Tag: congressional budget office

ObamaCare Cost Estimate Watch: Day #180

On Day #179 of the ObamaCare Cost Estimate Watch, Sen. Jim Webb (D-Va.) wrote in The Winchester Star of his involvement in the Senate health care debate:

At the start of this debate I was one of eight senators who called on Senate Majority Leader Harry Reid to post the text and complete budget scores of the health-care bill on a public web site for review at least 72 hours prior to both the first vote and final passage. This request was agreed to, affording proper transparency in the process.

On the contrary, as I explain in this Richmond Times-Dispatch oped, Reid did not comply with Webb’s request.

Indeed, a memo recently issued by the Congressional Budget Office suggests that Reid has been working very hard to conceal the legislation’s full cost all along.

FEHBP Plan Is No ‘Moderate Compromise’

Senate Majority Leader Harry Reid (D-NV) has announced that he has reached a super secret compromise on how to deal with the so-called public option for health reform.  While Reid said the agreement was too important to actually tell anyone what is in it, most of the details have been leaked to the press.

Rather than set-up a completely government-run insurance plan to compete with private insurance, Congress would establish a program similar to the Federal Employees Health Benefit Program (FEHBP), which currently covers government workers, including Members of Congress.  The FEHBP offers a variety of private insurance plans under a program managed by the US Office of Personnel Management (OPM).  Each year OPM uses the Federal procurement process to solicit bids from insurance companies to be one of the plans offered.  Premiums can vary, but participating plans operate under stringent rules.   As a model, the FEHBP is apparently acceptable to moderate Democrats because the insurance plans are private rather than government entities, while liberals like it because it is government regulated and managed.

In addition, the compromise plan would expand Medicare, allowing workers ages 55 to 65 to “buy in” to the program, and may also expand Medicaid.

A few reasons to believe this is yet another truly bad idea:

  1. In choosing the FEHBP for a model, Democrats have actually chosen an insurance plan whose costs are rising faster than average.   FEHBP premiums are expected to rise 7.9 percent this year and 8.8 percent in 2010.  By comparison, the Congressional Budget Office predicts that on average, premiums will increase by 5.5 to 6.2 percent annually over the next few years.  In fact, FEHBP premiums are rising so fast that nearly 100,000 federal employees have opted out of the program.
  2. FEHBP members are also finding their choices cut back.  Next year, 32 insurance plans will either drop out of the program or reduce their participation.  Some 61,000 workers will lose their current coverage.
  3. But former OPM director Linda Springer doubts that the agency has the “capacity, the staff, or the mission,” to be able to manage the new program.  Taking on management of the new program could overburden OPM.  “Ultimate, it would break the system.”
  4. Medicare is currently $50-100 trillion in debt, depending on which accounting measure you use.  Allowing younger workers to join the program is the equivalent of crowding a few more passengers onto the Titanic.
  5. At the same time, Medicare under reimburses physicians, especially in rural areas.  Expanding Medicare enrollment will both threaten the continued viability of rural hospitals and other providers, and also result in increased cost-shifting, driving up premiums for private insurance.
  6. Medicaid is equally a budget-buster. The program now costs more than $330 billion per year, a cost that grew at a rate of roughly 10.7 percent annually.  The program spends money by the bushel, yet under-reimburses providers even worse than Medicare.
  7. Ultimately this so-called compromise would expand government health care programs and further squeeze private insurance, resulting in increased costs and higher insurance premiums, and provide a lower-quality of care.

No wonder Senator Reid wants to keep it a secret.

Reid Health Bill Perpetuates the $1.5 Trillion Fraud

Senate Majority Leader Harry Reid (D-NV) has finally unveiled his massive 2,074-page health care bill.  The Congressional Budget Office reports that the insurance-expansion provisions would cost the feds $848 billion over 10 years.  To raise those funds, the bill would tax wages, medical devices, prescription drugs, sick people, health insurance premiums (twice), HSAs, FSAs, HRAs, and – why not? – cosmetic surgery.  The remainder would supposedly come from $491 billion of Medicare cuts, even though Medicare’s chief actuary says such cuts are “unrealistic” and “doubtful.”  But don’t worry.  Somehow, this thing’s gonna reduce the deficit.

Of course, that $848 billion only accounts for part of the federal government’s share of the tab.  There is other new federal spending.  My read is that the CBO estimates $998 billion of total new federal spending – though I’ll be waiting for former CBO director Donald Marron to provide a more authoritative tally.

And then there are costs that Reid and his comrades have pushed off the federal budget.  For example, the $25 billion unfunded mandate that Reid would impose on states.  Total so far: just over $1 trillion.

But the biggest hidden cost is that of the private-sector mandates.  In both the Clinton health plan and the Massachusetts health plan, the private-sector mandates –- the legal requirements that individuals and employers purchase health insurance –- accounted for 60 percent of total costs.  That suggests that if the Reid bill’s cost to federal and state governments is $1 trillion, then the total cost is probably $2.5 trillion, and Harry Reid – like House Speaker Nancy Pelosi – is hiding $1.5 trillion of the cost of his bill.

Without a cost estimate of the private-sector mandates, Reid has not yet satisfied the request made by eight Democratic senators for a “complete CBO score” of the bill 72 hours prior to floor consideration.

Fortunately, by law, the CBO must eventually score the private-sector mandates.  When that happens, the CBO will reveal costs that the bills’ authors are trying to hide. When that happens, the CBO will present the new federal spending on page 1, new state spending maybe on page 10, and the cost of the private-sector mandates on page 20 or something.  Democrats will tout the figure on page 1.  But the bill’s total cost will the sum of those three figures -– a sum that will reveal the costs that the bill’s authors have been hiding.

The House passed its bill without a complete CBO score.  The Senate should not follow suit.

I’ve written previously about this massive fraud here, here, here, and here.

(Cross-posted at Politico’s Health Care Arena.)

Obamacare Will Be a Budget Buster

Does anyone think that a huge new entitlement program will lead to lower budget deficits? Sounds implausible, yet proponents of government-run healthcare claim this is the case according to the official estimates from the Congressional Budget Office and Joint Committee on Taxation.

To use a technical phrase, this is hogwash. This new 6-1/2 minute video, narrated by yours truly, gives 12 reasons why Obamacare will lead to higher deficits - including real-world evidence showing how Medicare and Medicaid are much more costly than originally projected.

By the way, this video doesn’t even touch on the mandate issue, which Michael Cannon explains is not being counted in order to make the cost of government-run healthcare less shocking.

Recapping the Costs of the REAL ID Revival Bill

In late July, the Senate Homeland Security and Governmental Affairs Committee passed a new version of PASS ID, the REAL ID revival bill. I’ve posted about various dimensions of it: the national ID question, the politics of PASS ID, whether PASS ID protects privacy, a run-down of the Senate hearing on it, and the inexplicable support of the Center for Democracy and Technology for this national ID law.

Three months later, the committee still has not reported the bill, meaning that the public doesn’t get access to the version the committee passed. (A resolution in the House would require committees there to publish amendments to bills within 24 hours.) But the Congressional Budget Office scored the bill this week. That is often a signal that legislation is on the move.

So it’s a good time to look at costs again. The National Governors Association and the National Conference of State Legislatures both premised their support for PASS ID on the idea that it would reduce costs to states to just $2 billion.

But in July I examined the likely costs of PASS ID and NGA’s cost calculations. To save you a burdensome click, here are some highlights:

But there is reason to doubt [the NGA’s $2 billion] figure. PASS ID is a lot more like REAL ID — the original REAL ID — in the way that most affects costs: the implementation schedule.

Under PASS ID, the DHS would have to come up with regulations in just nine months. States would then have just one year to begin complying. All drivers’ licenses would have to be replaced in the five years after that. That’s a total of six years to review the documents of every driver and ID holder, and issue them new cards.

How did the NGA come up with $2 billion? Maybe they took the extended, watered-down, 75%-over-ten-years estimate and subtracted some for reduced IT costs. (The NGA is free to publish its methodology, of course.)

But the costs of implementing PASS ID to states are more likely to be closer to $11 billion than the $2 billion figure that the NGA puts forward. In just six years, PASS ID would send some 245 million people into DMV offices around the country demanding new cards. States will have to hire and train new employees to handle the workload. They will have to acquire new computer systems, documents scanners, data storage facilities, and so on.

The NGA’s claim of savings from PASS ID is weak. Did the new CBO score change anything?

First, let’s review what a CBO score is. When CBO scores a bill, it reports how a bill will change costs to the federal government. Other CBO reports may include overall costs for federal programs, but when CBO scores a bill, it just reports the difference between current federal spending and spending if a new proposal should pass. CBO sometimes mentions mandates on states and private-sector costs in their bill-scores, but those are rarely if ever thoroughly reported. CBO’s wheelhouse is federal spending, and that’s what it reports.

Now, let’s look at how CBO has done with estimating the costs to states from implementing federal national ID standards.

Its first cut at scoring national ID standards was when it looked at H.R. 10 in the latter stages of the 108th Congress. (This was before REAL ID — H.R. 10 was an early version of the bill that became law as the Intelligence Reform and Terrorism Prevention Act.) When CBO scored H.R. 10 in late 2004, it lumped national ID standards along with several other policies and programs in a category called ”Mandates With no Significant Costs.”

Four months later, in early 2005, CBO scored the REAL ID Act, which had been introduced early in the new Congress. It found then that the national ID standards Congress had put into law in December had changed from a mandate with “no significant costs” to a mandate costing more than $100 million.

CBO thought REAL ID would only cost $20 million more than that, an amount below the reporting threshold of the Unfunded Mandates Reform Act, so CBO did not do a thorough analysis.

Then the folks actually faced with implementing it took a look at REAL ID. More realistic estimates of costs to states in the $10+ billion range came forward, including an estimate from the National Governors Association, as I discussed in my previous post on costs.

With that background we’re ready to look at the CBO score for PASS ID. CBO makes no precise estimate of costs to states. Its specialty, again, is federal spending. But it makes a few observations about such costs:

  • “The bill would require states to issue public notices about their security and privacy policies that include information about how personally identifiable information is used, stored, accessed, and shared.”

This, all should agree, is a complex problem but a small cost.

  • “The bill also would require states to have a process that would allow individuals to access, amend, and correct their information. Information from groups representing state governments [NGA and NCSL, most likely] indicates that most states currently have such policies and procedures, though some may need to be revised.”

No. They. Do. Not.

As I said in my post on the privacy consequences of PASS ID:

This is a new and different security/identity fraud challenge not found in REAL ID, and the states have no idea what they’re getting themselves into if they try to implement such a thing. A May 2000 report from a panel of experts convened by the Federal Trade Commission was bowled over by the complexity of trying to secure information while giving people access to it. Nowhere is that tension more acute than in giving the public access to basic identity information.

No state has opened its driver databases for review and correction by the public. That would be an all-you-can-eat buffet for identity fraudsters. The CBO has been bamboozled about state policies.

But the language of PASS ID finesses this, doesn’t it? It says that opening up identity data and giving the public correction rights would be done “as determined appropriate by the State.” So states wouldn’t really have to do anything, right? Right!

Except that the Department of Homeland Security gets to interpret what that language means, and a court will defer to any reasonable DHS interpretation. That’s the Supreme Court’s Chevron doctrine. (It’s an unfortunate abdication of power to administrative agencies, but it’s the law today.)

If the NGA and NCSL have told their clients that they will have the last word on how PASS IS is implemented, they are wrong. It’s DHS’ call — not states’. There may be huge costs to states — hidden at first, but growing and growing — if they stick their heads into the jaws of the federal lion.

Returning to the CBO’s assessment of state costs:

  • “The bill would repeal the requirements of the REAL ID Act and replace them with more flexible requirements for issuing compliant driver’s licenses and identification cards.”

This is true in some respects, and not in others. As I noted before, PASS ID is on a tighter implementation schedule which is the main driver of costs.

  • “The bill also would authorize appropriations that could be used to pay for those requirements, and it would prohibit the federal government from charging fees to states to access the SAVE and SSOLV data systems.”

Because it’s federal, this is something that CBO actually knows about, and its assessment is that PASS ID would dole out a total of $123 million to states over the next five years. Washington, D.C.’s highest spending year would be fiscal 2013, in which it would spend $39 million, less than $1 million per state.

And those savings when the federal government doesn’t charge states for using its databases? Just $2 million each year in fiscal 2010 and 2011.

Nothing in the CBO estimate changes the conclusion that implementing a national ID would cost states over $10 billion dollars, as they hired new staff, acquired new equipment and systems, and marched 250 million Americans through their DMVs. The federal government is promising to dole out $123 million and offer states a whopping $4 million in savings on data access.

The National Governors Association’s argument that PASS ID reduces costs to states is ludicrous. And the paltry funds Congress might share with states is a drop in the bucket. The homeland security appropriations bill for fiscal 2010 cuts funding for REAL ID by $40 million from its 2009 funding level. PASS ID would fare no better.

State governors and legislatures that have fallen for the PASS ID cost estimates of the National Governors Association and National Conference of State Legislatures should fire these financial advisors. NGA and NCSL are trying to grow federal power at the expense of state coffers.

Baucus Bill Would Cost More than $2 Trillion

Sen. Max Baucus’s (D-MT) health care overhaul would cost more than $2 trillion.  It would expand the deficit.  But he has carefully and methodically hidden those facts – so well that he has completely hoodwinked nearly all the major media.

The media are reporting that the Baucus bill would reduce the deficit by $81 billion over 10 years.  Wrong.

The Baucus bill assumes that Congress will allow the “sustainable growth rate” cuts in Medicare’s physician payments to occur beginning in 2012.  Yet Congress has routinely and repeatedly blocked those cuts, making Baucus’s assumption preposterous.  The CBO handled the issue delicately, but essentially said, “Sure, provided that the sun rises in the west in 2012, then yes, this bill would reduce the deficit.”

That means Baucus will come up at least $200 billion short on the revenue side, making his bill a budget-buster.

The media are reporting that the Baucus bill would cost just $829 billion over 10 years.  Wrong.

As Donald Marron observes, that number omits as much as $75 billion in new federal spending.  It also omits a $33 billion unfunded mandate on state governments.

But the worst part is that the Congressional Budget Office’s preliminary cost estimate omits the cost of the private sector mandates in the Baucus bill.  In Massachusetts, those costs accounted for 60 percent of the total cost of reform.  That suggests the actual cost of the Baucus bill – $829 billion plus $75 billion plus $33 billion, times 2.5 – is well over $2 trillion.

Yet the CBO score pretends those costs aren’t even there.  It’s like a mystery novel that’s missing the last 50 pages.  And the media aren’t even curious.

In the words of Brad DeLong, why, oh why, can’t we have a better press corps?

Cross-posted at Politico’s Health Care Arena.

Wednesday Links - Health Care Costs

The Congressional Budget Office released a report this week that revealed that the proposed health care bill would not increase the deficit.  But is it that simple? Cato health care policy experts have examined the bill and added up the costs. Here are a few things they have found: