By John Reichard, CQ HealthBeat Editor
July 24, 2012 -- New independent congressional analyses of the health care law, released Tuesday, underscore the takeaway that the Obama administration fared far better in the Supreme Court’s June 28 ruling than many, if not most, observers predicted it would.
The latest take from the Congressional Budget Office and Joint Committee on Taxation: The ruling leaves intact much of the law’s unprecedented expansion of insurance coverage. And getting rid of the law would make deficit spending worse rather than improve the nation’s fiscal outlook, according to the analysts.
From a practical policy point of view, the findings don’t make it an easier for opponents of the law to get rid of it in the wake of the Supreme Court ruling—although there are findings here and there that sharpen some of the GOP arguments against the measure.
The impression of the law created by the new CBO reports stand in sharp contrast to the growing Republican confidence in the days leading up to the ruling that the high court would deal a dramatic blow to the law, a sense so strong that House Speaker John A. Boehner, R-Ohio, warned his troops against “spiking the ball” when the ruling was announced.
Despite high-profile statements by a number of state officials in the days after the ruling that they will turn down the billions of dollars the law provides for expanding Medicaid, CBO says just 3 million fewer uninsured Americans will get coverage than would have been the case if the entire law (PL 111-148, PL 111-152) had been upheld.
To be sure, 3 million people is a large number, and it’s likely to raise eyebrows among hospital executives looking for relief from the costs of uncompensated care. But CBO is still predicting that 27 million uninsured Americans will gain coverage under the law by 2022—not dramatically fewer than the 30 million it had predicted had the law survived unchanged.
CBO didn’t say how many or which states it expects to opt out of Medicaid.
In addition to its report Tuesday on the cost of the health care law as modified by the high court, CBO issued a study on what the impact on deficit spending would be if a Republican bill (HR 6079) repealing the overhaul become law.
Passage of the repeal would add $109 billion to federal budget deficits between 2013 and 2022, CBO Budget Director Douglas Elmendorf noted in his blog on the report.
Other numbers are more problematic for the White House, however. Hospital associations agreed to Medicare and Medicaid cuts in the health care law totaling $155 billion over 10 years, on the assumption the measure would increase coverage so that 95 percent of the American people would have health benefits.
But CBO now says the increase will be to 92 percent rather than 95 percent. That undermines the case for hospital support of the law. Former Clinton White House health budget chief Dan Mendelson tweeted that the “CBO estimates of coverage loss seem high. States will be under pressure from hospitals and others to grow Medicaid.”
Sen. Orrin Hatch, R-Utah, said in a statement that the CBO report shows that “the cuts to Medicare to fund the law are now over $700 billion” rather than the $500 billion that CBO estimated in a 2010 analysis of the law. An Obama administration official did not dispute the figure, but said that changing budget windows account for the higher figure and that Republicans have voted for the same level of cuts in approving budget legislation in the House.
CBO also says that premiums in the individual market and for policies sold through new insurance exchanges will be 2 percent higher than it estimated in March. Why? Because the people who would have obtained Medicaid coverage but instead will get health benefits through private plans sold on exchanges are in poorer health and are likely to consume more health care.
On the other hand, the latest CBO analysis arguably weakens somewhat the argument that the health care law is a government takeover of health care in that it forecasts 3 million more people will get private coverage through exchanges—25 million instead of 22 million.
John Reichard can be reached at [email protected].
