If you want to talk about what I am saying you need to address the FACT that the CBO counted those private premiums against Hillarycare when it was up for debate, and that the new law was specifically written to avoid that same trap.
There weren't "private premiums" under the 1994 proposal,
that's the point. Under that plan, premiums (from employers and household) were paid to a government agency or non-profit acting under the authority of the government, not to a private insurer. The government agency then reimbursed payers with which it contracted as necessary. That means all of the money flowing to insurers was coming through regional government agencies, not in the form of private payments directly from individuals. That's why those funds were counted by CBO as government expenditures--all the money passed through a government agency.
I'm sure this seems like a grand trick to you but the reason this isn't true of the ACA score is that the ACA doesn't do this. "It was written to avoid that trap" is another way of saying "the ACA implements an entirely different system." This is
not the same plan and, shockingly, its implications for the federal budget are not the same.
The one comparable bit is that the level of federal
subsidies is dependent on premium levels in both the '94 proposal and the ACA. And both scores thus contain estimates of what premiums (and thus the subsidies) will be. Premium levels are considered in both scores.
Sigh.
There were private premiums, and they were counted against the bill. The entire test of the bill is actually available online.
Bill Text - 103rd Congress (1993-1994) - THOMAS (Library of Congress)
Then I'd suggest you read it. I just told you what it says. In particular you might want to check out sections 1345 and 1351, concerning the responsibilities of new government agencies known as regional alliances.
SEC. 1345. COLLECTIONS.
(a) IN GENERAL- Each regional alliance is responsible for the collection of all amounts owed the alliance (whether by individuals, employers, or others and whether on the basis of premiums owed, incorrect amounts of discounts or premium, cost sharing, or other reductions made, or otherwise). No amounts are payable by the Federal Government under this Act (including section 9102) with respect to the failure to collect any such amounts. Each regional alliance shall use credit and collection procedures, including the imposition of interest charges and late fees for failure to make timely payment, as may be necessary to collect amounts owed to the alliance. States assist regional alliances in such collection process under section 1202(d).
[...]
SEC. 1351. PAYMENT TO REGIONAL ALLIANCE HEALTH PLANS.
(a) COMPUTATION OF BLENDED PLAN PER CAPITA PAYMENT AMOUNT- For purposes of making payments to plans under this section, each regional alliance shall compute, under section 6201(a), a blended plan per capita payment amount for each regional alliance health plan for enrollment in the alliance for a year.
(b) AMOUNT OF PAYMENT TO PLANS-
(1) IN GENERAL- Subject to subsection (e) and section 6121(b)(5)(B), each regional alliance shall provide for payment to each regional alliance health plan, in which an alliance eligible individual is enrolled, an amount equal to the net blended rate (described in paragraph (2)) adjusted (consistent with subsection (c)) to take into account the relative actuarial risk associated with the coverage with respect to the individual.
So, as seems to always be the case with you, I'm going to copy and paste what I've already said and hope that this time you'll understand it. There weren't "private premiums" under the 1994 proposal,
that's the point. Under that plan, premiums (from employers and households) were paid to a government agency or non-profit acting under the authority of the government [a regional alliance], not to a private insurer. The government agency [regional alliance] then reimbursed payers with which it contracted as necessary.
That is why the mandate is specifically not defined as a tax in the PPACA, so that the CBO, as required by law, will ignore its cost.
Obamacare was specifically written to avoid the pitfalls of Hillarycare. You can posture all day long, it will not change the facts.
You're misinformed. The controversy over the '94 score--whether or not to include most money ultimately going to private insurers in calculations of federal revenues and expenditures--was not whether a premium should be counted as public or private, which seems to be the issue on your mind in this thread. The controversy was whether money flowing through regional alliances should be counted as federal revenues and expenditures. Regional alliances would technically not have been federal entities, they were regional governmental authorities, so the Clinton administration argued the answer was no. CBO decided that since they were effectively agents of the federal government, that flow of money should be included in the federal budget.
This has nothing to do with the mandate in the ACA. To repeat: under the '94 proposal, your "premiums" were in fact payments made to a government agency.
You wouldn't pay a private insurer for insurance products provided, the government agency you're funding would decide how much to pay it on your behalf based on a number of factors. The concept is not entirely dissimilar from the way Medicaid works right now in most jurisdictions--a state agency pools federal and state (tax) revenues, it lets it enrollees choose a private insurance company (i.e. a managed care organization), and then it generally pays to that insurer a risk-adjusted capitated rate for each enrollee.
Again, and no worries I don't really expect you to get this, this is not how the ACA works. Under the ACA, you buy insurance and pay a premium directly to your chosen insurer
just like right now. It remains an entirely private transaction. The difference from now is that you if you're buying in the individual market you become eligible for a tax credit based on that purchase. That's very much how employer-sponsored coverage works now, except the tax credit is refundable, advanceable, and valued differently than the tax exemption for employer-sponsored plans.
Your premiums are not government expenditures. That has nothing to do with the mandate, it had to do with the fact that they don't ever go through a government agency (which was not the case in the '94 proposal). CBO estimates government expenditures (and generally partners with JCT to get revenue figures). But yes, the revenues raised by the mandate were estimated, as were the revenues raised by the provisions specifically labeled as taxes. The effects of the legislation were projected, the labels chosen for political reasons are irrelevant to the outcome.
If you want national spending (public + private) projections, try the CMS Actuary.
