This is what they left out according the Paul Ryan.
Misleading arguments about its true deficit impact exclude the $115 billion needed to implement the law...
The vast majority of those appropriations don't disappear if the ACA goes away. The CBO addressed this in its analysis of the repeal bill:
In addition, H.R. 2 would repeal a number of authorizations for future appropriations, which, if left in place, might or might not result in additional appropriations. CBO estimated that such provisions authorizing specific amounts, if fully funded, would result in appropriations of $106 billion over the 20102019 period. However, most of those authorizations, for more than $86 billion, were for activities that were already being carried out under prior law or that were previously authorized and that PPACA authorized for future years; for example, that amount includes an estimated $39 billion for ongoing activities of the Indian Health Service and $34 billion for continued grants to federally qualified health centers. Consequently, just as the authorizations in PPACA of an estimated $106 billion over the 20102019 period will not necessarily lead to an increase of that amount in total discretionary spending, the repeal of those PPACA authorizations would not necessarily result in discretionary savings of that amount.
I missed it, did Paul Ryan also promise to defund all other previously existing federal health programs unrelated to the ACA, like the Indian Health Service?
and over $500 billion in double-counting Social Security payroll taxes, CLASS Act premiums, and Medicare reductions.
The "double counting" charge concerns
rhetoric implying that savings in Medicare are being pumped back into Medicare. That doesn't change the fact that the legislation itself finds cost offsets to cover its new spending.
The odd part of this suggestion is that it ignores the fact that the law's primary funding mechanism, an excise tax on high-cost insurance plans, doesn't take effect until 2018. And it ignores the much more important point that the law's fiscal balance only gets better with time. Your implication is that in the second decade (i.e. past the 10-year budget window in which it was evaluated) the wheels come off but in fact the opposite is true: revenues grow faster than spending. As the CBO points out:
Last March, CBO estimated that enacting PPACA and the Reconciliation Act would reduce federal deficits in the decade after 2019, with a total effect during that decade in a broad range around one-half percent of gross domestic product (GDP). The imprecision of the calculation reflects the even greater degree of uncertainty that attends to it, compared with CBOs 10-year estimates. Correspondingly, CBO estimates that enacting H.R. 2 [the repeal bill] would increase federal deficits in the decade after 2019 by an amount that is in a broad range around one-half percent of GDP, plus or minus the effects of technical and economic changes that CBO and JCT will include in the forthcoming estimate. For the decade beginning after 2021, the effect of H.R. 2 on federal deficits as a share of the economy would probably be somewhat larger.
They make a similar point in discussing the repeal bill effect on the federal budgetary commitment to health care. They point out that the ACA increases the federal budgetary commitment over the first decade. However:
In contrast, CBO estimated that enacting that legislation [the ACA] would reduce the federal budgetary commitment to health care during the decade after 2019. The impact in the second decade was estimated to be different than that in the first decade because the effects of those provisions that would tend to decrease the federal budgetary commitment to health care would grow faster than the effects of provisions that would tend to increase it. Correspondingly, by repealing all of those provisions, H.R. 2 [the repeal bill] would roughly reverse those outcomes, thereby diminishing the federal budgetary commitment to healthcare over the next decade and increasing it in subsequent years.
They also left out the 200 Billion doctor fix. They put that on a seperate bill so it wouldn't adversly effect the outcome.
I'm confused by this one. Are you suggesting that if the ACA is repealed an SGR fix won't be needed? That money won't be spent?
If your answer to those questions is no, then what does that have to do with the balance between ACA's revenues and spending? That's about as honest as implying we'll stop funding the IHS or FQHCs if the ACA goes away simply because the appropriations for them
were authorized in the ACA.
These are fiscal issues that exist independently of the ACA. On the one hand, appropriations that would've been authorized anyway for some safety net programs were tacked onto the ACA and you're dissatisfied with that ("They've included 'hidden' spending by authorizing future appropriations! They're gaming the system!"). On the other hand, the SGR fix money that will be spent anyway was removed from the final iteration of the legislation and you're dissatisfied with that ("They haven't included that spending! They're gaming the system!"). Spending independent of health reform is going to happen with or without ACA; some of that spending was authorized in the legislation, some was left out but Ryanites find a way to be upset either way.
How any thinking person can think adding millions to the rolls isn't going to cost someone somewhere more money is mindboggling to me. Common sense folks.
Who suggested it doesn't cost anything? The CBO score of the final legislation was pretty widely circulated: it's estimated to cost $940 billion in the ten-year budget window. The novel concept at work is that it combines spending cuts and revenue increases to pay for those costs and it does it so well that it comes out over $100 billion in the black. Maybe you're referring to someone discussing what it costs
on net?
