Latish yesterday the Congressional Budget Office released a preliminary score of the draft health care legislation under consideration by the Senate Committee on Health, Education, Labor, and Pensions. The news was not pretty. On the one hand, the bill was estimated to cost $1 trillion over ten years. That’s a lot of money, though not in my view too much money to spend on something important. But what you get for the money is very disappointing—a net reduction in the quantity of the uninsured of only about 16 million people. When you spend a trillion bucks on your universal health care bill, you’re generally looking to get a lot closer than that to a world in which everyone has health insurance.
Now the CBO does caution that this is only an estimate of a partial bill. In particular, the actual HELP legislation is expected to contain a more robust employer mandate and some provisions related to Medicaid, among other things. But how much difference does that make? According to Ezra Klein a lot:
The bill that CBO scored did not look much like the bill they intend to write. Which means that the numbers aren’t correct. If HELP is writing a bill with a strong employer and individual mandate, and CBO scores a bill with no employer mandate and a weak individual mandate, it’s not clear where that estimate leaves us.
By Monday night, members of the HELP Committee were scrambling to give the CBO something closer to the final legislation to examine — this time including rough details of the employer mandate and the individual mandate. They’re hoping to have a new set of estimates by Friday, though that’s probably ambitious.
The bottom line is that we should expect the real bill to have a somewhat higher cost number but a much higher number of people getting health coverage. Consequently the cost per person will be much lower and the legislation will look much more reasonable. Jonathan Cohn explains some of the mechanics by which the inclusion of the employer-side provisions will dramatically alter the final impact of the bill.
But long story short, for now this looks more like a problem of legislative mechanics—they shouldn’t have had the CBO score this in such a preliminary way and get a misleading headline number out there—than one of policy gone off the rails.