In March 2010, the Congress passed and the President signed into law legislation that
makes major changes to the U.S. health care and health insurance systems. That legislation
came in two parts: the Patient Protection and Affordable Care Act and the Health Care and
Education Reconciliation Act of 2010. Among other things, those laws will establish a mandate
for most legal residents of the United States to obtain health insurance; create insurance
exchanges through which certain individuals and families will receive federal subsidies; significantly
expand eligibility for Medicaid; reduce the growth of Medicare’s payment rates for
most services; impose an excise tax on insurance plans with relatively high premiums; impose
certain taxes on individuals and families with relatively high incomes; and make various other
changes to the federal tax code, Medicare, Medicaid, and other programs. (In addition, the
Reconciliation Act substantially alters federal programs governing loans and grants for postsecondary
education.)
In the course of the deliberations over health care legislation, the Congressional Budget
Office (CBO) provided a wide variety of estimates and other analyses regarding the impact of
proposals on the federal budget and on aspects of health care and health insurance that were
of interest to policymakers. In many cases, those estimates and analyses were produced in collaboration
with the staff of the Joint Committee on Taxation (JCT). That process began in
early 2009 and continued past the enactment of the legislation in March of this year.
Responding to many requests, this report compiles a set of those estimates and analyses for
easy reference. The report begins with the cost estimate for the final legislation and several
analyses related to that legislation. It also includes several cost estimates and analyses of earlier
versions of that legislation and alternative proposals that were considered in the House and
Senate before final passage. In addition, this report brings together analyses that CBO issued
during this period concerning insurance premiums and premium subsidies, the budgetary
accounting of proposals, changes to the medical malpractice system, and certain related topics
that arose during the Congressional debate. A number of related cost estimates and publications
are not included in this volume but are available on CBO’s Web site. In keeping
with CBO’s mandate to provide objective, nonpartisan analysis, this report makes no
recommendations.
