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.