Can we get a CBO score on repealing health care reform?

Logically, there’s no difference between supporting the Affordable Care Act and opposing repeal. But rhetorically, there’s all the difference in the world.

According to the final CBO scores, the Affordable Care Act will reduce deficits by $138B in the first decade and by $1.2T in the second decade.  It logically follows that repealing ACA, as some wingnuts are demanding, would increase deficits by the same amounts.

I’d love to see Henry Waxman file a straight repeal bill and get a CBO score on it. Then every Democratic candidate in November whose Republican opponent is running on a repeal platform can honestly say “According to the Congressional Budget Office, my opponent’s proposal would add one point three trillion dollars to the national debt.  That’s ‘trillion,’ with a ‘t.’  Why does he want to leave our children and grandchildren saddled with that burden?”

As long as we’re arguing about whether the ACA was a good idea, the basic conservatism of the electorate (in the sense of reluctance to change, and greater willingness to believe bad news than good news)  will be a drag on us. But as soon as we start talking about maintaining the ACA vs. getting rid of it, that flips over.  After all, there’s a lot of motherhood and apple pie in the bill, and any proponent of straight repeal winds up being against a lot of stuff the voters are for and for a lot of stuff they’re against.

*  “Why do you want to legalize discrimination against sick children by health insurance companies?”

* “Why do you want to increase taxes on small businesses that provide health insurance for employees?”

* “Why do you want to charge seniors more for prescription drugs?”

* “Why do you want to cut loan funds for nursing students?”

* “Why do you want to cut Medicare reimbursement for rural doctors?”

Logically, there’s no difference between supporting ACA and opposing repeal.  Rhetorically, there’s all the difference in the world.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

7 thoughts on “Can we get a CBO score on repealing health care reform?”

  1. It's still not clear whether Mark understands that the law actually increases deficits, or whether he even cares. How odd that a solid majority of the American people understand this issue better than he does.

  2. Hey, no problemo, we'll cut the benefits four years before ending the tax, and promise to do other stuff to save money that everybody knows we're not really going to do, and it will all work out, since the CBO is legally required to work based on Congress's assumptions even if they know they're wrong.

  3. It wouldn't be unreasonable, though, to score repealing "health care reform", but not repealing the Medicare/Medicaid reimbursement changes; there's no necessary link between the mandate/subsidies/underwriting restrictions and lowering reimbursement for most doctors.

  4. Mark, I guess it's better to say that you believe accounting fictions to be true and meaningful, which is a foolish thing to do, and that most people are not quite so foolish.

    As for what Republicans should if faced with a Waxman request for a CBO score, I think they should be happy. Because the CBO never scored the 2nd ten years, and because any repeal would take effect prior to benefits coming on line and after taxes have been raised and collected, so the score would obviously be less than $138 billion. Republicans should simply promise to instead nationalize the higher education industry instead of the health care industry, and move the savings from there. (Assume the same revenues and write into law a unified budget declining 10% a year–think of the money that could be saved! Let's see the score!) It's more complicated than the straight repeal, but would really help the middle class. Or maybe adopt an even more generous long-term care program and require everyone to join–sure, we'd dramatically worsen the long-term fiscal situation, but in the short term we'd lower the deficit. Or maybe we could simply adopt different accounting standards–say, for example, require that Medicare taxes and Social Security taxes be counted only for those programs in years in which those programs have an actuarial deficit, so that the new Medicare and Social Security revenues would count only toward long-term deficits and not toward the unified budget. There are all sorts of ways to get to a score.

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