Roll Call: Latest News on Capitol Hill, Congress, Politics and Elections
July 31, 2014

Obamacare $100 Billion Cheaper Than Expected

“Republicans and their allies keep saying the Affordable Care Act will bankrupt the taxpaying public. Now there’s one more reason to think they are wrong,” Jonathan Cohn reports.

“It comes from the Washington’s official accountant, the Congressional Budget Office, which on Monday released a newly updated projection on how the Affordable Care Act will affect the deficit and insurance coverage. In February, the last time CBO addressed these issues comprehensively, it predicted that the net cost of the law’s coverage provisions would be about $1.4 trillion over ten years. Now, CBO says, it’s likely to be about $1.3 trillion, or $100 billion less.”

acafigure2 Obamacare $100 Billion Cheaper Than Expected

“It’s actually the latest in a series of revisions, each one suggesting the law would cost less money than the previous projection had suggested… And why this latest change? It doesn’t appear to be because the law will reach fewer people. CBO now expects slightly more people to end up with health insurance, at least over the long run. The CBO’s primary explanation for lower costs is that health insurance premiums on the new exchanges—what the administration calls ‘marketplaces’—are lower than CBO had originally expected they would be.”

  • moderatesunite

    very good news for the country

    • PopTheLid

      If you think coming in under what you really expected to come in at on your last projection is good news, I don’t. It’s simply spin city; see above.

      • moderatesunite

        after reading your post i was quite confused for a minute before realizing that the 2010 projection was for the next 10 years, (roughly 2010-2020), and included several years before large parts were implemented.
        The later projections in 2011, and 2012 were likely more because they included more years of implementation, the 2013, and 2014 revisions, however, now include even more years of full implementation and so should represent genuine cost reductions.

        • PopTheLid

          OK. Thanks. I think I’m clear on what you are saying, at some point in the future I’ll need to reconcile my thoughts on the 200 billion from Medicare that will no longer be counted as Obamacare cost reductions and the impact of delay of the employer and individual mandates until 2016.

          Another day.

          • Lorehead

            The individual mandate has not been delayed.

          • PopTheLid

            Yeah it has, I had an unexpected increase in essential expenses.

            The individual mandate includes a “hardship exemption.” People who qualify can either ignore the individual mandate altogether or purchase a
            cheap, bare-bones catastrophic insurance plan that’s typically only available to people under 30.

            2. According to HHS,the exemption covers people who “experienced financial or domestic circumstances, including an unexpected natural or human-caused event,
            such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan.”

            http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/19/the-obama-administration-just-delayed-the-individual-mandate-for-people-whose-plans-have-been-canceled/

          • Lorehead

            No. Notice that your source does not say that the individual mandate has been delayed. Characterizing that story that way is incredibly tendentious.

            The hardship exemption has been in the law since it was drafted, but a few weeks ago, the right-wing media played a game of Telephone and convinced themselves that the Obama administration was going to start giving them out to anyone for any reason and allow them to opt out of the mandate entirely.

            That is false. I tracked down the original memo that those stories cited as their source, and it said nothing like that.

          • PopTheLid

            Wow. You really go to great lengths to defend obamacare. The regulation wasn’t written until around December 2013. The source is one I figured you wouldn’t attempt to Alinsky as seems quite common on this site from those leaning to the far left – Ezra Klein.
            Or are you at odds with Ezra as well now? Is he on the unnapproved lists of Alinsky sources?

            My source doesn’t explicitly spell it out for you, therefore that is tendentious. How silly. Read the words don’t look for someone to explain it to you or group a bunch of words in the manner you would like.

            As someone familiar with law I can tell you immediately if the law provides a loophole as this most certainly does, for generic all encompassing reasons….it will be widely used. We all have a “financial or domestic circumstance that prevented us from obtaining a qualified healthplan” .

            Say goodbye to the youth signups, which never happened anyway.

            Now, what “Original Memo” are you referring to? We are talking about the HHS written regulations, not a memorandum.

            Please provide a link.

          • Lorehead

            You are conflating two very different claims. One, on which the story you quote is based, derives from this memo. It says that a narrow category of people will be able to buy higher-deductible catastrophic coverage rather than a bronze plan, but will still have to buy insurance like everybody else. This is true. Like Ezra Klein, I don’t think it was a good idea. It is also not a delay of the individual mandate.

            The second claim is that the Obama administration is about to sabotage its own law by giving everyone who asks a hardship waiver that lets them not buy insurance. That is pure wishful thinking on your part.

            By the way, your rants about Saul Alinsky are paranoid and undermining your credibility. If you can’t make your case without nattering about how evil are the evil evil liberals who always lie, your partisanship has destroyed your reason.

          • PopTheLid

            Yes, yes. I’m paranoid and responding directly to posts with zero content consisting of pure and only attacks on sources is paranoid. Trust me, it isn’t my credibility that is at stake when that occurs. If you can’t make your case without attempting to alinsky the source and refuting naught of what is said, you just may not have a case and YOUR partisanship is lamely covered by your attempts to claim otherwise. Notice the first thing done here is to attack the source.

            You went on to emotionally describe how Obama sabotaging its own law would be pure wishful thinking.

            Are you not following along? Nearly every mandate has been delayed until 2016 and we both know why. Just who do you think you are kidding with YOUR partisanship? Surely you can’t be this naive or uninformed.

            Now, there is no conflation of two different claims, are you just grouping words together without really thinking of their meaning?

            The whitehouse DID issue a blanket waiver to the individual mandate tax until 2016.

            They in an extremely low key regulatory shift issued in the beginning of March expanded the hardship exemption to include pretty much anyone willing to “attest” that they’ve experienced some sort of trouble
            obtaining insurance.

            Regulation/rule of law – no penalty can ever be assessed or collected when hardship for any sort of trouble can be applied. Understand?

            From the WSJ

            “But people can also qualify for hardships for the unspecified nonreason that “you experienced another hardship in obtaining health insurance,” which only requires “documentation if possible.” And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.”

            Now, explain to me again how the original memo from DEC 2013 that breached softening the mandate, obscures the regulation HHS wrote in March 2014 allowing hardship exemption – effectively eliminating the mandate – has not delayed the individual mandate.

            Explain how you do not understand HHS regulations written in March 2014, override any memo written as a guideline in Dec 2013. Explain how you portray this as a “right wing telephone game” and how you are not a partisan schill.

            Or try and attack me personally again, because at this point that is all you have left.

          • Lorehead

            Now, follow the links in that WSJ article, and you will see that the basis for that claim is the memo I linked, which says no such thing. The WSJ editorial board is engaging in pure wishful thinking.

          • PopTheLid

            Regulations issued 1st week of March……

            Rule of law: Please think – stop feeling and focusing on “sources” or people or what they may desire… eg “wishful thinking” focus rather on the regulations issued by HHS.

            You’re obviously convinced the problem is with someone else’s reporting, someone else’s take on it and that’s all you want to talk about.

            Forget that, view the regulations, the law what will be used to provide “Blanket exemptions from the mandate.

            Simply advise you have a personal hardship or difficulty and voila – no penalty.

            “…..experienced financial or domestic circumstances, including an unexpected natural or human-caused event,such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan.”

            See how this covers everything and anyone who wants an exemption?

          • Lorehead

            If you actually follow the links in the WSJ article you quoted, which I have, and read the memos they cite as the basis for their claims, they do not say what the WSJ claims they said. When former Secretary Sebelius told them that the story is not true, the WSJ quoted her denying it, then repeated its original, false claims and accused her of trying to cover them up, then printed the resulting mess under the title, “Sebelius vs. Accuracy: The HHS chief confirms her secret waiver of the individual mandate.”

            In other words, the WSJ totally blew this story. HHS is not suspending the individual mandate by waiving it for everyone.

  • PopTheLid

    Wow. I’m sorry, didn’t you forget the original budget promise?

    Wasn’t Obamacare projected to cost 940B when passed in 2010? Then 1.13T in 2011, then 1.51 T in 2012, and then 1.36 T in may 2013.

    Now it’s projected to be slightly under the last projection , but not the previous 3 and not even close to the original bill budget projection and you push that as if it’s good news. The newest prediction is under the last prediction….LOL.

    In 1965 the forerunner to the CBO projected that Medicare/Medicaid would
    cost $5 billion by 1990. Turned out to be $80 billion. Actual cost today $790 billion. Yeah, your projections are good news.

    • RonnieJ25

      Actually, no. The graph clearly shows you what the March 2010 CBO estimates were for each year. You are likely comparing different 10 yr sets to one another.

      • Lorehead

        This is correct. The spending provisions of the law did not kick in until this year, so the cost of those provisions is higher for the 2015–2025 budget window than it was for the 2011–2021 budget window. However, the projections for the cost in 2020 or 2021 have decreased, which is good news for the budget if true.

        Or if that’s counting our chickens before they hatch, there has been an immediate fall in medical inflation.

    • centerroad

      Fun with big numbers.

      1965 the gnp was $700 billion, today its $17 trillion.

      U.S. number one in costs
      u.s 37th in health

      Every country with universal coverage has better health and lower costs says Rand corp. Kaiser foundation, oecd, and world health organization.

      That should pop your lid.

      • PopTheLid

        Staying in the center of the road means you need a yellow stripe down your back for camouflage.

        Costs will go down because Obamacare pays less than medicaid, God help you trying to find a doctor not in a ghetto that isn’t a nurse practitioner; who is lucky they know where your kneecap is.

        As for that silly WHO ranking from 2000, that you qoute the U.S being 37th in healthcare…

        “…..The WHO study, however, suffers from so many flaws that it brings into question whether or not those who cite it even bothered to read the thing.

        First off, there are two different WHO rankings on healthcare:
        overall attainment (OA) and overall performance (OP). Using attainment, America ranks 15th, but naturally critics choose whatever looks worse.

        Still, only a few of the factors the WHO uses when calculating
        national performance rankings are even relevant to how well a healthcare system functions.

        There is a reason for the shoddy design of this study. When it was published, the organization was under the control of former Norwegian prince minister Gro Harlem Brundtland, a staunch socialist.

        Speaking on the issue of healthcare, Brundtlant stated,
        “The ultimate responsibility for a country’s health system’s
        performance rests with the government, but the impact lies
        disproportionately on the poor.”

        http://www.turningpointusa.net/no-rank-37th-healthcare/

        • centerroad

          It’s pure cowardice to spew lies while digressing into socailist trivia..

          Try reading from real sources then give accurate answers.

          Rand corp. Kaiser foundation, oecd, and world health organization.

          37th in health, number one in costs.

          Tell us again how the stats are wrong and distorted, Koch employee.

          • PopTheLid

            LOL. Koch employee. LOL. Real sources – Alinsky…….One of them. Yes, provide your list of acceptable sources for quotes, but abstain from any semblance of critical thinking.

            Koch employee……LOL.

            Have a nice night.

          • centerroad

            Your one source is an extreme right wing site with no credibility, I’ve cited four of the highly regarded studies countering your cowardly lies that are straight from the mouth of the Koch’s. They spent $250 million last year alone hiring clowns to lie about health care.

            Critical thinking, you can barely spell it, Rand, Kaiser, WHO, OECD. they are critical thinkers, Koch clones who cite right wing kiddie articles are not critical thinkers.

          • centerroad

            No doubt you’ll feel compelled to reply, without proper citations, you guys are paid per comment right?

          • PopTheLid

            How are you paid? In attaboys from Nancy Pelosi?

          • PopTheLid

            Sigh. I didn’t realize this site had liberal ideologues on it.

            You just went to town playing the Alinsky game, yet you offered not even a single tidbit refuting even one of the comments from the “extreme right wing site” oh my god, they must be evil…they are extreme.

            With you here, is this an extreme collective socialist Marxist site?

            Koch’s spend 250 million…..I don’t need someone to tell me about Obamacare and lies, I get them directly from the source and do my own research. If you like your plan you can keep your plan: period . Not one cent…..

            Sorry to ruffle your feathers, you seem overly emotional and completely lacking in any semblance of critical thinking (did I spell that correctly, you accused me of misspelling it earlier?)

            I’ll leave you to your emotional state. It’s a shame this is how people like you have conversations, brook no dissent and at the slightest bit of thinking start alinskying, name calling acting like a demented Harry Reid.

            Oh and on YOUR sources on a study from 2000

            “So, sure, the United States ranks poorly in health care, when you design a study that measures almost everything other than healthcare.

            You have a nice life.

            P.S while typing this I saw your other fast and furious post (man you are emotional) no, I won’t be giving you any sources to defend against your liberal insanity of name calling, alinsky tactics, koch brother rants…..

            Those are all you. You should get out more, meet a more varied group of intellectuals, learn to have differing opinions and trade notes….you won’t be such a mess and try to blame your lack of thinking on someone else being a paid troll……LOL.

          • Phaedrus

            It’s not liberal idealogues. It’s policy wonks.

            Y’know, the guys who actually read the laws and understand what they mean, and not have it spoon-fed to them by people with an agenda. Primary-source types.

            You know. Sources. Those things you don’t have.

          • PopTheLid

            You might want to read them closer and with less bias and a hell of a lot less arrogance, or at least offer something other than smugness to back up your accusations.

            Notice how all the silliness is directed towards me. Seems as if you’re the one with the agenda and you won’t brook any differing of facts, especially if they pop your agenda driven bubble.

            Was it difficult coming up with that original thought – no sources? Sources are only as good as the intellect interpreting them, see my sources throughout my posts.

            Have a nice day.

          • Phaedrus

            Your source is a right-wing spintank. One single source, which even if it were primary would not be sufficient to back up your point.

            If you think the animosity against your arguments comes from partisanship, I challenge you to go post on a neurology forum about how humans only use 10% of their brain or on any professional forum about an idea that is similarly demonstrably wrong but inexplicably popular. You’ll get the same reaction. Not because of politics, but because of frustration.

            What you perceive as smugness is in reality exasperation.

          • PopTheLid

            Have you noticed that your entire retort has been decrying the source and saying how it is a right wing spintank , and now claiming it was only 1 which isn’t enough?

            You think it isn’t noticeable that you haven’t been able to counter the simplest of thoughts from that unreliable source? If it were such hogwash, why even a partisan hack would be able to easily counter it – one who beleives himself so wise that he becomes exasparated with those who think outside his box of accepted Primary sources, instead of putting all efforts into Alinksying it .

            Now you say “even were it primary, it would not be sufficient…… are you supposed to be a thinker? Primary, translating into a source you accept and even if, it wouldn’t matter..you would alinsky it.

            Finally you further enter partisan hack land insert a straw argument and argue against it…..to prove you aren’t unnecessarily smug and arrogant, you challenge me to go on to a neurology board to discuss another topic….

            So now you have offered more than smugness to back you your assertions, you simply attempt to relable your smugness and now call it exasparation.

            Funny how superior you obviously think yourself to be, when seemingly you lack the capabilities to do more than Alinksy thought that don’t fit your molded agenda.

            By chance are you a Freshman in college?

          • Phaedrus

            Fine. Five minutes, that’s all your idiocy gets.

            1) WHO’s Attainment score ignores all the distribution variables. We still rank 15th. 15th is not best.

            2) Everything about the writer of the report is classic ad-hominem.

            3) The major utility of a health care system to a government, looking at it from a pure Ebineezer Scrroge utilitarian perspective, is to keep the poor from becoming disease factories. From that perspective, dispersion of care is very important.

          • PopTheLid

            More Alinsky gibberish.

            1) The WHO’s attainment score looks at everything BUT healthcare. You are completely wrong, but you knew that.

            2) Classic Ad hominem – you mean like your alinksky schtick? No examples, nothing but Ad Hominem?

            3) The major utility of a health care system to a government……..ok this conversation is done.

            Obamacare isn’t dispersing care, it’s weakening it despite dispersing insurance cards.

            Lets end this now. It’s pointless, you have nothing but a false sense of superiority and are obviously a big government hack.

            Don’t let history teach you anything or the reality of results inflict on your fallacious theories.

            Later, much later.

          • Phaedrus

            You seriously just say “Alinsky” whenever you don’t have a couunterargument. It’s hilarious. Say it again.

          • PopTheLid

            And you seriously attack every source when you have a lame argument or none at all, do it again.

            So far you have had nothing to argue. You said nothing but

            “Your source is a right-wing spintank.”

            ” Everything about the writer of the report is classic ad-hominem.”

            Straw arguments -” If you think the animosity against your arguments comes from partisanship, I challenge you to go post on a neurology forum” Really? You wanted to discuss your understanding of Obamacare and attacking sources by comparing them to a neurology forum debate? Phew……..

            I promise you, you are going to fail your political science class with this type of unacceptable performance.

            Nothing but dancing and absolutely no ability to review or discuss the content – NONE.

            Now go ahead, try and Alinksy me by claiming it is my issue for noticing your alinsky lame tactics.

            LOL.

          • Phaedrus

            You also seem to suffer from an inability to let anyone have the last word. And any time I can pin you down in a three day old thread no one else reads is less tim you can write where you might actually fool someone.

            Btw. I aced my polisci classes. at West Point. 15 years ago. They even asked me to come back an teach!

          • PopTheLid

            Project much? I type quick and think even quicker , it literally takes seconds for a reply to posts of your caliber.

            If you are this accomplished why are you so insecure and get off with silliness that amounts to nothing?

            Every phrase gives you away – you pinned me down in a 3 day old thread no one else reads.

            So that’s what your vacuity is all about? You are attempting to put on a show for someone?

            You can have the last word, I see it means a lot to you and you never did come even close to discussing the actual topic.

          • Phaedrus

            Bored, mostly.

            Go on.

  • http://www.facebook.com/profile.php?id=720164731 Kyle Becker

    Not one dime added to the deficit…

    • moderatesunite

      that’s right it’s paid for with a mix of taxes, changes to increase the efficiency of medicare, and efforts to reduce the growth in future healthcare spending.

      • PopTheLid

        I like that. Reduce Medicaid/Medicare payments until Doctors refuse any new patients and hospitals do not accept plans from the Obamacare exchange (happening right now) Call it a savings but don’t mention the decrease in actual care or the increase of emergency room costs…

        Unintended Consequences -

        • moderatesunite

          As far as I’m aware direct reductions to doctor reimbursements are nowhere in the law.
          Some doctors do refuse medicaid/medicare patients, but by doing so they deprive themselves of a vast number of their potential customers, and as a result either shoot themselves in the foot, or end up specializing in serving the wealthy, but that’s a pretty limited market.
          This is not likely to be a major issue though the so-called doc-fix could exacerbate it, depending on how it is resolved.

          The other things you mention are either completely false non-issues, or things that could be become issues in the future,but are impossible to judge until the new health system has been operating for months-years.

          • PopTheLid

            Really quick…..the savings Obamacare touts are completely and solely from Doctor Hospital cuts in reimbursement rates and treatment types.

            http://www.forbes.com/sites/merrillmatthews/2013/12/02/doctors-facing-a-24-pay-cut-in-both-medicare-and-medicaid-reimbursements/

            if there is a doc fix, then that means the rate reductions and savings are false….just paid later and yet again the acclaimed reductions are simply creative accounting.

            The rest is already happening, Doctors are refusing patients, hospitals are not accepting Obamacare exchange rates, look it up. Easy to find.

            As for the outcome being impossible to judge…it’s common sense. If you can’t find a doctor nearby or at all, they will continue using the emergency room.

          • moderatesunite

            The doc fix is a separate issue from Obamacare, its a product of a law passed in 1997,

            Your article was a good refresher on what the numbers are now albeit with a point of view I find slanted.

            The congress implemented the doc fix a couple times immediately after its passage, but then under pressure from lobbyists, and doctors congress began delaying its implementation by a year, and then another year, and another, without ever actually repealing the law.
            If it had been implemented as originally intended(as a decrease in the allowed increase per year to not be more than a couple% higher than inflation) It may have had positive or at least mixed or easier to judge results.

            As it has actually happened though through republican and democratic congresses, and administrations, all the delays have created a unstable situation. Your right that if the doc fix were ever not passed a sudden 24% or higher cut in reimbursement rates would have very negative effects.

            The amount this would reduce the deficit by is included in all “current law” accounting’s of the budget though, and it is the biggest example of creative accounting by congress.

            But it is not part of Obamacare, nor the source of its cost savings, those are from a variety of other sources and appear to be real.

          • PopTheLid

            Taken directly from the CBO report

            A crucial factor in the current revision was an analysis of the characteristics of plans offered through the exchanges in 2014.
            Previously, CBO and JTC had expected that those plans’ characteristics would closely resemble the characteristics of employment-based plans throughout the projection period. However, the plans being offered
            through the exchanges this year appear to have, in general, lower payment rates for providers, narrower networks of providers, and tighter management of their subscribers’ use of health care than employment-based plans do. …

            http://cbo.gov/sites/default/files/cbofiles/attachments/45231-ACA_Estimates.pdf

          • moderatesunite

            Yes, “providers” in this context primarily means hospitals, and insurance companies.

            The lower than expected costs likely have something to do with the market based competition between insurance companies on the exchanges, as well as various cost control measures targeting the insurance companies and hospitals, although some amount may be the result of reevaluating the cost effectiveness of some procedures, and experiments by hospitals and states to change the way in which doctors are paid. ( most of which involve some form of moving from fee per service, to a health result for the patient, or salary model). Some of that could end up lowering doctor pay, but if it does that will be driven by market competition.

          • PopTheLid

            No. Providers in this context are healthcare providers, this is clear. It means Doctors and Hospitals, not insurance companies.

            “…lower payment rates for providers”. Insurance companies receive premiums, Insurance companies are the ones making lowered payment rates to providers.

            CBO says narrower network of providers – Meaning less choice of Doctors and Hospitals who accept Obamacare exchange policies.

            Now, talking about indulging in alternative modes of payment – Health result for patient – vs service performed fees…I think you’re approaching a land we will never see in this country and so far out of the current scheme it really isn’t worth attempting to insert into the CBO current report on projected cost reductions. It is not reality and isn’t happening.

          • Lorehead

            That’s incorrect. Obamacare raises revenues to pay for the subsidies on the exchanges through taxation and by cutting the subsidies previously given to hospitals that treated uninsured patients, of whom there are fewer now. It also contains cost controls that are not reimbursement cuts.

            This report finds that the direct costs of Obamacare are lower than expected, because premiums are lower than expected. This, in turn, is because medical inflation fell to its lowest rate in fifty years.

          • PopTheLid

            Why are premiums lower than expected? Because medical inflation fell….no….because largely from the fact that insurance companies have redesigned plans on
            the government-run exchanges to shave costs. CBO found that individual policies on those marketplaces have narrower networks of doctors and lower reimbursement rates for health-care providers than is typical of employer-sponsored health plans.

            http://online.wsj.com/news/articles/SB10001424052702303887804579501684279691284?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052702303887804579501684279691284.html

    • Dave

      Unlike the GOP’s Medicare Part D expansion, which was totally unfunded.

    • John

      fact. CBO does no research. They do no independent research. fact. CBO compiles reports from data given to them by “the government”…fact…Obama is a proven liar. fact. CBO’s numbers are lies. Fact…You have no merit. move along.

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