Ongoing Cost Impact Controversies

While the Congressional Budget Office (CBO) provides the official cost projections for congressional bills, the chief actuary for the federal Centers for Medicare and Medicaid Services (CMS) has also been giving forth financial projections, since the bills of course involve changes to Medicare and Medicaid. This analysis says the bill passed in the Senate, according to the New York Times (click here), “would increase total national health spending from 2010 to 2019 by $222.3 billion, or 0.6 percent.” Opponents of reform of course cite that as another red flag.

But the projection methods differ in some ways. As the Times notes, the CMS approach “does not take into account a number of the proposed tax provisions in the bill that would increase government revenues.”

Interestingly, the CMS projection estimated that 36 million more people would get coverage under the Senate bill, compared to an estimate of 31 million by the CBO.

According to the Times article:

“The analysis found that the two proposals - an independent government agency to recommend Medicare savings and a proposed excise tax on high-cost, employer-sponsored insurance policies - would both help reduce long-term health care spending. That could give advantage to the Senate in its negotiations with the House. President Obama has already indicated that he, too, favors those two ideas but some House Democrats are still resistant.

The actuary’s report also said that a third component of the Senate bill, proposed reductions in Medicare payment updates for health care providers, would also reduce costs, but that Congress was unlikely to carry through and cut payments to providers.”


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