was a hard bill to write. Pairing the largest coverage increase since the Great Society with the most aggressive cost-control effort isn’t easy. And since the cost controls are complicated, while the coverage increase is straightforward, many people don’t believe that the Democrats have done it. But to a degree unmatched in recent legislative history, they have.

Matthew Continetti at The Weekly Standard:

Via NRO, the guy in the video is challenging the notion that the numbers leadership is peddling are accurate: “The Congressional Budget Office has confirmed that there is currently no official cost estimate.  Yet House Democrats are touting to the press — and spinning for partisan gain — numbers that have not been released and are impossible to confirm.  Rep. James Clyburn stated he was ‘giddy’ about these unsubstantiated numbers.  This is the latest outrageous exploitation by the Majority — in this case abusing the confidentiality of the nonpartisan Congressional Budget Office — to pass their massive health care overhaul at any cost.”Something to keep in mind as the conversation unfolds today. Unless of course politics is temporarily suspended for the March Madness tip-off.

Steve Benen:

[…] it’s hard to overstate how pleased Democrats are with the new health care reform score from the Congressional Budget Office. House Majority Whip James Clyburn (D-S.C.) conceded this morning, “We are absolutely giddy.”

To briefly review, the final package costs $940 billion over 10 years. It reduces the deficit by $130 billion in the first decade, and $1.2 trillion in the second. The bill will bring coverage to 32 million Americans, while extending Medicare solvency by at least 9 years.

Democrats have begun calling the package the “biggest deficit reduction measure in 25 years,” which happens to be true. It’s also arguably the biggest cost control bill ever.

Also note, the final Democratic proposal lowers the deficit more than the previous versions. The Senate bill was projected to reduce the deficit by $118 billion in the first decade, and this one does even better.


All the leadership and the White House have to do now is figure out of how to get the votes. For Democrats who claim to care principally about fiscal responsibility, it’s very difficult to take a firm stand against reform after a CBO score like this one.

But I still don’t know exactly where Pelosi & Co. find the votes. Stupak and at least a few of his friends will chose betrayal, and so far, only one “no” vote from November — Dennis Kucinich — has been willing to switch sides. They have 72 hours, but they don’t yet have the votes.

Ed Morrissey:

Undoubtedly, this is good news for Nancy Pelosi and the Democrats. The overall deficit reduction number from the CBO, as well as the under-$1 trillion price tag, gives them some momentum towards winning the votes of reluctant moderates. Whether they can overcome the issues of abortion and Demon Pass will still have to be seen, but at least on cost they have some ammunition.

That also applies to the reluctance in the Senate to take this bill back up again.  The House version with the reconciliation package saves more money off of the deficit than the Senate version alone, at least according to the CBO.  If the Senate balks at considering the reconciliation changes, they’ll essentially be writing off supposed savings to the deficit.


Oddly, CBO score was going to be the Last Great Chance to push this bill in a more progressive direction, as there are policy options (public option, Medicare buy-in) which would have made things cheaper and reduced costs, but since hippies like those options they won’t happen and so Labor is going to suck on it instead.


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