Congressional Budget Office

Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act Congressional Budget Office

Publisher Marketing: The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) have updated their estimates of the budgetary effects of the provisions of the Affordable Care Act (ACA) that relate to health insurance coverage. The new estimates, which are included in CBO's latest baseline projections, reflect CBO's most recent economic forecast, account for administrative actions taken and regulations issued through March 2014, and incorporate new data and various modeling updates. Relative to their previous projections, CBO and JCT now estimate that the ACA's coverage provisions will result in lower net costs to the federal government: The agencies now project a net cost of $36 billion for 2014, $5 billion less than the previous projection for the year; and $1,383 billion for the 2015-2024 period, $104 billion less than the previous projection. The estimated net costs for 2014 stem almost entirely from spending for subsidies that are to be provided through insurance exchanges (often called marketplaces) and from an increase in spending for Medicaid (see Table 1). For the 2015-2024 period, the projected net costs consist of the following: Gross costs of $1,839 billion for subsidies and related spending for insurance obtained through the exchanges, Medicaid, the Children's Health Insurance Program (CHIP), and tax credits for small employers; and A partial offset of $456 billion in receipts from penalty payments, additional revenues resulting from the excise tax on high-premium insurance plans, and the effects on income and payroll tax revenues and associated outlays arising from projected changes in employer coverage. Those estimates address only the insurance coverage pro-visions of the ACA, which do not generate all of the act's budgetary effects. Many other provisions, on net, are expected to reduce budget deficits. Considering all of the provisions including the coverage provisions CBO and JCT estimated in July 2012 (their most recent comprehensive estimate) that the ACA's overall effect would be to reduce federal deficits.3