Comparing The CBO Scores For Different Health Care Bills

We’re still waiting on the the language of the reconciliation bill, but I’ve gone through the preliminary CBO report and pulled out some numbers to compare the new package with the old Senate and House drafts. Obviously, the new package spends more and achieves greater deficit reductions than the old Senate bill. It puts more money towards affordability credits, increases the federal contribution towards Medicaid and increases Medicaid reimbursement for primary care physicians. The bill pays for this new spending by imposing higher penalties on employers, extending the payroll tax to unearned income and levying new taxes on the pharmaceutical, medical device, and insurance industries.

Here is a breakdown of the different CBO scores:

	New Bill	Senate Bill	House Bill
Costs	Reduce deficits: $138B/10yrs Cost: $940B/10yrs Spends on subsidies: $466B/10yrs On Medicaid/CHIP: $434B/10yrs On Small Employer Credit: $40B/10yrs	Reduce deficits: $118B/10yrs Cost: $875B/10yrs Spends on subsidies: $436B/10yrs On Medicaid/CHIP: $395B/10yrs On Small Employer Credit: $40B/10yrs	Reduce deficits: $109B/10yrs Cost:$1.2T/10yrs Spends on subsidies: $605B/10yrs On Medicaid/CHIP: $425B/10yrs/10yrs On Small Employer Credit: $25B/10yrs
Insured	Uninsured reduced by: 32M Uninsured in 2019: 22M In Exchanges: 24M In Medicaid: 16M	Uninsured reduced by: 31M Uninsured in 2019: 23M In Exchanges: 26M In Medicaid: 15M	Uninsured reduced by: 36M Uninsured in 2019: 18M In Exchanges: 30M In Medicaid: 15M
Revenue	Mandate penalty: $17B/10yrs Free rider penalty: $52B/10yrs Excise tax: $32B/10yrs Payroll tax: $210B/10yrs	Mandate penalty: $15B/10yrs Free rider penalty: $28B/10yrs Excise tax: $149B/10yrs Payroll tax: $87B/10yrs	Mandate penalty: $33B/10yrs Pay-Play penalty: $135B/10yrs Excise tax: — Payroll tax: —
Medicare and Medicaid	Total savings: ~$493B/10yrs Medicare Advantage: $200B/10yrs	Total savings: $483B/10yrs Medicare Advantage: $118B/10yrs	Total savings: $426B/10yrs Medicare Advantage: $170B/10yrs

One of the most stunning numerical changes is in the excise tax on Cadillac plans. While the bill changes the indexing from inflation plus 1 to inflation — strengthening the provision — it pushes back the entire effort to 2018 and significantly raises the thresholds. I suspect the bill makes up the difference with the payroll tax and the savings from the college loan provisions. More to come.