Alliance for Health Reform: Briefing

July 31, 2009

G. William Hoagland

VP Public Policy, CIGNA

Show Me the Money!

Congressional Budget Totals: FY 2008 – 2014S. Con. Res. 13

(In Billions of Dollars – % of GDP)

2008 2009 2010 2011 2012 2013 2014% ∆ annual

2008-2014

• Receipts 2,524 2,186 2,322 2,624 2,856 3,057 3,298 + 4.6 %

• Spending 2,983 3,879 3,555 3,541 3,476 3,639 3,821 + 4.2 %

• Deficits

• % of GDP

459

3.2%

1,693

12.0%

1,233

8.5%

916

6.1%

620

3.9%

581

3.5%

523

3.0%

NA

NA

• Public Debt

• % GDP

• Debt Subject to Limit

• % GDP

5,803

41%

9,986

70%

7,723

55%

12,016

85%

8,778

61%

13,233

92%

9,683

64%

14,349

95%

10,345

66%

15,277

97%

10,931

66%

16,160

98%

11,499

67%

17,022

99%

+ 12.1%

+ 9.3%

Source: Concurrent Resolution on the Budget for FY 2010, S.Con.Res. 13 . April 29, 2009.

Congressional Budget Office, A Preliminary Analysis of the President’s Budget and an Update of CBO’s Economic Outlook. March 2009.

Concurrent Resolution on the Budget FY 2010 Health Care Reserve Funds

U. S. House of Representatives: Passed April 29 – 233 to 193U.S. Senate: Passed April 29 – 53 to 43.

Subtitle A – Senate Reserve Funds

• Sec. 301: Deficit-Neutral Reserve Fund to Transform and Modernize America’s Health Care System. “The Chairman of the Committee on the Budget may revise allocations…aggregates…limits in this resolution ….provided such legislation would not increase the deficit over either the period of the total of fiscal years 2009 through 2014 or the period of the total of the fiscal years 2009 through 2019.”

Subtitle B – House Reserve Funds

• Sec. 321: Deficit-Neutral Reserve Fund for Health Care Reform. “The Chairman of the House Committee on the Budget may revise allocations …aggregates…levels in this resolution …if such measure would not increase the deficit or decrease the surplus for either time period provided in clause 10 of rule XXI of the Rules of the House of Represenatives.”

(Clause 10, Rule 21 = Pay-Go)

Title III – Reserve Funds

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

$5,000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Year

$ in

Bill

ions

National Health Expenditure AmountsCumulative Federal Costs for Medicare and Medicaid

2008-2019

2019Cumulative FederalMedicare/MedicaidEstimate$1,223B

2019Total NationalHealth ExpenditureAmounts Estimate$4,643B

Federal Medicaid

Federal Medicare

Other Public/PrivateExpenditures

$2,379B$2,379B

$586B$586B

$3,311B$3,311B

$900B$900B

House of Representatives Senate

(H.R. 3200)2010–2019

(H.R. 3200) 2019

HELP2010–2019

HELP2019 Finance

Coverage Impact Exchange Subsidies +773 +160 +723 +140 ? Employee Payments/Net Subsidies -208 -51 -52 -9 ?

Payments by Uninsured Individuals -29 -5 -36 -7 ? Medicaid/CHIP +438 +84 -36 (+500)* -4 (+100)* ?

Small Business Tax Credits +53 +10 +56 +8 ? Associated Tax Revenues -15 +4 -10 -5 ? Class Act/Reinsurance – - -48 -3 ? Net Coverage Impact +1,042 +202 +597 (+1,097)* +120 (+220) ?Change in Other Programs/Provisions Medicare Advantage -162 -27 –* –* ? SGR Reform +228 +38 – – ? Part A & B Market Basket/Home Health/etc. -282 -56 – – ? Waste/Fraud/Abuse ** 0 – – ? Other -3 -6 – – ?Net Change in Other Programs -219 -51 –* –* ?Change in Revenues +583 +86 –* –* ? Deficit Impact +239 +65 +597 (+1,097)* +120 (+220) ?

* = Committee has no jurisdiction over Medicaid, Medicare or tax policy. However, policy assumption expressed is to expand Medicaid eligibility to 150% Federal Poverty Level. Numbers in ( ) reflect this policy.

** = Less than $100 million.

Sources: CBO July 17 letter to Chairman Charles Rangel. CBO July 1 Table to HELP Committee members. G. William Hoagland author’s aggregation.

Preliminary Estimates of Health Care Reformon the Federal Deficit: FY 2010 – 2019

(In Billions of Dollars)

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