In preparing the March 2012 baseline budget projections, CBO and the staff of the Joint Committee on Taxation (JCT) have updated estimates of the budgetary effects of the health insurance coverage provisions of the Affordable Care Act (ACA)—the health care legislation enacted in March 2010. Those provisions:
The most recent previous estimate of those effects was prepared in March 2011. For more details on the insurance coverage provisions of the ACA, you can see CBO’s cost estimate for the health care legislation, which was issued in March 2010.
CBO and JCT now estimate that the insurance coverage provisions of the ACA will have a net cost of just under $1.1 trillion over the 2012-2021 period-about $50 billion less than the agencies' March 2011 estimate for that 10-year period. (For comparison with previous estimates, these numbers cover the 2012-2021 period; estimates including 2022 can be found below.)
The net costs--specifically the combined effects on federal revenues and mandatory spending--reflect:
Those amounts do not encompass all of the budgetary impacts of the ACA. They do not include federal administrative costs, which will be subject to future appropriation action. Also, they do not include the effects of the many other provisions of the law, including some that will cause significant reductions in Medicare spending relative to that under prior law and others that will generate added tax revenues relative those under prior law.
CBO and JCT have previously estimated that the ACA will, on net, reduce budget deficits over the 2012-2021 period; that estimate of the overall budgetary impact of the ACA has not been updated.
The current estimate of the gross costs of the coverage provisions—$1,496 billion through 2021—is about $50 billion higher than last year's projection; however, the other budgetary effects of those provisions, which partially offset those gross costs, also have increased in CBO’s and JCT’s estimates—to $413 billion—leading to the small decrease in the net 10-year tally.
Over the 10-year period from 2012 through 2021, enactment of the coverage provisions of the ACA was projected last March to increase federal deficits by $1,131 billion, whereas the March 2012 estimate indicates that those provisions will increase deficits by $1,083 billion.
The net cost was boosted by:
But those increases were more than offset by a reduction of:
The major sources for the differences between the March 2011 and March 2012 projections are the following:
CBO and JCT's projections of health insurance coverage have changed since last March. Fewer people are now expected to obtain health insurance coverage from their employer or in insurance exchanges; more are now expected to obtain coverage from Medicaid or CHIP or from nongroup or other sources. More are expected to be uninsured. The extent of the change in insurance coverage varies from year to year.
Compared with prior law, the ACA is now estimated by CBO and JCT to reduce the number of nonelderly people without health insurance coverage by 30 million to 33 million in 2016 and subsequent years, leaving 26 million to 27 million nonelderly residents uninsured in those years (see Table 3 at the end of the report). The share of legal nonelderly residents with insurance is projected to rise from 82 percent in 2012 to 93 percent in 2016 and subsequent years. That share rose to 95 percent in CBO and JCT's previous estimate.
According to the current estimates, from 2016 on, between 20 million and 23 million people will receive coverage through the new insurance exchanges, and 16 million to 17 million additional people will be enrolled in Medicaid and CHIP as a result of ACA. Also, 3 million to 5 million fewer people will have coverage through an employer compared with the number under prior law
This report also presents estimates through fiscal year 2022, because the baseline projection period now extends through that additional year. The ACA’s provisions related to insurance coverage are now projected to have a net cost of $1,252 billion over the 2012-2022 period; that amount represents a gross cost to the federal government of $1,762 billion, offset in part by $510 billion in receipts and other budgetary effects (primarily revenues from penalties and other sources).
The addition of 2022 to the projection period has the effect of increasing the costs of the coverage provisions of the ACA relative to those projected in March 2011 for the 2012-2021 period because that change adds a year in which the expansion of eligibility for Medicaid and subsidies for health insurance purchased through the exchanges will be in effect. CBO and JCT have not estimated the budgetary effects in 2022 of the other provisions of the ACA; over the 2012-2021 period, those other provisions were previously estimated to reduce budget deficits.