Days before the Congressional Budget Office (CBO) released its revised figures for the Affordable Care Act (ACA, or the health care act), the spin had already started. Depending on what you read, your take was either that we were approaching the end of the world wherein President Obama and the Supreme Court (SCOTUS) had bankrupted us or that this was the best thing that could ever happen to us.
The truth is that neither view is correct. The June 28, 2012, SCOTUS ruling didn’t change the financial numbers significantly one way or the other.
The estimated cost of the insurance coverage provisions of the ACA is now estimated to cost $1,168 billion, down from $1,252 billion. That’s a difference of $84 billion which feels like a lot of money. It is. A lot of zeroes. It looks like this:
$84,000,000,000
But a little context is needed. Our deficit currently perched at $1.4 trillion. Even more zeroes. It looks like this:
$1,400,000,000,000
While chipping away at the deficit is important, the drop is a mere 6%. Our debt is growing faster than that.
Even more dramatic: the net drop is over 11 years. And let’s be honest: who among us genuinely believes that this legislation is going to remain in place – as is – for 11 more years?
I don’t want to downplay the importance of the drop. Less spending is better than more, absolutely. So ultimately, it’s a good thing for the federal budget.
It is, however, important to consider where we’re getting those savings. The SCOTUS decision to allow states to choose whether to expand eligibility for Medicaid coverage means that fewer people will be covered and thus, more people will be uninsured; estimates are that about 3 million more people will be uninsured. So federal Medicaid spending will decrease – less coverage – but the numbers of folks without coverage will rise, which means that there will be a cost. It’s just not showing up on paper: what that will cost our families and communities hasn’t been measured in terms of real dollars.
We like to frame issues in terms of dollars because it feels like it’s easier to understand. We like charts and graphs. “More” and “less” are terms we get. So I expect a lot to be made out of this $84 billion figure.
What’s interesting to me, though, is that the healthcare debate has actually focused on a lot of issues that aren’t strictly spending oriented (the “tax” issue aside) – like states’ rights, religious freedoms, abortion, government control, personal responsibility and burdens on employers. Those things are a bit more difficult to plot on a graph.
So, where do we go from here? Lots of posturing and arguing, I suspect. Beyond that, I don’t think this cost revision will mean much in the grand scheme of the debate. That won’t, however, keep us from talking about it. So I put the question to you: what next?
