Jonathan Cohn and Ezra Klein make a valid and important point about the new House majority’s push to repeal Obamacare. Here’s Cohn:
The media is playing [the repeal resolution] as a pointless stunt, because the Senate would never pass it and President Obama would never sign it. This seems unfair to me. Repeal of health care is among the very top priorities for these Republicans. Passing such a bill has important symbolic value.
But precisely because I do take this seriously, I’m curious: Will the Republicans ask the Congressional Budget Office to score the bill? Say what you will about the process that produced the Affordable Care Act, but it was not rushed and it did not try to game the budget accounting process. On the contrary, Democrats went to great pains–and, arguably, suffered tremendous political damage–because they were determined to produce a bill that the CBO would pronounce as deficit-reducing.
They succeeded, too. CBO projections suggest that the Affordable Care Act will reduce the deficit by more than $100 billion over ten years, which is not bad–indeed, not bad at all–for an initiative that will allow 30 million more people to get insurance and push the entire health care system in the direction of more efficiency. It stands to reason that if the Republicans repeal the bill, they will be increasing the deficit by an equivalent amount.
Ezra, in a detailed post, points out some of the apparent inconsistency in GOP’s position:
House Republicans are in a pickle: One of their new rules says that new legislation must be paid for. But the health-care bill reduces the federal deficit by more than $100 billion over the next 10 years. Luckily, they’ve figured out an answer to their problem: They’ve decided to simply exempt the repeal bill from the rules. That means they’re beginning the 112th Congress by lifting their own rules in order to take a vote that will increase the deficit. Change we can believe in, and all that.
Republicans are aware that this looks, well, horrible. So they’re trying to explain why their decision to lift the rule requiring fiscal responsibility is actually fiscally responsible. Majority Leader Eric Cantor got asked about this, and he returned the reporter’s serve with a volley of nonsense. “About the budget implications, I think most people understand that the CBO did the job it was asked to do by the then-Democrat majority, and it was really comparing apples to oranges,” Cantor said. “It talked about 10 years’ worth of tax hikes and six years’ worth of benefits. Everyone knows beyond the 10-year window, this bill has the potential to bankrupt this federal government as well as the states.”
That’s all well and good — but it’s not true. Take Cantor’s core point: The health-care reform bill includes “10 years’ worth of tax hikes and six years’ worth of benefits.” There’s nothing philosophical about this statement. It can be checked with a simple look at the spending tables the Congressional Budget Office published in their analysis of the bill. And when you look at those tables, Cantor’s statement falls apart.
I have a piece out today, on National Review’s main page, that discusses this problem in depth. The basic point is that, while conservatives are rightly cynical of CBO projections about Obamacare’s deficit-reducing features, as a matter of parliamentary procedure, the CBO’s opinion is extremely important.
If Republicans manage to take back the White House and gain majority control of the Senate in 2012, they are almost certainly going to have to use the reconciliation process to repeal Obamacare. I note in the article:
As we learned last year, the reconciliation process is different from the normal legislative process. The Senate parliamentarian, using Congressional Budget Office estimates, certifies measures that, either by raising taxes or by cutting spending, will reduce the budget deficit. Only deficit-reducing measures can be passed using reconciliation.
The problem for Republicans is that the CBO estimated that the PPACA would reduce the deficit by $132 billion over the 2010–2019 period. Because of amendments passed in late 2010, it’s likely that the CBO’s estimate of the cost of repeal will be even higher in 2013. Hence, a simple, two-paragraph repeal measure won’t get through reconciliation.
This is where the agenda of the next Congress comes in. In place of comprehensive health-care reform, House Republicans are promising to reverse some of Obamacare’s most unpopular elements: for example, the new 1099 provision, which requires that all businesses issue an IRS form 1099 for any payments to vendors of more than $600 per year. The CBO scores this measure as raising $18 billion for the government over ten years: indeed, that’s why it was included in the PPACA in the first place. If Congress reduces Obamacare spending elsewhere to “pay for” this tax cut, ultimate repeal could become more difficult.
The individual mandate is a more worrisome example. Last June, the CBO projected that repealing the individual mandate would reduce the deficit by $252 billion in the 2011–2020 timeframe. Under current law, the CBO is counting on some people under PPACA paying the fine for not purchasing health insurance, thus increasing revenues to the government; however, repeal of the mandate would generate savings by reducing the number of people who rely on Medicaid and exchange subsidies. If the mandate is eliminated, repealing the rest of Obamacare will become $252 billion harder.
Hence, if Republicans in the 112th Congress succeed in eliminating some of these provisions, they may increase the fiscal cost, as scored by the CBO, of repealing the rest of Obamacare in the next Congress. In addition, every unpopular tax increase that is eliminated now will need to be offset by additional tax increases or spending cuts, which complicates things when the real repeal effort starts in 2013. Republicans, therefore, may be setting a trap for themselves.
It’s a long article, but it explores a lot of the implications of this problem. Let me know what you think.
Doesn't repealing the $18B 1099 provision first DECREASE the overall cost of repealing the rest of the PPACA by $18B?
Reply to this commentLinkReport AbuseAlso, since the PPACA front-loaded the revenue but not the outlays, wouldn't repeal in 2013 cost slightly less, since for 2013-2023 there are 9 years of outlays to consider rather than 6?
Nevertheless these are good things to be thinking about - glad you brought them up.
Reply to this commentLinkReport AbuseIf repealing the bill requires new spending cuts (or tax increases), then Congress should just implement the spending cuts. This is a win-win!
Reply to this commentLinkReport Abuse1776: Your view works if you think that moderates are more likely to support repeal if they have to support additional tax increases and/or spending cuts.
Reply to this commentLinkReport AbuseRemoving the $18B provision is a cost, yes. But you do that in a separate bill, say this year, which might pass on its own since even many Dems recognize that it's awful. Then when 2013 rolls around and you repeal the *remainder* of PPACA, you're not removing the $18B of revenue in that repeal bill since it's already been removed in 2011.
Same principle would work if there are any cuts that really ought to be restored (not sure if there are - Medicare Advantage, maybe?) - do it now, or at least separately, to reduce the cost burden on the full repeal bill.
Reply to this commentLinkReport AbuseHi Steve(s), I apologize for the confusion -- I clearly could have articulated this concept better. I will write a follow-up post about it. Thanks for highlighting it.
The most important thing to keep in mind is that, under Paygo rules, every tax cut or spending increase has to be offset by equally large tax increases and/or spending cuts.
In the case of the "doc fix" of December 2010, the doc fix was paid for using spending cuts (i.e., elimination of tax credits) from PPACA. This makes PPACA harder to repeal. If you do it the opposite way -- for example, eliminating the 1099s while offsetting that tax cut with a non-PPACA-related tax increase (say a tax on yacht sales that is not considered an amendment to PPACA) -- then you have tilted the reconciliation field in your favor for PPACA repeal.
So, the latter approach is a strategy that Republicans could use -- albeit one that has political pitfalls as well.
If you repeal the individual mandate today, you don't need offsets today, but you'd have to come up with $242 billion in other spending cuts and/or tax increases to offset the additional cost of repeal, that you weren't planning to use for overall deficit reduction. That's not so easy.
The other option is to dump Paygo altogether, and choose to increase the deficit in the near-term in order to make repeal of PPACA easier in the long-term. That will be risky.
On the issue of PPACA being front-loaded (brought up by another Steve) -- it isn't as front-loaded anymore as it was in the original drafting. They fixed that.
Hope that helps, and once again, I'm sorry I didn't do a better job of explaining this in the article.
Reply to this commentLinkReport AbuseEvery year the CBO numbers should change, and each year they should get MUCH worse, if they do their 10 year cost analysis based starting from the current year (which I believe they do). This is because, as Cantor pointed out, the revenue stream to pay for it starts a few years prior to the benefits kicking in.
The taxes to pay for it start much higher than the costs (which initially are trivial) but barely increase over time. The costs on the other hand are flat for the first 4 years (using '09 as year 1, as the bill does), moderate in year 5 and then explode as full benefits kick in, and keep rising after that at a rate much faster than the revenues to pay for it. The original CBO score was done in 2009 and only worked for the Dems because they backloaded most of the costs, with very little payout in the first 4 years or so.
So, now that we're in 2011, ask for a new CBO score, they'll score it from 2011 to 2021 and those numbers will show that it does NOT reduce the deficit. The Dems are still using the original 2009 numbers to claim deficit reduction.
Also, since congress passed another 'doc fix' in 2010, that should change things for the worse by a couple hundred billion. The CBO score assumes the ~20% cut to reimbursements for medicare/medicaid in its cost estimate, since they must take the bill at face value, but no one on the planet thinks congress will ever allow those cuts to take effect.
An honest analysis of the bill, based on realistic expectations (as opposed to the restrictions CBO faces, having to believe the absurd assumptions written into the bill), would most likely show that, once benefits kick in the bill is only about 40% paid for (~100 billion in revenue per year to pay ~250 billion in benefits). Even this is wildly optimistic. CBO assumed only about 15 million people would go on govt subsidies for their insurance. But, as we know, the incentives for companies to dump their employees off their current coverage is enormous (personally, my company would save 80% of the cost of my insurance by dumping me and paying the penalty instead). Also, is there anyone deluded enough to believe that the 40% tax on 'cadillac' insurance plans, already kicked to 2018 as a sop to the unions, will ever actually be implemented? Does anyone think the full $500 billion in medicare cuts will actually take effect? The 'pay-for' for this bill is smoke and mirrors, no one should be surprised if much of it never materializes. We may well see the revenue in the 25-40 billion per year range.
To borrow a couple phrases from Bill O'Reilly from last night (from his critique on Pelosi's absurd 'pay-go' claims), anyone who believes this bill will reduce the deficit is a moron. Anyone that tells you that it will reduce the deficit is either a Liar or Delusional.
Reply to this commentLinkReport AbuseFor years I have to contend with people telling me that you have to spend money to make money. Now, they are telling me that you have to spend money to save money. Oh, how the world becomes more confusing when the government gobbles it up.
Reply to this commentLinkReport AbuseWhy has all the emphasis been only on the time period 2010-2019? Is the world going to end in 2019? Does this bill sunset in 2019? This is a new entitlement and any actuarial analysis of it should take into account the fact that it is meant to exhist in perpetuity. Neither Ezra Klein nor the Democratic party have made any reference to that fact. When Republicans debate this bill, we need to begin talking about it in terms of its entire existence, not just the years the Democratic party manipulated to look budget friendly.
What does the deficit look like in the 2019-2029 period? The 2029 - 2039 period? What do the estimates now look like with both growth and employment being below the CBO's estimates when these projections were first done in March? Paul Ryan, Econ 21, Avik Roy, and Reihan - I await your tutelage!
Reply to this commentLinkReport AbuseIt would be helpful if you could explain why you think "conservatives are rightly cynical of CBO projections about Obamacare’s deficit-reducing features," because I've yet to see a cogent explanation for such cynicism. Much of the argument focuses on things not actually included in, or connected to the bill (e.g., the doc fix), or speculation about future measures that a Congress might undertake that is not actually contemplated by the bill (like, well, repealing its cost-saving features).
Reply to this commentLinkReport AbuseMost of what has been mentioned in this article deals with cost Cutting measures that imply rapid increase of payments. Republicans should allow the cost to bypassed on to the public and as soon as the cost becomes set- evident proceed to amend cost cutting legislation ensuring a fail- safe contingency in Congress.
Reply to this commentLinkReport AbuseThe point is let the deems. Cut their throats first with ineffective healthcare and let them prove the republican agenda as a viable. Option.
Hi guys,
Upon re-reading the original NRO article, I realized that I garbled some of the discussion of the fiscal tactics noted above -- the revised version (now reflected in the original article as well as this blog post) should read more clearly.
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