Dynamic Scoring Drops Obamacare Repeal Cost

Congressional Budget Office Director Keith Hall told House Budget Committee members Wednesday (June 3) that dynamic scoring, which predicts how policies change behaviors that in turn affect the economy, would likely reduce the cost of repealing the Affordable Care Act.

Republicans and Democrats sparred at the hearing over how CBO’s new interest in so-called dynamic scoring should be applied to health care proposals. Hall, who recently became CBO director, told Budget Committee members that his office plans to spend more resources looking at dynamic scoring and “analyzing the economic effects of health care proposals,” especially if the Obama administration loses King v. Burwell at the Supreme Court. (John Wilkerson, “CBO Director Says Dynamic Scoring Would Lower Cost Of ACA Repeal,” Inside Healthcare Policy, June 3, 2015)

Among other things, Mr. Hall is surely referring to two issues: The taxes on businesses (e.g. medical device excise tax, “Cadillac” tax on employer benefits, employer mandate to offer government-compliant benefits) and the taxes on individuals that cause them to work less (2.5 million fewer jobs, according to CBO).

CBO’s new commitment to dynamic scoring is good news. NCPA has a Tax Analysis Center that will bring dynamic scoring to our analysis of various reforms, including health reform


Comments (4)

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  1. John Bailey says:

    I would be interested in a discussion of why health care providers, especially hospitals, have very large nominal bills that are apparently not intended to be collected.

    • Me too. The simple answer is that Medicare and Medicaid and private insurers demand “most favored customer” clauses preventing provides from charging lower fees from self-paying patients.

      Insurers like the high chargemaster prices because many individuals believe that the insurer has negotiated a discount. It is a complete fantasy: There are many instances of direct-paying patients paying less than network rates, although often only after a lot of nonsensical paperwork.

  2. Bob Hertz says:

    Not sure that I understand the ‘most favored customer’ clause.

    If Medicare pays $5000 for a procedure, I can understand that Medicare might not want someone to be charged $4000.

    But that is not the problem. The problem is that HSA customers and the uninsured are charged $40,000 in some cases.

    Why would Medicare care at all if these persons were charged $5000?


    • Regulations with unintended consequences. Two sources:

      Pryor, Carol, and Robert Seifert (2003). Unintended Consequences: How Federal Regulations and Hospital Policies Can Leave Patients in Debt. New York, NY: The Commonwealth Fund.

      Wielawski, Irene (2000). Gouging the Medically Uninsured: A Tale of Two Bills. Health Affairs 19, 5: 180–85