When the Congressional Budget Office scores a bill, its looks at the budgetary effects over the immediate ten year window. So on the health care bill, the headline cost of $849 billion covers the period between 2010 and 2019. Problem is, it's a misleading figure since most of the new programs don't actually kick in until 2014, and, as a result, most of the spending—99 percent, according to the CBO—doesn't occur until the final six years. That means it's not actually a very good reflection of how much it's going to cost to run the bill's new programs over a decade-long period.
Think of it this way: If you decided to add the cost of a gym membership to your budget next year, at $100 a month, it would cost you $1200. But if you decided to wait until July to join, the cost would only be $600 in next year's budget. Cheap, right? Well, not really, because the following year, and every year after, the membership would cost you the full $1200. That's basically what Democrats are doing here: Holding off on implementing the bulk of the reform's new programs and new spending in order to make the initial total seem less expensive.
So what sort of numbers would you see if you started the score in 2014 and added up the first decade in which all the parts of reform are actually in full effect?
The Pacific Research Institute's Jeffrey Anderson did just that, and, not surprisingly, the totals are a lot higher:
In other words, according to data provided by the CBO, starting up the entire reform apparatus is going to cost more like $1.8 trillion over its first real decade of operation.
(Chart via the Republican Congressional Health Care Caucus.)