H.R. 849 would repeal the provisions of the Affordable Care Act (ACA) that established the Independent Payment Advisory Board (IPAB) and that created a process by which the Board (or the Secretary of the Department of Health and Human Services) would be required under certain circumstances to modify the Medicare program to achieve specified savings.
CBO estimates that enacting H.R. 849 would increase direct spending by $17.5 billion over the 2018-2027 period. That estimate is extremely uncertain because it is not clear whether the mechanism for spending reductions under the IPAB authority will be invoked under current law for most of the next ten years. Under CBO’s current baseline projections such authority is projected to be invoked in 2023, 2025, and 2027. However, given the uncertainty that surrounds those projections, it is possible that such authority would be invoked in other years. Taking into account that possibility, CBO estimates that repealing the IPAB provision of the ACA would probably result in higher spending for the Medicare program over the 2022 through 2027 period than would occur under current law. CBO’s estimate represents the expected value of a broad range of possible effects from repealing IPAB provisions.
Pay-as-you-go procedures apply because enacting the legislation would affect direct spending. Enacting the bill would not affect revenues.
CBO estimates that enacting H.R. 849 would increase net direct spending and on-budget deficits by more than $5 billion in one or more of the four consecutive 10-year periods beginning in 2028.
H.R. 849 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act.