No, ObamaCare Won’t Reduce the Deficit

A new paper by one of Medicare’s Trustees reveals the disastrous budgetary consequences of the health law.

The short version: Despite repeated claims to the contrary, ObamaCare won’t reduce the deficit over the next decade.

The longer version: The health law’s backers relied on—and are still hiding behind—government budgeting conventions in order to argue that the law will result in lower overall deficits relative to expectations about the current fiscal trajectory. No matter how you run the numbers, the law can be expected to increase both total federal health spending and deficits.

That’s the conclusion reached by Charles Blahous, a Medicare Public Trustee, in a new paper for the Mercatus Center at George Mason University.

Blahous ran the law through three possible futures. The first is an “optimistic scenario” in which all of ObamaCare’s hoped-for cost savings, including both those many suspect are “politically implausible” and even “some additional savings not scored by [the Congressional Budget Office].” The second, intermediate scenario assumes that Congress will weaken the effects of some of the law’s cost-savings. A third and final scenario does not represent the true worst case, but looks at the budgetary effects will play out should Congress decide “to overturn certain savings provisions under the ACA in a manner relatively consistent with historical precedent”—in other words, if Congress behaves exactly as it has in the past.

In every single scenario—from the most optimistic to the most historically consistent—Blahous finds that health spending increases. So do federal deficits.

Why are these projections so different from the favorable Congressional Budget Office (CBO) scores touted by the administration? Because unlike the CBO, Blahous is not bound to a scoring convention that requires him to participate in the administration’s double counting of the law’s supposed Medicare savings.

The law includes about $500 billion in Medicare savings, mostly stemming from reduced payments to providers. The CBO score assumes that these savings will be plowed back into the law’s expansion of health coverage—the combination of expanded Medicaid and middle-class health insurance subsidies that account for the vast majority of the law’s spending.

But the same reductions also allow Medicare’s officials, as well as various opportunistic legislators and senior members of the Obama administration, to claim that the law extends the life of Medicare’s Hospital Insurance (HI) trust fund. As Blahous notes, two Democratic members of Congress, Reps. Henry Waxman and Frank Pallone, wrote a Dear Colleague letter in January, 2011 noting that the law “strengthens the Medicare trust fund, extending its solvency from 2017 through 2029.” Health and Human Services Secretary Kathleen Sebelius has made the same claim, as did former Medicare head Donald Berwick.

But make no mistake. This is a form of double counting, as the same Congressional Budget Office that provided the favorable scores agreed. In December, 2009, CBO Director Doug Elmendorf responded to questions about the scoring convention:

CBO has been asked whether the reductions in projected [Medicare] Part A outlays and increases in projected HI revenues under the legislation can provide additional resources to pay future Medicare benefits while simultaneously providing resources to pay for new programs outside of Medicare. Our answer is basically no....To describe the full amount of HI trust fund savings as both improving the government’s ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement in the government’s fiscal position. [bold added]

Richard Foster, Medicare’s Chief Actuary, provided an even more detailed answer at a think tank panel last summer—the gist of which was that, because of trust fund accounting conventions, the law collects trust fund dollars once but allows them to be spent twice. Ultimately that means that the second, imaginary dollar will have to be paid for either by borrowing, cutting spending elsewhere, or raising taxes. 

So if Medicare’s solvency is to be extended, the law’s Medicare savings won’t be usable for funding the coverage expansion. And since legislators and administration officials have spent the last two years touting how the law extends Medicare’s solvency, there’s no reason to think that federal legislators will choose to let Medicare go into insolvency earlier—especially given the extreme political sensitivities surrounding the program’s fiscal health. That means that the money won't be available to pay for the insurance subsidies.

The administration, however, is still hiding behind the scoring convention. “Opponents of reform are using ‘new math’ while they attempt to refight the political battles of the past,” a White House budget official told The Washington Post in response to questions about Blahous’ paper. “The fact of the matter is, the Congressional Budget Office and independent experts concluded that the health-reform law will reduce the deficit.” Another important fact would seem to be that the score was generated using assumptions that don’t accurately reflect the reality of how the law will be implemented and funded.

And the reality, according to Blahous, is that even under the rosy assumption that the law’s various health savings mechanisms actually pay off, the deficit still increases by about $340 billion. If the savings mechanisms don't work, the damage will be even worse.

This is not the fault of the budget scorekeepers. As Blahous says, “To point out that the oft-cited CBO analysis is based on a scoring convention rather than on a literal reading of law should not be construed as a criticism of the methodology of the CBO or of the Medicare trustees (of whom this author is one).”

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  • Old Mexican||

    But make no mistake. This is a form of double counting, as the same Congressional Budget Office that provided the favorable scores agreed.


    "It's not accounting fraud when we do it!"

  • lightning||

    My reaction to the title of this article:

    No duh! My 5 year old knows the math doesn't work.

  • Sevo||

    "If the savings mechanisms don't pay off, the damage will be even worse."

    'Nuff said.

  • R C Dean||

    I thinkn your autocorrect inserted "If" when you meant "When".

  • NoVAHockey||

  • Old Mexican||

    The first thing to understand here is that this is not a study by a government agency. It’s a paper by Charles Blahous. Who is Charles Blahous? He’s a Republican policy guy.


    "No need thus to go over the numbers! Nothing to see here!"

  • Registration At Last!||

    Maybe if Old Mexican continued to read the posting by Chait, he would have noticed this passage, where Chait 'goes over the numbers:'

    "...the roughly $500 billion in Medicare savings that Obama used to help cover the uninsured is money that Blahous assumes the government wouldn’t have spent anyway. Without the health-care law, in other words, we would have had Medicare cuts but no new spending on the uninsured. Now we have the Medicare cuts and new spending on the uninsured. Therefore, the new spending in the law counts toward increasing the deficit, but the spending cuts don’t count toward reducing it.

    That is a completely bizarre assumption. It’s not an assumption that any scoring agency ever applies in other situations."

    ... and here's where Old Mexican, confronted with the red-handed evidence of his own off-the-cuff-stupidity, starts going ad hominem, dodging the issue, and moving the goalposts in 3... 2... 1...

  • wareagle||

    so de facto Dem policy guy Chait is to believed over Repub policy guy Blahous why? Chait assumes there would be "Medicare cuts but no new spending on the uninsured". By what political calculus does Chait assume Medicare cuts would have occurred? And to call $500-billion in Medicare payments NOT made a type of "savings" requires a totally new dictionary.

  • KPres||

    Savings - reduction in the rate of growth by my team.

    Draconian cuts - reductions in the rate of growth by their team.

  • mr simple||

    The first thing to understand here is that this is not a study by a government agency.

    And only the government can be trusted.

  • mr simple||

    It was published by the Mercatus Center, a Koch-funded organization that produces some quality work as well as a fair amount of schlock that does not meet the standards of your typical university economics paper.

    Ad hominem attacks and hatchet job comlumns, however, are the surest sign of quality journalism

  • wareagle||

    and what exactly are the standards of the "typical university economics paper" that makes them so credible? Probably because no problem was ever found in a paper produced by academia.

  • wareagle||

    why does anyone pretend that Obamacare will reduce the deficit? It has nothing to do with either the deficit OR reducing health care costs. The IRS fines for non-compliance are purposely low so that businesses will voluntarily pay the fine instead of buying insurance for their staffs, thereby creating a single payer system by default.

  • Tman||

    I wonder if we bought everyone a Pony -a nice pretty Pony- would THAT reduce the deficit?

  • mr simple||

    We'll never know until we try. I have a right to a pony!

  • Gadianton||

    Do we all have a right to a pony? If so, I need a Pony Subsidy.

  • albo||

    The whole idea is a whopper from the start: That the federal government could create a massive entitlement that would save, not cost, money? It would be the first one ever.

    I guess people and the media went along because if anyone could do it, the Annointed One could.

    But it's willful idiocy. Like being convinced that the Adam Sandler movie you're gonna see will be the comedic next coming of Animal House.

  • Avater||

    Sadly, this valid argument will do little to sway supporters of Obamacare. To them, deficits and debt are irrelevancies.

  • Concerned Citizen||

    Unless Team Red is in the White House.

  • TheZeitgeist||

    From personal greed perspective, there is going to be big business - and investment opportunity - in offshore medical facilities for people who can pay their own insurance.

    Insurance Co. is going to realize paying $400 for MRI in Costa Rica + cost of ticket, hotel, meals for two days = $2000 for grand total of $2400 vs. shelling out ~$5,000 for MRI in the States.

    Something's gotta give there and Obamacare - if implemented - will break that camel's back.

  • CE||

    Why not an offshore ocean liner with a hospital, in international waters?

  • TheZeitgeist||

    That is not a bad idea.

  • CE||

    Next by Peter Suderman: why a shopping spree won't pay off your credit cards.

  • ||

    Whoa now. A federal entitlement program whose budget projections are a complete load of shit? Well I'll be damned...

  • Harvard||

    Tony? Bueller? S'plain all this in that funky no nonsense way of yours.

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