The House Health Bill: Rolling The Dice On The Big Bang Approach to Policy
Dennis Smith /
Very soon, the House of Representatives is expected to vote on legislation ( H.R. 3962). That 1990 page bill, if enacted, will have an unprecedented impact on our economy, the federal budget, and the lives of all Americans. You can read that bill right here.
Here is a crucial question: Do members of Congress have any idea how this massive legislation will really affect us? Does anyone in the Speaker’s Office or in the Congressional leadership really know how moving the various parts of health care legislation will interact with one another and impact our care, our spending, our pocketbooks?
Straight talk and honesty are at a premium. Taxpayers can be sure of the honesty of one top level public official: The Chief Actuary at the Centers for Medicare and Medicaid Services (CMS). He does not know the answers to these questions, and he told us that he doesn’t.
The Stakes. Consider that national health care spending will represent 17.9 percent of our entire economy next year. By 2019, under current law, CMS forecasts we will spend $4.67 trillion.
The Chief Actuary of the CMS did not analyze H.R. 3962. But he did analyze its successor, H.R. 3200, and, given that the basic policies in the earlier version are the same, the analysis should give House members pause. Indeed, under the earlier analysis, CMS says spending will increase to $4.796 trillion. This is important precisely because President Obama promised repeatedly that health care reform that would lower the cost of health care.
Words of Warning. Consider the words of warning of the Chief Actuary:
- “The actual future impacts of H.R. 3200 on health expenditures, insured status, individual decisions, and employer behavior are very uncertain.”
- “The legislation would result in numerous changes in the way that health care insurance is provided and paid for in the U.S., and the scope and magnitude of these changes are such that few precedents exist for use in estimation.”
- “Consequently, the estimates presented here are subject to a substantially greater degree of uncertainty than is usually the case with more routine health care proposals.”
- “… the longer-term viability of the Medicare update reductions is doubtful.”
- “Many of the provisions, particularly the coverage proposals, are unprecedented or have been implemented only on a smaller scale (for example, at the State level). Consequently, little historical experience is available with which to estimate the potential impacts.”
- “The behavioral responses to changes introduced by national health reform legislation are impossible to predict with certainty.”
- “In particular, the responses of individuals, employers, insurance companies, and Exchange administrators to the new coverage mandates, Exchange options, and insurance reforms could differ significantly from the assumptions underlying the estimates presented here.”
Simply put, one of the top experts in Washington doesn’t know what all of this means.
Unsafe Estimates. The estimates are based on a number of assumptions which CMS acknowledges may not turn out to be correct. For example, CMS assumes smaller employers are likely to drop coverage while more employees of large employers will take up employer sponsored insurance. On net, the number of people with employer sponsored insurance will decline by 15 million. However, the decline of employer coverage could be even greater if employers continue to cover the employee but drop other family members which would be shifted to government assistance. There is an underlying assumption that all states will continue to participate in the Medicaid program. We already know the current program is unsustainable for states and the additional costs of covering 18 million more individuals as CMS estimates would occur could result in states leaving the program. Collectively, states would save more than $2 trillion by getting out of Medicaid, leaving the federal government to pick up the entire cost. Nothing in federal law would prevent that from happening.
It is becoming clearer as to how much of a gamble the politicians in Washington are willing to take with our lives, our fortunes, and our futures.