Affordable Care Act

If current laws generally remained unchanged, large budget deficits would boost federal debt to unprecedented levels over the next 30 years, CBO projects.

CBO and JCT project that federal subsidies, taxes, and penalties associated with health insurance coverage for people under age 65 will result in a net subsidy from the federal government of $737 billion in 2019 and $1.3 trillion in 2029.

If current laws remain generally unchanged, CBO projects, federal budget deficits and debt would increase over the next 30 years—reaching the highest level of debt relative to GDP in the nation’s history by far.

CBO and JCT project that the federal subsidies, taxes, and penalties associated with health insurance coverage for people under age 65 will result in a net subsidy from the federal government of $685 billion in 2018.

This report assesses the accuracy of projections that CBO and JCT made in 2010 and 2013 of federal spending for people made newly eligible for Medicaid by the ACA and of subsidies for health insurance purchased through the ACA marketplaces.

CBO and the JCT estimate that, by itself, repealing the mandate would reduce federal deficits by about $338 billion over the 2018–2027 period and increase the number of uninsured people by 4 million in 2019 and 13 million in 2027.

CBO and the JCT estimate that enacting the legislation would reduce the deficit by $3.8 billion over the 2018–2027 period without substantially changing the number of people with health insurance coverage, on net.

Over the 2017-2026 period, CBO and JCT estimate, the legislation would reduce the on-budget deficit by at least $133 billion and result in millions fewer people with comprehensive health insurance that covers high-cost medical events.

CBO and JCT project that the federal subsidies, taxes, and penalties associated with health insurance coverage for people under age 65 will result in a net subsidy from the federal government of $705 billion in 2017.

CBO and the Joint Committee on Taxation estimated the effects on the federal budget, health insurance coverage, market stability, and premiums if payments for cost-sharing reductions would end after December 2017.

Medicaid spending under the Better Care Reconciliation Act of 2017 would be about 35 percent lower in 2036 compared with CBO’s extended baseline. Such spending under the bill would increase each year throughout the next two decades.

CBO reports on the estimated changes in health insurance coverage and premiums that would result from leaving the Affordable Care Act’s insurance market reforms in place while repealing the law’s mandate penalties and subsidies.

Premiums for private health insurance, which are high and rising, are affected by various federal subsidies and regulations. In 2016, the federal government will subsidize most premiums, at a cost of roughly $300 billion.

CBO and the staff of the Joint Committee on Taxation estimate that, over the next decade, a repeal of the Affordable Care Act would probably increase budget deficits with or without considering the effects of macroeconomic feedback.

Under the ACA, most legal residents must get health insurance or pay a penalty. CBO and JCT estimate that 30 million will be uninsured in 2016, but most will be exempt from the penalty; 4 million will make payments totaling $4 billion.