Rep. Darrell Issa (R-CA) has an op-ed in today’s Politico in which he argues that the Congressional Budget Office underestimated the cost of the Affordable Care Act by an incredible $1 trillion dollars:

Beginning in 2014, tens of millions of employees will be eligible for these new subsidies. Many already have access to health insurance through their employers but are likely to find it more advantageous if this insurance is dropped, and they can instead have taxpayer health care subsidies and slightly higher wages.

While this creates a win-win for the employer and worker, it creates a lose-lose for the nation’s credit rating and taxpayers. Holtz-Eakin has calculated that previous projections may have underestimated Obamacare’s 10-year cost by roughly $1 trillion.

Issa argues, via former CBO director Douglas Holtz-Eakin, that employers will drop coverage because the cost of providing insurance is more than the penalty for not offering it and that workers will simply gravitate toward more affordable government-subsidized plans. But this argument doesn’t account for the increased compensation employers would have to provide to their employees if they stopped offering insurance or that employees “who have a coverage offer from their employer are not eligible for premium tax credits unless the coverage offered is seriously deficient.” As the Urban Institute explains, “[T]here is little scope for firms being able to save money from dropping ESI [employer sponsored coverage] coverage except perhaps in firms where most workers have low wages as well as low family incomes, and these types of firms are the least likely to offer ESI today.” Note that Holtz-Eakin’s estimates is on the very periphery of other studies of employer dumping:

But what’s really astounding is that Holtz-Eakin would produce a $1 trillion figure — a number so large that it seriously questions the competency if not the sanity of the actuarial office he used to manage.

Sarah Kliff finds a health care angle to this weekend’s “decision fatigue” article in the New York Times, in which John Tierney argues that “[t]he more choices you make throughout the day, the harder each one becomes for your brain, and eventually it looks for shortcuts.” Kliff notes that beneficiaries in Medicare Advantage face a similar challenge when presented with too many choices:

In Medicare Advantage, enrollees were more likely to enroll in a plan as choice increased, but only when choosing between fewer than 15 options. Between 15 and 30 plans, the extra choice doesn’t seem to do much to affect sign up numbers. But when seniors have more than 30 plans to choose from, enrollment drops off sharply.

Look:

States should keep this in mind when designing their health insurance exchanges — allowing too many insurers into the new market would make it all the more difficult for beneficiaries to compare policies and purchase the coverage they need. As studies conducted by the Massachusetts Connector — the state’s exchange — demonstrated, consumers felt that too much choice was “confusing” and “overwhelming.” “Participants expressed a desire a for manageable numbers of plans (e.g. three to four) offered by four to six carriers. In addition, consumers expressed difficulty making plan comparisons under the existing model.” “Instead, consumers preferred for information to be presented in a simple and standardized format that clearly distinguished between different benefit design options.”

Politico’s Pulse reports that Maine Sen. Olympia Snowe (R) “is inviting people to send a ‘thank you’ note to the 11th Circuit Court of appeals for deeming the individual mandate unconstitutional. “I applaud you and your efforts for standing up for the constitution and for defending my individual liberties,’ reads the note on her reelection website, conveniently omitting the fact the Snowe was the only Republican to vote in favor of the mandate when she supported moving the health reform legislation out of the Senate Finance Committee:

In fact, she did not publicly oppose the individual requirement to purchase coverage — which the 11th Circuit found unconstitutional — until October of 2009. Earlier that year, she had indicated that she could support an individual requirement if coverage became more affordable. “I understand the rationality behind the individual mandate,” Snowe said during the committee’s mark-up hearings. “Certainly we shouldn’t pay for those who don’t have health insurance.”

But this isn’t the first time Snowe has attempted to cloud her role in moving forward the health care legislation. In March, Snowe issued a press release announcing that she is co-sponsoring an amendment “to repeal the employer mandate imposed by the new health reform law.” The “mandate” she was referring to, however, is actually a “free rider” compromise provision that she helped broker in her effort to draft a bipartisan health care law.

Merrill Goozner examines the campaign donations of the 12 members of the super committee for hints of what its recommendations would look like and finds that “the pattern of donations makes it highly unlikely they will vote to raise taxes to limit the size of the reductions in domestic and military programs needed to reach over $100 billion a year in spending cuts over the next decade.” The size of the health care cuts in Medicare and Medicaid may also be smaller, given the industry’s investment:

Yet health professionals and the pharmaceutical industry are among the top three industries contributing to Rep. Dave Camp, R-Mich., Fred Upton, R- Mich., Rep. Chris Van Hollen, D-Md., Rep. Xavier Becerra, D-Cal., and Sen. Jon Kyl, R-Ariz., according to the Maplight analysis, which looked at the last two years for House members and the last six for senators.

Even when aggregated contributions from health-related firms do not represent a large share of a committee member’s contributions, individual health firms play a major role. Sen. Max Baucus, D-Mont., for instance, counted drug firm Schering-Plough as his single largest contributor over the last election cycle. Rep. James Clyburn, D-S.C., listed Davita International, a leading dialysis firm heavily dependent on Medicare funding, as his third largest contributor.

Look:

Interestingly, the ideological rigidity of the GOP may actually dampen the influence of campaign contributions on the final outcome, as Republicans have already demonstrated significant enthusiasm for taking huge sums of money out of both Medicare and Medicaid.