A little footnote in a budget report generated a lot of attention.
The real reason CBO won’t re-score Obamacare
Paul Krawzak at Roll Call noticed a footnote in the Congressional Budget Office’s April update on Obamacare, which stated that CBO and the Joint Committee on Taxation “can no longer determine exactly how the provisions of the ACA that are not related to the expansion of health insurance coverage have affected their projections of direct spending and revenues.”
In other words, Congress’s official scorekeeper is no longer going to estimate Obamacare’s total cost.
Twitter, predictably, exploded:
Total cost of the Affordable Care Act? CBO's given up measuring it http://t.co/AT7401EpDW #Obamacare
— Steven Dennis (@StevenTDennis) June 4, 2014 More fabulous Obamacare news! RT "CBO Can No Longer Assess the Fiscal Impact of Health Care Law" http://t.co/bHCsA6HlHl via @rollcall
— Monica Crowley (@MonicaCrowley) June 4, 2014 CBO says ObamaCare’s economic impact is immeasurable beause of delays to implementation. http://t.co/Ukd6i6YDPE
— Rep. Todd Rokita (@ToddRokita) June 6, 2014 "Don't worry" they said. "Obamacare will reduce the deficit" they said. http://t.co/kHW2z1T5yb
— Kevin Eder (@keder) June 4, 2014 But here’s the thing: it’s not weird that the CBO won’t re-score Obamacare in its entirety. It would actually contradict historical precedent if the agency did.
“I find the brouhaha over them no longer scoring the ACA to be puzzling,” said Peter Orszag, who served as CBO director from 2007 through 2008 and then as Obama’s budget director from 2009-2010. “As a general practice, they don’t do ex-post scoring; they score beforehand. What’s unusual in this case is not that they stopped scoring — but that they did a bunch ex-post scoring in the first place.”
Loren Adler, Research Director at the Committee for a Responsible Federal Budget, agrees. “We talked through the question here at CRFB, and none of us can even think of a law that interacts with different parts of the budget that has ever been re-scored in its entirety after implementation,” he said.
As an example, Adler points to Medicare’s prescription drug program, which passed into law in 2003. “Part D is the most comparable recent example; they haven’t re-scored the entire law since implementation,” Adler said. “They’ve re-estimated how much the new coverage cost, but never re-estimated the large reduction it caused in Medicaid spending.”
There’s a reason CBO doesn’t fiddle around with ex-post scoring: the numbers get much harder to tease out once a new policy is set in motion.
"The question CBO is trying to answer is 'What is the marginal effect of this policy?' And to answer that, you have to ask 'What would the world look like without this policy?'" Orszag explained. "That's easy to do before the legislation is enacted, because that is the world. It's a lot harder after the legislation has been enacted and starts getting entangled with other things, and it becomes increasingly difficult as more time elapses."
Orszag adds that it’s not sensible to draw conclusions about Obamacare’s bottom line from CBO’s decision not to re-score the full law. “I saw some commentary that it suggests that somehow the effects may have changed or maybe the sign of the estimated impact is different. That’s not at all what CBO said. They said that they can no longer reliably estimate it, because the world has changed.”
Update: On June 17, the CBO issued an official response on why they won’t comprehensively re-score the Affordable Care Act. You can read that in full here.
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