The Congressional Budget Office’s (CBO) projections concerning possible deficit reductions found in the ACA are continually under fire from opponents of the act. The projections are said to be grossly inaccurate, excluding pertinent expenses and assuming actions that have a pattern of deferment. For example, while the CBO states that there will be a net deficit reduction of $124 billion in the first 10 years after the passing of the reform--due to the ACA--the revised numbers presented in the Holtz-Eakin & Ramlet (HE&R) article assert that there will actually be an increase in the deficit by an additional $554 billion over the same period of time. A large percentage of this disparity is represented in what HE&R considered to be invalid assumptions. Most of these assumptions were invalidated because of their dependence on congressional action.
The politics of Congress, wrote HE&R, will stifle the implementation of cost saving measures. Prior legislative action is replete with evidence to support this stance, but two key examples come to mind most readily. First, Congress has overridden the “sustainable growth rate” formula, which would lower Medicare payment to physicians, every year since 2002. Second, Congress already gave in to labor lobbies by pushing back an ACA excise tax on high-premium health plans.
The political hurdles to overcome don’t end when Congress has relented to lobbies and public interest groups. The very constitutionality of a portion of the ACA, the individual mandate, is being scrutinized. Under such scrutiny there is virtually no chance that Congress, the IRS, or any other authority will seek to enforce the penalties tied to this mandate. By not levying these “penalties” the CBO net deficit reduction amount is diminished even further. If the mandate is removed from the act, then spending will outpace the projections of even the harshest of the ACA’s critics. Many of those in the low-risk pool will, as they have been, continue to choose to be uninsured, and Medicaid will be extended to a larger group of people that may be in the high-risk pools.
Finally, an appeal to common sense must be made. Does it really seem plausible that the roll-out of a federal program of the magnitude of the ACA will decrease government spending? Has a large, mandatory entitlement program ever meant decreased spending? In all likelihood the answer must be, no. Myriad projections can be published, but, if left in its current state, this ACA will inevitably contribute more expense to the staggering deficit. Too many of our countries initiatives are focused on the long-term, or from a politician’s perspective, during some else’s term. Too often our leaders point to the future to distract from the present. If this legislation is going to work, then someone needs to make bold, unpopular decisions that will reduce the hemorrhaging of tax payer dollars. Otherwise it may very well be that healthcare, ironically, bleeds the US out.
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