While we still haven’t heard from the U.S. Supreme Court on King v. Burwell regarding the legality of health insurance premium subsidies to citizens in state’s that let the federal government run their Marketplaces (like South Carolina), we have heard how Congressional opponents of Obamacare plan to act should the Court ruling go in their favor. They want to extend the subsidies for several years to protect the 6.5 million Americans who otherwise would mostly lose their health insurance.
They do want some Obamacare concessions from the President to take this approach but it is unlikely that the President would agree.
I expect that the solution to an incorrect Supreme Court ruling would ultimately be a simple change of a few words in the law to address the subsidies and an extension of the Affordable Care Act until after 2017.
Since the law was passed in 2010, “repeal” has been the political cry of the anti-Obamacare folks. But now facing a Court ruling that could essentially doom the law, the GOP controlled Congress realizes that “repeal” is not an alternative because of the public backlash they fear would be hurt them in the 2016 elections.
But there is also a fiscal reason for Congress not to repeal the law or let it die. Doing such would explode the federal deficit by up to $353 billion in the next 10 years according to a report released yesterday by the Congressional Budget Office (see below). The CBO provides nonpartisan analysis for Congress.
The low end of the projection would be increasing the deficit by $137 billion. But to arrive at this lower number the CBO had to buy into the idea that Obamacare is somehow holding back employment when all the hard data indicates job growth, especially in healthcare, has been the result of the laws increased healthcare spending.
To the extent that the Republicans in Congress actually pay more than lip service to the concept of reducing the federal deficit, repealing Obamacare or letting it die from a Court ruling should be a non-starter.
Report from the Congressional Budget Office
June 19, 2015
Budgetary and Economic Effects of Repealing the Affordable Care Act
Over the past several years, a number of proposals have been advanced for repealing the Affordable Care Act (ACA), which became law in March 2010. In this report, CBO and the staff of the Joint Committee on Taxation (JCT) analyze the main budgetary and economic consequences that would arise from repealing that law.
To conduct the analysis, CBO and JCT first considered the effects of the ACA’s repeal on health insurance coverage and on the federal budget over the next 10 years, holding gross domestic product (GDP) and other macroeconomic variables (such as interest rates) constant—assumptions that underlie most cost estimates used in the Congressional budget process. The agencies then examined the macroeconomic effects of repealing the ACA and estimated the consequences of the resulting feedback for the federal budget over the next decade (involving changes in tax revenue, for example, that stem from changes in GDP). Finally, CBO and JCT considered the budgetary and economic effects of repealing the ACA for the period beyond 2025.
As has been the practice for past analyses of the ACA, CBO and JCT estimated the budgetary implications of a repeal in two broad categories: the effects of repealing the act’s provisions concerning insurance coverage—including subsidies provided through the insurance exchanges, added costs for Medicaid, revenues from certain penalties and taxes, and related effects—and the effects of repealing other provisions of the act, which would mostly be related to Medicare spending and tax revenues. For the purposes of this analysis, CBO and JCT assumed that a repeal would take effect on January 1, 2016, and would not change federal law retroactively. As discussed below, all of the resulting estimates are subject to substantial uncertainty.
What Would Be the Major Effects of Repealing the ACA?
CBO and JCT estimate that repealing the ACA would have several major effects, relative to the projections under current law:
- Including the budgetary effects of macroeconomic feedback, repealing the ACA would increase federal budget deficits by $137 billion over the 2016–2025 period. That estimate takes into account the proposal’s impact on federal revenues and direct (or mandatory) spending, incorporating the net effects of two components:
- Excluding the effects of macroeconomic feedback—as has been done for previous estimates related to the ACA (and most other CBO cost estimates)—CBO and JCT estimate that federal deficits would increase by $353 billion over the 2016–2025 period if the ACA was repealed.
- Repeal of the ACA would raise economic output, mainly by boosting the supply of labor; the resulting increase in GDP is projected to average about 0.7 percent over the 2021–2025 period. Alone, those effects would reduce federal deficits by $216 billion over the 2016–2025 period, CBO and JCT estimate, mostly because of increased federal revenues.
- For many reasons, the budgetary and economic effects of repealing the ACA could differ substantially in either direction from the central estimates presented in this report. The uncertainty is sufficiently great that repealing the ACA could reduce deficits over the 2016–2025 period—or could increase deficits by a substantially larger margin than the agencies have estimated. However, CBO and JCT’s best estimate is that repealing the ACA would increase federal budget deficits by $137 billion over that 10-year period.
- Repealing the ACA would cause federal budget deficits to increase by growing amounts after 2025, whether or not the budgetary effects of macroeconomic feedback are included. That would occur because the net savings attributable to a repeal of the law’s insurance coverage provisions would grow more slowly than would the estimated costs of repealing the ACA’s other provisions—in particular, those provisions that reduce updates to Medicare’s payments. The estimated effects on deficits of repealing the ACA are so large in the decade after 2025 as to make it unlikely that a repeal would reduce deficits during that period, even after considering the great uncertainties involved.
- Repealing the ACA also would affect the number of people with health insurance and their sources of coverage. CBO and JCT estimate that the number of nonelderly people who are uninsured would increase by about 19 million in 2016; by 22 million or 23 million in 2017, 2018, and 2019; and by about 24 million in all subsequent years through 2025, compared with the number who are projected to be uninsured under the ACA. In most of those years, the number of people with employment-based coverage would increase by about 8 million, and the number with coverage purchased individually or obtained through Medicaid would decrease by between 30 million and 32 million.