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Posted at 11:15 AM ET, 01/ 6/2011

Repealing health-care reform would cost $230 billion over 10 years -- and more after that

By Ezra Klein

The Congressional Budget Office took a look at the Republican repeal bill and came back with some numbers (pdf) the GOP isn't going to like. Jon Cohn summarizes:

The news from the CBO is exactly what you would have thought: Getting rid of the Affordable Care Act will mean higher deficits. The CBO is projecting that repeal would increase the federal deficit by around $230 billion in the next decade and by an even larger amount after that.

Wait, there's more. The CBO also estimated how repeal would affect insurance premiums. And, once again, the effect is entirely predictable. Premiums for people buying coverage on their own would fall a bit, but only because people were getting less protective insurance and because many with pre-existing conditions would be locked out of the market altogether. And even though premiums would be lower, many people buying coverage on their own would still end up paying more for their policies, because they would not benefit from the enormous subsidies that the Affordable Care Act makes available.

Speaking of people locked out of the insurance market, the CBO ran the numbers on the uninsured. An additional 32 million people would be expected to go without health insurance, bringing the percentage of non-elderly adults without coverage to 17 percent, which is more or less what it is today.

Rep. Anthony Wiener is pushing an amendment to the repeal legislation that would say no such legislation could pass unless it was deficit neutral. The odds that Republicans allow his amendment to be offered -- much less embrace it as part of their crusade to cut the size of the deficit -- do not seem good.

By Ezra Klein  | January 6, 2011; 11:15 AM ET
Categories:  Health Reform  
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Comments

Repealing health-care reform would cost $230 billion over 10 years -- and more after that . . .

and fixing it to get rid of perverse incentives to pharma, doctors and hospitals would save a TON of money.


But then again neither's going to happen is it?

Posted by: visionbrkr | January 6, 2011 11:18 AM | Report abuse

You left out the best part of the letter:

The projections of the bill’s
budgetary impact are quite uncertain, both because CBO has not completed
a detailed estimate of the effects of H.R. 2 and because assessing the effects
of making broad changes in the nation’s health care and health insurance
systems—or of reversing scheduled changes—requires assumptions about a
broad array of technical, behavioral, and economic factors

Posted by: NoVAHockey | January 6, 2011 11:24 AM | Report abuse

230 billion is nothing compared to the increase in costs that occur with every government run entitlement program. SS, medicare/medicaid have ended up costing billions more then what they were projected to cost, and are a financial burden to our economy. See what happens when you elect an incompetent community organizer as POTUS?

Posted by: WorkOrStarve | January 6, 2011 11:37 AM | Report abuse

Thank You NoVAHockey for pointing out the slanted approach this writer takes.

Posted by: red4ever2 | January 6, 2011 11:42 AM | Report abuse

Just $23 billion a year? OK, no problem.

Let's start by cutting elsewhere -- say ashcanning the Department of Education. That saves $100 billion a year.

Next.

Posted by: karl-keller | January 6, 2011 11:42 AM | Report abuse


it doesnt take a crystal ball, to know that...

health care reform is going to stay.
the tea partyfolk will be humbled.
the economy is going to improve.
president obama will be re-elected.

Posted by: jkaren | January 6, 2011 11:49 AM | Report abuse

Stop obsessing over something that isn't going to happen. These posts are becoming last year's deficit reduction posts redux.

Posted by: 54465446 | January 6, 2011 11:50 AM | Report abuse

it doesnt take a crystal ball, to know that...

health care reform is going to stay.
the tea partyfolk will be humbled.
the economy is going to improve.
president obama will be re-elected.


Posted by: jkaren


I'm guessing your mommy's lesbian lover told you one too many fairy tales.

Posted by: WorkOrStarve | January 6, 2011 11:52 AM | Report abuse


Republicans are a bunch of lying sacks of crap.

First they claim to be "conservative" and then nag about what Democrats spend on the Aemrican People because even a penny is too much of our money to be spending on ourselves.

Then, NO SOONER then they arrive in Washington, billions and trillions of dollars in spending is "nothing" to the Republicans.

Just look at these stupid posts -- "Just $23 billion a year? OK, no problem." -- Republican.

"230 billion is nothing..." -- Republican.

And that doesn't even count the billions Republicans "lost" in giving multi-millions the same tax cuts the millionaires DIDN'T WANT before.

Nor does that count the trillions of dollars Republicans spent on that LIE CALLED THE WAR IN IRAQ, which DEBT Republicans have just turned their back on and ignore likes it's their ugle cousin or something.

So, Republicans still have the same plans as they did when Bush was in office -- borrow and spend trillions and trillions of dollars, forget they borrowed it, forget they spent it, and then blame the Democrats.

Posted by: lindalovejones | January 6, 2011 11:54 AM | Report abuse

it doesnt take a crystal ball, to know that...

health care reform is going to stay.
the tea partyfolk will be humbled.
the economy is going to improve.
president obama will be re-elected.


Posted by: jkaren

I'm guessing your mommy's lesbian lover told you one too many bedtime stories.

Posted by: WorkOrStarve | January 6, 2011 11:55 AM | Report abuse

54465446,

its not obsession, its scoring political points. Its a shame because this blog used to be about clear intellectual thought and its become reduced to politicization at this point. Really reall sad. Anybody with half a brain knows its going to pass the House and stop there. But if Ezra can score some points by saying its not deficit neutral and that the CBO report shows PPACA was deficit positive (even though there's swiss cheese holes through that theory) they'll run with it for as far as the truth will taken them which isn't very far.

Posted by: visionbrkr | January 6, 2011 12:03 PM | Report abuse

Nor does that count the trillions of dollars Republicans spent on that LIE CALLED THE WAR IN IRAQ, which DEBT Republicans have just turned their back on and ignore likes it's their ugle cousin or something.

So, Republicans still have the same plans as they did when Bush was in office -- borrow and spend trillions and trillions of dollars, forget they borrowed it, forget they spent it, and then blame the Democrats.

Posted by: lindalovejones


Yep Linda, Welfare, Medicaid, SS, and Medicaid were all Republican ideas. Linda, for months now you have nothing intelligent to say, which is typical of being a loony toon leftist. And why no mention Linda of the deficit spending under the Hussein/Piglosi administration, eh? You, Piglosi and Hussein remind me of a child who always says "It wasn't me". Perhaps that's why liberalism is considered a mental disorder. lol

"ASK NOT WHAT YOU CAN DO FOR YOUR COUNTRY, ASK WHAT YOUR COUNTRY CAN DO FOR YOU"-liberal motto

Posted by: WorkOrStarve | January 6, 2011 12:04 PM | Report abuse

Thank you NoVAHockey for that intelligent response. Mine is less so- too flipping bad about the costs Democrats. You should have asked us first. It would have saved us all a great deal of time and money. Voters will be watching to target legislators who fail to repeal. The next accountability will be the 2012 election. 2010 was a start and not a one time event. We will continue to clean house of those who fail to follow through.

Posted by: Desertdiva1 | January 6, 2011 12:07 PM | Report abuse

This is all good Politics by Dem, in the end beneficial to common Americans.

Question is will Dems continue to show the spine to do something concrete for Americans - keep defending Affordable Care Act? Where is Obama here? Is it going to cost him so much to say few things here? Having 3 secretaries defend, well; this is not about bureaucracy; it is Politics to be conducted by elected folks and by the President. He is missing here and that is shame to him.

Obama, speak, speak and defend here.

Ezra - regardless of all bad criticism here and everywhere, you are doing good; keep pointing out fallacies in the attack on ACA. Time will come when you will have good dressing down of Megan Arguments too. She is still stealing the 'game' on Right.

Posted by: umesh409 | January 6, 2011 12:13 PM | Report abuse

Ezra, any thoughts as to why only 8,000 people so far have joined the high risk pools, with fewer than 100 in 29 states?

http://www.insure.com/articles/healthinsurance/health-insurance-pool-enrollment.html

Posted by: justin84 | January 6, 2011 12:21 PM | Report abuse

Is the GOP really going with "the Job-Killing Health Care Law Act" as the name of the bill?

The makes me smile and sad at the same time.

@Chris_Gaun
chrisgaun@gmail.com

Posted by: chrisgaun | January 6, 2011 12:24 PM | Report abuse

--*Rep. Anthony Wiener is pushing an amendment that to the repeal legislation that would say no such legislation could pass unless it was deficit neutral.*--

I wonder what impact abolishing Medicare would have on the deficit.

Posted by: msoja | January 6, 2011 12:25 PM | Report abuse

"And even though premiums would be lower, many people buying coverage on their own would still end up paying more for their policies, because they would not benefit from the enormous subsidies that the Affordable Care Act makes available."

What enormous subsidies? I make about $80k a year and my subsidy isn't a red cent.

Posted by: krazen1211 | January 6, 2011 12:30 PM | Report abuse

"So, Republicans still have the same plans as they did when Bush was in office -- borrow and spend trillions and trillions of dollars, forget they borrowed it, forget they spent it, and then blame the Democrats."

You just described 2009 and 2010, only you got a few words flipped. Try again.

Posted by: krazen1211 | January 6, 2011 12:32 PM | Report abuse

"What enormous subsidies? I make about $80k a year and my subsidy isn't a red cent."

Krazen,

It actually is (quite a few) "red" cents, in that you're expected to pay the subsidies for others.

Posted by: justin84 | January 6, 2011 12:41 PM | Report abuse

Obama promised me a lot of things with his 'Yes we can!" ragain control of DC. Instead, he lied about everything! His real intent seems to be to become 'Chief Ruler of the New World'; one that includes the US only as a source of stuff to provide for the rest of the world. We have a lot of problems; here are a few of them:


Ken Huber from Tawas City, MI letter to Newspaper

Editor:
Has American become the land of the special interest and home of the double standard?

Let's see: if we lie to the Congress, it's a felony and if the Congress lies to us its just politics; if we dislike a black person, we're racist and if a black dislikes whites it's their 1st Amendment right; the government spends millions to rehabilitate criminals and they do almost nothing fr the victims; in public schools you can teach that homosexuality is OK but you better not use the word God in the process.

You can kill an unborn child, but it is wrong to execute a mass murderer; we don't burn books in America, we now rewrite them; we got rid of the communist and the socialist threat by renaming the progressives; we are unable to close our border with Mexico, but have no problem protecting the 38th parallel in Korea;

If you protest against President Obama's policies you're a terrorist, but if you burned an American Flag or George Bush in effigy it was your 1st Amendment right. You can have pornography on TV or the Internet, but you better not put a nativity scene in a public park during Christmas; we have eliminated all criminals in America, they are now called sick people; we can use human fetus in medical research, but it's wrong to use an animal.

We take money from those who work hard for it and give it to those who don't want to work; we all support the Constitution, but only when it supports our political ideology; we still have freedom of speech, but only if we are being politically correct; parenting has been replaced with Ritalin and video games; the land of opportunity is now the land of handouts; the similarity between Hurrican Katrina and the gulf oil spill is that neither president did anything to help.

And how do we handle a major crisis today? The government appoints a committee to determine who's at fault, then threatens them, passes a law, raises our taxes, tells us the problem is solved so they can get back to their reelection campaign.

What has happened to the land of the free and the home of the brave?

Posted by: bailey50 | January 6, 2011 12:49 PM | Report abuse

You are wasting your and our time writing with this health care repeal nonsense. It's not going to happen, it's literally impossible for the GOP to over turn it, so why write about it? Seriously, for someone who calls himself a policy wonk, you spent a lot of time being a political hack.

Posted by: 31otter | January 6, 2011 12:54 PM | Report abuse

Ezra,

If you're so passionate about the deficit, then why aren't you calling for a retention of the PPACA tax increases and spending cuts, and elimination of the expenditures?

For many years Social Security and Medicare ran surpluses. In the coming decades, the projected deficits will dwarf any past surpluses. Do you expect us to believe that PPACA will be any different?

Posted by: ElGipper | January 6, 2011 12:58 PM | Report abuse

As an aside, is there a dumber human being working for a major publication than Veronique de Rugy? I'm sure you've seen her condescending piece of total idiocy here but damn: http://www.nationalreview.com/corner/256474/re-no-ezra-klein-obamacare-will-not-reduce-deficit-veronique-de-rugy

It's an amazing example of the conservative determination to view the deficit solely in terms of outlays rather than revenues. It doesn't appear to even occur to de Rugy to consider the possibility that, shockingly, Obamacare might decrease the deficit by increasing government revenues.

Posted by: DanielGatti | January 6, 2011 12:58 PM | Report abuse

Repealing the hc reform law also puts real small businesses at a disadvantage again. One problem small business owners have is attracting and maintaining good employees. Many times bigger organizations can offer a better benefits packages like health insurance that small businesses can't. HC reform actually makes small businesses competitive - and that's where the real job growth is going to come from.

Boehner and Cantors act is all stagecraft and no substance - they're parroting nouns, verbs, and "job-killing" - yet I haven't heard one idea from them on creating jobs.

Posted by: notfooledbydistractions1 | January 6, 2011 1:08 PM | Report abuse

WorkorStarve wrote: "I'm guessing your mommy's lesbian lover told you one too many bedtime stories."

Ezra, if you read the Comments section, thank you for not shooting yourself in despair over the cretins lurking here. Keep up the great work.

Posted by: Fishpeddler | January 6, 2011 1:38 PM | Report abuse

I wonder now what new lies the conservatives will dream up in response to this major ideological setback?

The CBO once again makes it CLEAR that the ACA is a major step in the right direction and that all naysayers (here and elsewhere) are just a bunch of misinformed and/or dishonest whiners.

Now that we've got ACCESS largely solved, we need to start solving the cost problems.

Posted by: lauren2010 | January 6, 2011 2:08 PM | Report abuse

@msoja:
"I wonder what impact abolishing Medicare would have on the deficit."

It would probably add $10-20 trillion to the deficit over the next 30-40 years, depending on how you did it.

Not sure how that is topical.

Posted by: eggnogfool | January 6, 2011 2:21 PM | Report abuse

--*It would probably add $10-20 trillion to the deficit over the next 30-40 years*--

How so?

Posted by: msoja | January 6, 2011 2:38 PM | Report abuse

Mr. Klein,

Why do you continue to hold that the health care reform bill reduces the deficit when you've admitted in correspondence with Rep. Paul Ryan that the score is unrealistic.

Related expenses (doc fix, use of trust fund accounting techniques) were removed while unrelated revenues (biofuel tax revision, 2.3% investments tax) were included.

The CBO even issued a follow up to the original score to note that, with the related expenses considered, the bill would add to the deficit.

The House knew this. They passed the bill with a doc fix before learning it passed the magic $1 trillion figure that might trigger an even greater PR debacle for the bill. They removed the related expenses and put them into another bill. And then added more unrelated revenues. In fact, they gamed the score so much that in the end they had enough left over education loan reform too.

Mr. Klein, you're a bright individual. You don't need to resort to lies. The health care reform bill does not pay for itself, it adds to the deficit. And thus it's repeal does not add to the deficit it cuts it.

Posted by: cprferry | January 6, 2011 2:40 PM | Report abuse

"On the basis of
those cuts in payment rates and the existing “sustainable growth rate”
mechanism that governs Medicare’s payments to physicians, CBO projects
that Medicare spending (per beneficiary, adjusted for overall inflation) will
increase significantly more slowly during the next two decades than it has
increased during the past two decades. If those provisions would have
subsequently been modified or implemented incompletely, then the
budgetary effects of repealing PPACA and the relevant provisions of the
Reconciliation Act could be quite different—but CBO cannot forecast
future changes in law or assume such changes in its estimates."

Translation: Without the PPACA's false claims of cutting payment rates then repealing PPACA would cut the deficit.

Posted by: cprferry | January 6, 2011 2:45 PM | Report abuse

http://www.washingtonpost.com/wp-dyn/content/article/2011/01/06/AR2011010603628.html


The Pentagon will have to cut spending by $78 billion over the next five years, Defense Secretary Robert M. Gates said Thursday, forcing the Army and Marine Corps to shrink the number of troops on active duty and eventually imposing the first freeze on military spending since the Sept. 11, 2001, attacks.

Here it comes, lefties. Enjoy.

Posted by: krazen1211 | January 6, 2011 2:48 PM | Report abuse

@msoja:

Lost revenue; we project to have on the order of $2.5 trillion in revenue from the Medicare program this decade alone, probably around $4 trillion in the 20s. It will be quite a while before a Medicare abolishment was able to start reducing spending. Probably not a significant effect for another 20 years.

Posted by: eggnogfool | January 6, 2011 2:48 PM | Report abuse

cprferry:

"They passed the bill with a doc fix before learning it passed the magic $1 trillion figure that might trigger an even greater PR debacle for the bill. They removed the related expenses and put them into another bill. And then added more unrelated revenues. In fact, they gamed the score so much that in the end they had enough left over education loan reform too."

The PPACA didn't create the "doc fix situation". pretending that doc fix issues are somehow the fault of PPACA is dishonest; why should the house have tried to mislead people into thinking the bill was worse than it actually was?

you can choose a no-doc fix baseline if you want, but then the intellectually honest comparison is to a PPACA with no doc fix. the more useful comparison is current healthcare system + doc fix vs. PPACA system + doc fix, but comparing current healthcare system (no fix) vs. PPACA + fix does nothing but mislead people.

Posted by: eggnogfool | January 6, 2011 2:56 PM | Report abuse

I'm just here to say I love Wiener.

Oh, and to those that think PPACA will add to the deficit because we'll never actually implement Medicare cost controls:

The long-term deficit is driven entirely by Medicare and Medicaid cost growth; everything else amounts to a rounding error. So if we'll never be able to implement those cost controls, we're screwed no matter what.

Posted by: mutterc | January 6, 2011 3:14 PM | Report abuse

"Lost revenue; we project to have on the order of $2.5 trillion in revenue from the Medicare program this decade alone, probably around $4 trillion in the 20s. It will be quite a while before a Medicare abolishment was able to start reducing spending. Probably not a significant effect for another 20 years."

Eggnogfool,

By "abolish Medicare", I think msoja refers to getting rid of both the spending and revenue portions immediately.

Posted by: justin84 | January 6, 2011 3:54 PM | Report abuse

"The long-term deficit is driven entirely by Medicare and Medicaid cost growth; everything else amounts to a rounding error. So if we'll never be able to implement those cost controls, we're screwed no matter what."

Repealing Medicaid is a 100% cost control.

Posted by: krazen1211 | January 6, 2011 3:54 PM | Report abuse

Hey Ezra, the 112th Congress will be working with real budget cutting and spending figures, not those imaginary numbers of you and your ideological buddies.

By trashing Obamacare they will immediately save money and make it possible to start work on real health care reform that will not be as hampered by The Law On Unintended Consequences.

Posted by: BlackGumTree | January 6, 2011 4:04 PM | Report abuse

Justin

I DARE the GOP to abolish medicare.

Posted by: lauren2010 | January 6, 2011 4:41 PM | Report abuse

"Repealing Medicaid is a 100% cost control."

So you'd let 10000s Americans die each year or lead debilitating painful lives to save a little money?

Posted by: lauren2010 | January 6, 2011 4:47 PM | Report abuse

"The PPACA didn't create the "doc fix situation". pretending that doc fix issues are somehow the fault of PPACA is dishonest; why should the house have tried to mislead people into thinking the bill was worse than it actually was?

you can choose a no-doc fix baseline if you want, but then the intellectually honest comparison is to a PPACA with no doc fix. the more useful comparison is current healthcare system + doc fix vs. PPACA system + doc fix, but comparing current healthcare system (no fix) vs. PPACA + fix does nothing but mislead people.

Posted by: eggnogfool"

The House originally included the doc fix in the bill. Because they realized it was a related expenditure and a necessary component of health care reform. However, their score was not politically popular. They then went back and removed the doc fix from the bill and added extra revenues to make it look better.

Removing related expenditures and adding unrelated revenues is misleading! It's dishonest to say that PPACA reduces the deficit. The score was gamed to say it can.

It was a callous political decision to mislead the public to the cost of the bill.

Posted by: cprferry | January 6, 2011 7:19 PM | Report abuse

@Justin84:

If defaulting on debt is considered a legit approach to dealing with the deficit then we have no deficit issue, and the whole discussion is moot.

@cprferry:

You mean a 'callous decision to accurately communicate the price of the bill'.

Posted by: eggnogfool | January 6, 2011 8:13 PM | Report abuse

Cprferry

ACA could indeed have included the doc fix, and it would indeed have looked worse.

But ACA could also have then added further enhancements and fixes that significantly reduced cost.

No matter your spin, ACA, is a major step forward to providing access to most AMericans. And now that we are done doing this, we can start solving cost problems.

Pretending that adding doc fix to ACA would be a more honest accounting is itself misleading.

Posted by: lauren2010 | January 6, 2011 8:40 PM | Report abuse

Lauren2010,

The inclusion of doc fix would have been more honest. So too would the removal of biofuel tax revision, investment taxes and trust fund accounting procedures that also obscure the true cost of the reform. The doc fix was already part of the House bill before it came under political fire. THE ONLY REASON WHY IT WAS REMOVED WAS TO GAME THE SCORE FOR POLITICAL REASONS!! That's quite clear in the changes the House made.

Furthermore I reject your claim that better access itself provides credibility to PPACA. The bill in fact doesn't even cover 100% access. There were were many proposals that also claimed to provide better than present and even equal access than PPACA without resulting to its deception and coercion.

Posted by: cprferry | January 6, 2011 11:29 PM | Report abuse

Companies will be barred from instituting caps on coverage when your costs for treatments goes up due to sickness, you can now get insurance with out caps on coverage at "Wise Health Insurance" search them online.

Posted by: keithrybicki | January 7, 2011 2:32 AM | Report abuse

Only an idiot would say that having access for 32 million more people is not a success.

It's really simple people.

Health care reform is about precisely IWO issues: access and cost. When you solve one of those issues that means you are half way home to solving the entire problem.

And with ACA, we solve access AND the reforms included within ACA are conducive to building new reforms to solve the cost issue as well.

There are no good arguments here for repeal of ACA. Just a bunch of cry babies feeling sorry for themselves. You losers should get over your SECRET issues about why you truly support these GOP nihilists and saboteurs.

Posted by: lauren2010 | January 7, 2011 7:18 AM | Report abuse

The predictions from the Government are based on Models which do not reflect reality. For example, let's look at the Mortage Default Prevention Model that suggested Millions upon Millions of Home Owners would be saved from Default with this program. The reality: 80,000 +/-. So then, I say simply apply a constant of a "success factor" as a correction to any Government Projection. Which means that we're looking at 4% of what the $230B is about $10B. So for me, it is the further reduction in this $10B that should be looked to as the actual reduction. For otherwise I fear that the Government is going to say that this program will next pay for itself, for 10 years, as a result of the reductions made (being that $10B actual - $120B GOP Reduction results in a negative actual cost of $110B)! And God Forbid this type of thinking picks up as a form of reducing our Debt !?!

Posted by: jralger | January 7, 2011 8:25 AM | Report abuse

Lauren 2010,

Again you're suggesting that PPACA is the best based on its incremental gains and without analysis of alternative proposals.

There is not one intellectually honest report out there that suggests that medical spending will decrease. In fact, the individual mandate for comprehensive insurance is expected to increase medical spending and cause long wait lines for an industry that is already refusing to deal with government medical payments.

Posted by: cprferry | January 7, 2011 11:02 AM | Report abuse

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