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Posts Tagged ‘cost’

Picking Apart New CBO Numbers

The Congressional Budget Office finally released its score of the reconciliation bill, sending bloggers running to their keyboards to write up their thoughts.

Time’s Kate Pickert: “Some people say that comprehensive health care reform is like a balloon – squeeze one part and another part expands. … House Democratic leaders worked under severe fiscal constraints in designing their reconciliation package. They had to keep the legislation under $1 trillion over 10 years, make it save more than the Senate bill did, and expand coverage and affordability to satisfy House Democrats. These are not easy rules to follow, especially when the whip count is still volatile and the clock is ticking. But they followed the rules and the package could earn endorsements from some wavering House Democrats today.”

The American Spectator’s Philip Klein: “Democrats have maintained the strategy of delaying the major spending provisions until 2014 to create the appearance that the bill is cheaper over the CBO’s ten year budget window, from 2010 through 2019. In this version, the bill spends $17 billion in the first four years, while the remaining $923 billion, or 98 percent, is spent in the next six years. I’ve illustrated this tactic in the chart below.”

Hot Air’s Ed Morrissey: “Want to see what a shabby fraud these cost estimates are? Check out the line [in the CBO table] for ‘Gross Cost of Coverage Provisions’. This is why they’re delaying the start of the program, of course. If it kicked in right away, the decade-long estimate would obviously be well into the trillions. So they simply stalled it for four years, incurring just $17 billion in costs — or 1.8 percent of the total 10-year estimate — through 2013 so that wavering Democrats could go back to their districts and tell baldfaced lies to their constituents about the pricetag. A perfect ending to this travesty.”

The Washington Post’s 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?” He points out that Democrats will be loathe to vote against a bill that extends health insurance to 32 million people, ends some of the most dreaded insurance practices like discrimination based on pre-existing conditions and cuts the deficit.”

And in a separate post Klein says: “[The CBO score] moves the story from process to substance. How Congress will vote is not a good story for the Democrats. What they will be voting on is rather better, and they’re much more comfortable talking about it.”

Cato’s Michael Cannon: “As former Congressional Budget Office director Donald Marron has explained over and over, the figure that Democrats consistently cite for the cost of their bills is only the CBO’s estimate of the cost of federal spending related to the expansion of health insurance coverage.  It is not the full cost to the federal government, because each bill also spends taxpayer dollars on other items.

Marron examined the CBO’s March 11 score of the bill that passed the Senate on Christmas Eve, and found an additional $96 billion of spending over 10 years.  If the most recent iteration of ObamaCare is similar, then new federal spending in that bill would be approximately $1.036 trillion — pushing the total over the president’s spending target.”

The New Republic’s Jonathan Cohn: “After weeks of negotiation, [Democrats] have agreed upon a set of amendments to the Senate health care bill. The changes mean the package as a whole will cover more people, and save more money, than the Senate bill would have originally. House Democratic leaders are saying enactment would produce “biggest deficit reduction act in 25 years.” House Majority Whip James Clyburn described himself as “giddy.”

The Democrats had to confront some tough trade-offs, too. And the amendments reflect that. In order to satisfy Congressional Budget Office accounting standards for projections after 2020, they had to accelerate a tax on benefits and pull back on financial assistance for middle- and low-income Americans for later years. Still, those sacrifices have to be weighed against the other improvements the amendments make, not to mention the lawmaking opportunity it creates.”

Wonk Room’s Igor Volksy: “This package covers 32 million Americans and, as the reduction in Medicare spending suggests, begins to slow the growth in health care spending. It reverses the current trend and lowers the deficit quite substantially over the next 20 years.

So this is something to keep in mind as Republicans ignore the deficit reductions in this score and blanked cable tv to argue that the bill is full of gimmicks (because spending starts before benefits) and the government is taking over. In fact, the reverse is true. The bill reduces the deficit over the full 20 years and slows government spending (in terms of Medicare).”

Thursday, March 18th, 2010

Reaction to Senate Bill

The Senate finally released its merged health overhaul bill, sending the blogosphere a specific document to pour over.

The action took off when Democratic staffers announced the Congressional Budget Office’s assessment: $849 billion over ten years, a federal deficit reduction of $127 billion, and coverage for an additional 31 million Americans. Director Douglas Elmendorf offers a brief overview on his blog and is careful to note the uncertainties in some of the estimates.

Here’s what various folks are saying:

Hot Air’s Allah Pundit is very unimpressed, and argues that a CBO score matters only “when it’s bad:”

Another week, another “scoring” of a bill that (a) looks nothing like what it’ll look like in its final form and (b) almost certainly has been crafted to hide certain key costs (a la “doctor fix” in the House bill) to improve its “score.” Realistically, the only time a CBO score matters is when it’s bad: Were this to come in at over $900 billion or be judged a deficit-buster over the long term, it would be rejected for failing to meet the White House’s baseline demands. But this one just makes the cut, so look for the obligatory back-pat in this weekend’s presidential message about it being a “fine starting point” or an “encouraging beginning” or whatever. Reid managed to come up with a bill that isn’t too expensive … for Barack Obama. Congratulations.

The New Republic’s Jonathan Cohn compares the Senate’s offering with the House-passed bill.  Cohn seems cautiously optimistic, although he admits it’s “worse than the House:”

But, again, the Senate was never going to pass the House bill. Realistically, the question going forward was whether Majority Leader Harry Reid was going to be able to improve what came out of the Senate Finance Committee–and move it closer to what the Senate Health, Educaiton, Labor, and Pensions Committee produced. And there it seems pretty clear that he did, mostly. The early consensus among experts (and, again, this is pending further analysis) is that the new Senate bill boosts financial support for people purchasing health insurance. And, of course, it has a public insurance plan.

It’s not huge progress. But given the political pull to the right from conservative Democrats and independent Joe Lieberman, any progress is an accomplishment. And Reid clearly deserves credit for that.

The Washington Monthly’s Steve Benen thinks some Democratic holdouts should be satisfied: “it’s worth taking a moment to remember that center-right Democrats, who’ve been complaining about this initiative all year, have very little to complain about right now. Indeed, they should be thrilled — Senate Majority Leader Harry Reid (D-Nev.) has put together a reform package custom made to give the so-called “moderates” just about everything they said they wanted.”

Jacob Goldstein of the WSJ’s Health Blog lists the key tax provisions in the Senate bill, which include a tax on high-end health insurance plans and an increase in the payroll tax for high-income earners.

Insure Blog’s Henry Stern is nonplussed with the bill’s estimated savings: “That bears repeating: if (and that’s a big if) it really meets expectations, Sen Reid’s baby will cut, over 10 years, the equivalent of one month’s deficit. Color me underwhelmed.” (Italics/bold Stern’s).

The Washington Post’s Ezra Klein disagrees, looking at the bill’s cost provisions in the three decades following its passage.  “In the second decade, however, …savings from Medicare and Medicaid, paired with the excise tax (which CBO says “is effectively a reduction in the existing tax expenditure for health insurance premiums”) and a handful of other changes, leaves the government spending no more on health care than it otherwise planned to. That’s impressive stuff. And it implies, of course, that in the third decade, the federal commitment actually goes down relative to expectation. The curve, as they say, is bent.”  Klein goes on to argue that getting these cost controls in the bill was part of a “grand bargain” that would not have passed without coverage expansions.

Critical Condition’s Kathryn Jean Lopez posts a message from the National Right to Life Committee on the bill’s abortion provisions.  The anti abortion group says: “Regrettably but predictably, Reid rejected the bipartisan Stupak-Pitts language.  Instead, Reid has sought to please the militant minority that demands funding of abortion through federal programs, even though substantial majorities of Americans believe that abortion should be excluded from government-funded and government-sponsored health programs.”

Amy Allina of Raising Women’s Voices takes a look at the abortion provisions from the other side of the issue:

Senator Reid rejected the calls of antichoice activists to add the House-passed ban on abortion coverage in the exchange.  For the most part, the Senate bill confirms current law on access to abortion, as the Senate Finance bill did.  To respond to the concerns of antichoice Democrats, Reid’s bill spells out more specific accounting guidelines for the segregation of public and private funds to ensure that no federal money would be used to pay for abortion care.  It would allow insurers to offer abortion coverage to women in the exchange, including women who choose the public option if the Secretary of HHS ensures that federal money is not being used to pay for the services.  It also confirms that states would be allowed to pay for abortion services on their own, if the federal government decided not to include them in the public option.

Wonk Room’s Igor Volsky made a table comparing the House and Senate bills, saying, “The merged Senate legislation has lower affordability standards, covers less people, invests less in prevention, does not require all large employers to provide health insurance, and includes a weaker public option. But the bill goes further in controlling health care spending and reducing the deficit.”

And you can always follow the action on Twitter.  A selection of this morning’s many thousands of tweets below.

tweets

Thursday, November 19th, 2009

Reaction to House Bill Vote

 In our roundup of bloggers’ reactions the House vote to pass their health overhaul bill, conservatives speculate whether this is “the high water mark” and liberals take a moment to consider the historical significance.

  • Heritage’s Bob Moffitt and Nina Owcharenko: “The health care bill passed by the House tonight took another step towards transferring power over personal health care decisions from individuals to bureaucrats in Washington. The Republican alternative was a good strong first step of targeted reforms that are necessary to improve health care financing and delivery.”
  • The Washington Post’s Ezra Klein: “Health-care reform passed the House, quite literally, at the eleventh hour. It passed with a slim, two-vote margin. But it passed. That is more than has ever happened before. More than Truman or Nixon or Carter or Clinton managed. More than Rayburn or O’Neill or Gingrich managed. It is success, at least for this stage in the process. It is history, even, though it’s hard to sense the importance of the moment when you watch members of Congress spend the day squabbling over the true meaning of the word freedom.”
  • Cato’s Michael Tanner: “The fat lady hasn’t even started to warm up yet. The narrow 220-215 victory in the House on Saturday night was a step forward on the road to a government takeover of the health care system.  But as close and dramatic as that vote was, that was the easy part.  The Senate must still pass its version of reform—which will not be the bill that just passed the House.  Nancy Pelosi was, after all, able to lose the votes of 39 moderate Democrats.  Harry Reid cannot afford to lose even one.”
  • Families USA’s Ron Pollack: “It was a moment to cherish. Long in the making, this victory represents a major step toward the achievement of high-quality, affordable health care for all Americans. Those who were watching the vote on television saw the House erupt in celebration. What they could not see was the cheering in the homes of the activists and ordinary Americans who worked tirelessly to achieve this historic vote.”
  • Sally Pipes on Critical Condition: “Following the Republican gubernatorial wins last week in Virginia and New Jersey, it seems clear that there is a backlash against the Democrats and their plan to put government in charge of our health care.  The Republicans’ plan to take back the House in 2010 is underway.  The health-care reform plans as proposed by the House and Senate must be slowed down and ultimately stopped.  As Yogi Berra says ‘The ball game is not over till it’s over.’”
  • The Washington Monthly’s Steve Benen: “As for the bigger picture, there’s quite a bit of work to do before reform becomes law, but it’s worth pausing to appreciate the historic significance of last night’s accomplishment. A lot of presidents have pushed health care reform initiatives before this year, and a lot of lawmakers have tried to get to this point. When it comes to domestic policy legislation, health care reform has been something of a holy grail — but before nine hours ago, the House had never even voted on, better yet passed, a bill of this significance.And yet, here we are.”
  • Hot Air’s Ed Morrissey: “We always thought the fight was in the Senate, so the only real surprise yesterday was how weak Pelosi actually was on ObamaCare.  Our focus now has to shift to those red-state Senators who will have to explain to voters their potential support of a bill that imposes unconstitutional mandates and trillions of dollars in new costs on a government that can’t pay its bills now.  And in this case, we’ll only need two of them to stop the runaway tyranny of the Democratic agenda.”
  • The New Republic’s Jonathan Cohn: “Now is a moment to appreciate what has taken place. The House has passed what is arguably the most significant piece of domestic policy legislation in a generation. Dramatic or not, it qualifies as history.”
  • The American Spectator’s Philip Klein: “House Democrats just narrowly passed their health care legislation, by a margin of 220 to 215, with 39 Democrats voting against it, and just one Republican — Louisiana’s Joseph Cao — voting in favor. Obviously, this is an historic victory for Democrats as it’s the first time that a health care bill of this magnitude has made it this far. Passing it in the House gives it momentum going into the Senate. And also, in a larger sense, Democrats have proven once again that no matter how messy the daily grind may look, they’ve eventually been able to use their overwhelming majority to keep moving the health care ball down field.”

Monday, November 9th, 2009

House Calls?

Bloggers are rushing to put in their two cents before the House’s scheduled vote on a landmark health overhaul bill late  Saturday afternoon.  But questions remain on whether leaders have  enough votes, and Majority Whip Steny Hoyer admitted to reporters that a delay was possible.

Hot Air’s Ed Morrissey calls the scheduling of the vote a “Hail Nancy play.  She couldn’t afford to wait too long for the vote after dropping 2,000 pages on members last week, and having them see the results of the elections this week.  Pelosi and Hoyer thought that rushing a vote would allow them to bully recalcitrant moderates into support.”

Wonk Room’s Igor Volksy compiled a table comparing amendments on two key issues holding up votes: abortion and immigration.

Cato’s Michael Cannon in the National Review Online calls the bill a “$1.5 trillion fraud,” zeroing in on the off-budget costs of an individual mandate.

The Washington Post’s Ezra Klein says House leadership is “mired in negotiations with three different types of Democrats who are proving restive at the eleventh hour.”  According the Klein, those groups are the “controversialists” (lawmakers concerned with “electric” issues like abortion and immigration), “centrist skeptics” (general concerns about ideas like taxes or a public option) and lawmakers “worried about the process” (they don’t want to vote for a more liberal bill then the Senate.)

And Erin Kanoy of the Heritage Foundation looks at what might be happening in the Rules Commiteee: who set the guidelines for tomorrow’s debate: “The rule being debated today will not only cover HR 3962 but will also apply to HR 3961, the Medicare Physician Payment Reform Act, also known as the Doc Fix. This is a procedural gimmick that allows the costly Doc Fix bill to be combined with H.R. 3962 after the bill passes the House. This allows Congressional Leaders to avoid a stand alone vote on Doc Fix in the Senate.”

Stay tuned to KHN  this weekend for more coverage of the House vote.

Saturday, November 7th, 2009

Some Liberals Still Fighting To Strengthen House Bill’s Public Option

After a short break, commentators are back to the public option.

Heritage’s Conn Carroll, channeling Mike Meyers’ Saturday Night Live Character Linda Richman says the public option “is neither public, nor an option. Let’s discuss.”

The Washington Post’s Ezra Klein writes, “Most health-care wonks agree that the immense controversy generated by the public option has deflected attention from other important elements of the bill. You can draw only so many lines in the sand before a couple begin getting washed away. But there’s a split on whether that distraction has been a good or bad thing.”  Klein lumps himself in the “good thing ” camp, saying “it’s been a boon for the bill.”

Distraction or no, The New Republic’s Suzy Khimm reports that “House liberals still aren’t backing away from their push to strengthen the public option in the reform bill. Raul Grijalva, co-chair of the Congressional Progressive Caucus, sent a letter to [House Speaker Nancy] Pelosi on Friday that demanded an up-or-down vote on the Medicare-plus-5 rates–the strong public option that was passed up in favor of negotiated provider rates.”

Bob Laszewski says of the die-hards:

 I have been gratified to see many of these same people point out the health care bills have little in the way of cost containment. Their response was that the public option was a necessary means to that end. Without the public option, many said, there was no hope for long-term affordability. Now that the public option has been neutered in the House, and in that context an even more reluctant Senate is more unlikely to take any bold public option steps, just what will all of these people who saw it as the tool to manage costs say now?

Laszewski, a continued skeptic of the potential for a public option to constrain costs, says the bills before Congress do not lead “to health care reform or any real cost containment result.”

And Health Care for America Now distributed a new graph, sure to be picked up by the public plan proponents that are still working to change the newly announced legislation, that shows the difference in medical benefit-ratios, or the proportion of premium dollars spent on health costs, between Medicare and private insurers. hcan pub option graph

Tuesday, November 3rd, 2009

New GOP Health Care Strategies

The GOP and conservatives appear to be shifting opposition strategies as Democrats press forward with reform efforts (The House is scheduled to debate its almost 2,000 page overhaul bill this week.)

The GOP is reportedly set to release a new alternative to the House bill.  Minority Leader John Boehner said on Sunday: “What we do is we try to make the current system work better.”

Boehner delivered the Saturday Republican video address, and Sarah Palin  plugged it on her popular Facebook page, calling it a “game changer”.  According to Hot Air’s Allah Pundit, it was an unusual endorsement from Palin, who has been critical of party leaders.

A bill has not been released yet, but the GOP’s congressional website says it will be offered during floor debate this week.  According to the post, the bill emphasizes:

  • Number one: let families and businesses buy health insurance across state lines.
  • Number two: allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do.
  • Number three: give states the tools to create their own innovative reforms that lower health care costs.
  • Number four: end junk lawsuits that contribute to higher health care costs by increasing the number of tests and procedures that physicians sometimes order not because they think it’s good medicine, but because they are afraid of being sued.”

Time’s Karen Tumulty reacted, “But when you look at what the House Minority Leader is describing as an “innovative” solution, you’ve got to wonder. Specifically, he points to the kind of high-risk pools that many states have established for those who find themselves uninsurable as a result of a serious illness. That is not a new idea–some states have had these pools for three decades–or a solution for many. These pools already exist in more than 30 states, but they tend to be too expensive for those with limited means to buy into. And often, people cannot get into them for as long as a year after they apply.”

Elsewhere, conservative bloggers are latching onto a new opposition meme: Democratic lawmakers used “budget gimmicks” in order to receive specific cost estimates from the Congressional Budget Office.

James Capretta writes on Critical Condition, “In sum, then, the House plan is not a $900 billion program. It’s a $725 billion tax increase and a $1.5 trillion spending program. Tax and spend, indeed.”

And Dennis Smith of Heritage thinks the Finance Committee bill suffers from a similar affliction: “In the desperate attempt to portray their massive new spending bill as ‘budget neutral,’ Congress and the Obama Administration are relying on more desperate measures to hide the true cost of the legislation.”  Smith points to a specific provision that states the Secretary of Health and Human Services can reduce subsidies or credits should the bill increase the federal deficit.

Monday, November 2nd, 2009

A Rush To Dissect The House Bill

The House unveiled its final health overhaul bill this morning, presenting anxious Beltway observers with almost 2,000 pages to digest.

Some bloggers quickly went to work dissecting the bill, pointing out their least favorite provisions or looking for differences that remain with the other chamber.  Others are taking in the moment.

Critical Condition’s Mark Hemingway catalogues responses from GOP lawmakers, including Minority Leader John Boehner, who says the bill is “clearly designed for government takeover of our system.”

Wonk Room’s Igor Volsky has 10 reasons that Republicans should support the bill (though only one GOP senator has so far), framing  in an “Republicans asked for, Republicans got” style.  One example:

1. REPUBLICANS ASKED FOR – DEFICIT NEUTRAL BILL: “Do the American people believe that this almost 2,000 page bill won’t add to the deficit?” [Rep. Eric Cantor, 10/29/2009]

HOUSE BILL – DEFICIT NEUTRAL BILL: According to the Congressional Budget Office, the House bill costs $894 billion over 10 years and actually reduces the deficit by $30 billion and continues to reduce the deficit over the second 10 years.

Hot Air’s Ed Morrissey quips, “Nancy Pelosi and the House Democratic Caucus will unveil their version of ObamaCare this morning, and the New York Times reports some significant changes made in the last few days.  First, the ‘public option,’ which had changed to the quasi-Orwellian name of ‘competitive option,’ now goes the full 1984 to the ‘consumer option.’”

Heritage’s Marguerite Higgins writes, “As we scour through this 1,990-page monster of a bill (topping the 1,502-page health bill from the Senate Finance Committee), it will be important to determine how the feds and health care providers will come to these negotiated rates. Plus, other questions crop up, like will the government-run plan be subject to the same rules and market regulations that private insurers face? If we see the same language in the new House bill that was in H.R. 3200, then government will operate on an unlevel playing field where it has a clear advantage in the marketplace.”

Families USA’s Julia Eisman says the bill “sets a gold standard.”

The New Republic’s Jonathan Cohn titles his post, “House to PhRMA: No Deal.”  Cohn notes that the House bill does not square with the White House and PhRMA’s $80 billion deal: “The House, though, was not party to this deal. And so it’s decided to ask a little more–about twice as much, in fact.”

The Washington Post’s Ezra Klein interviews Rep. John Dingell, D-Mich., saying, “there is no politician alive today who has worked as long, or as hard, on health-care reform as Rep. John Dingell Jr.” Indeed, the octogenarian has worked on health legislation for decades. Dingell says, “This is the furthest I can recall health-care reform ever going, including in my days, and my dad’s days. A bill moving in the House. A bill moving in the Senate. Strong support in the admin. Strong popular support for the bill. A carefully crafted piece of legislation. A willingness of everybody to work together to work together towards what is a widely shared common goal.”

And The American Spectator’s Philip Klein points out new tax provisions, “Scanning through the bill, I noticed that the bill would add a new section to the federal tax code: “PART VIII:HEALTH CARE RELATED TAXES.” Among the new taxes are penalties for individuals who don’t purchase insurance and employers who don’t provide insurance, income tax surcharges of up to 5.6% to those earning more than $1 million, and a 2.5% excise tax on medical devices.”

Thursday, October 29th, 2009

Looking for More

 Bloggers continue to focus on the various facets of the health overhaul debate, in particular, that the Finance Committee bill needs additional funding.

Bob Laszewski pounds away at the Finance Committee bill, which he argues could “make access even more problematic” because of insufficient subsidies for middle-income families in the context of a weakened individual mandate.  Laszewski also takes time to blast AHIP for bad PR strategy, saying, “I swear, if AHIP issued a press release on a crystal clear day telling DC the sun was shining no one would believe them.”

Heritage’s Brian Darling is upset with reports that the health overhaul bills are being crafted “in secret:” “Democracy does not begin and end on Election Day for the American people. Whether you are for or against Obamacare, we the people deserve an opportunity to read, digest and understand the most important health care legislation to be debated in the United States Senate in our lifetime. The American people relied upon the promise of the Obama Administration and the leadership in Congress to be open and transparent, therefore it is time to stop the closed door negotiations and allow the American people to participate in the democratic process.”

Health Beat’s Maggie Mahar argues that insurers are “running scared” because “the public sector option is still alive.” With this point, she says she means “Medicare E (Medicare for everyone)” which she describes as “a public option for patients under 65, run by the federal government.  The scent of real competition is what has insurers on the run.”

Perhaps the public option is still breathing, but according to Hot Air’s Ed Morrissey, not because of much help from President Obama: “Is this leadership?  It’s a passive-aggressive approach that leaves both progressives and moderates in Obama’s own party twisting in the wind.  Obama wants his advisers to take all of the flak from progressive action groups that will result from a retreat on government-run health insurance, but doesn’t have the stomach to take that hit himself.  The end result is confusion among legislators on Capitol Hill, and further entrenchment on either side of the issue.”

The New Republic’s staff editorial argues that lawmakers’ “desire to expand health insurance coverage exceeds their willingness to pay for it,” and they need to find more money for the health bills but are running into roadblocks:

With so many ways to raise revenue, finding some combination capable of winning majorities in both chambers would seem simple. It isn’t. Liberals don’t like the insurance excise tax, in no small part because unions don’t want it affecting older workers who won generous benefits in past collective bargaining agreements. Centrists want no part of taxes outside the health care system, particularly those that target the wealthy. And neither group seems seriously interested in extracting more concessions from the health care industry, which may have a little something to do with the fact that it bankrolls so many political campaigns.

The Washington Post’s Ezra Klein uses an answer from Sen. Olympia Snowe to take a big picture look at health reform efforts this year, arguing, “We have a conservative system of government (in that it’s very hard to change the status quo), and [Democratic lawmakers] designed health-care reform to be sensitive to that fact.”

Mark Trahant looks at another issue in the health overhaul debate: an exemption for Indian Americans to the requirement to purchase insurance.  According to Trahant, “But even if you agree with the exemption – as I do – there remains another issue to resolve, the money. Unless health care reform substantially improves the funding stream for the Indian health care delivery system, then the individual exemption is only a guarantee of permanent disparity.”

Monday, October 19th, 2009