CBO’s overlooked caution: ‘ObamaCare’ impact on deficit ‘highly uncertain’

I don’t think anyone in this town believes that repealing ObamaCare is going to increase the deficit.

— John Boehner, speaker of the House, Jan. 6, 2011, at his first press conference as speaker.

The Congressional Budget Office, in response to a request from John Boehner, opined Tuesday in a letter to the speaker that GOP-sought repeal of the Affordable Care Act would increase the nation’s federal spending deficit, adding $109 billion from 2013-2022.

And, as might be expected following the release of the CBO’s letter, partisan voices are either assailing the nonpartisan CBO estimate as illusory or using it as a cudgel against the health care law’s opponents.

Virtually all miss the nuances of the CBO’s letter regarding the fiscal impact of H.R. 6079, the Repeal of Obamacare Act. No one really knows if the deficit will increase or decrease whether the ACA survives or is repealed.

The CBO’s letter notes that all deficit estimates of the act, whether alive or dead, are in fact estimates. Says the CBO:

Why Are These Estimates Uncertain?

Projections of the budgetary impact of H.R. 6079 are quite uncertain because they are based, in large part, on projections of the effects of the ACA, which are themselves highly uncertain. Assessing the effects of making broad changes in the nation’s health care and health insurance systems requires estimates of a broad array of technical, behavioral, and economic factors. Separating the incremental effects of the provisions in the ACA that affect spending for ongoing programs and revenue streams becomes more uncertain as the time since enactment grows. The recent Supreme Court decision that essentially made the expansion of the Medicaid program a state option has also increased the uncertainty of the estimates. However, CBO and JCT, in consultation with outside experts, have devoted a great deal of care and effort to the analysis of health care legislation in the past few years, and the agencies have strived to develop estimates that are in the middle of the distribution of possible outcomes. [emphasis added]

If your support of or opposition to the ACA rests largely in its overall fiscal impact on the federal budget, that support or opposition is based on … well, budgetary guesstimates. No one really knows.

The press did not pick up on the uncertainty, either. Neither a New York Times story or a Washington Post piece on fiscal consequences of ACA repeal contained a single sentence noting the CBO’s emphasis on uncertainty.

Perhaps your support or opposition should rest in other, more personal, even selfish concerns:

• Do you have health insurance?

• What do you pay for it?

• Do you have a pre-existing condition?

• Do you have access to the the care you need?

• What out-of-pocket costs do you shoulder?

Yes, you may have questions about the Supreme Court’s support of the individual mandate as a tax. You may believe being required to buy health insurance is unethical and constitutional. You may believe that the government is too large, that its embrace of tens of millions without health insurance is government grown well beyond its Constitutional functions and limitations.

Fine. Just don’t base your support or opposition on whether the ACA — or its repeal — will affect the federal deficit up or down. Because no one knows.

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