CBO

The Congressional Budget Office (CBO) released its report on the Senate Finance Committee's amended health care reform plan, known as America's Health Future Act of 2009. The CBO concludes that the plan achieves one of the President's goals of enacting health care reform without increasing the deficit. The plan would lead to health insurance coverage for 94% of legal American residents (91% if illegal residents are included.) But there are "important" caveats, such as the plan "has not been converted into legislative language. The review of such language could lead to significant changes in the estimates of the proposal’s effects on the
federal budget and insurance coverage. This caveat grabbed my attention:

These projections assume that the proposals are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the sustainable growth rate (SGR) mechanism governing Medicare’s payments to physicians has frequently been modified (either through legislation or administrative action) to avoid reductions in those payments. The projected savings for the proposal reflect the cumulative impact of a number of specifications that
would constrain payment rates for providers of Medicare services. In particular, the proposal would increase payment rates for physicians’ services for 2010, but those
rates would be reduced by about 25 percent for 2011 and then remain at current-law levels (that is, as specified under the SGR) for subsequent years. [The House majority bill, which has a significantly higher CBO score, provides a permanent fix, and the doctors always get their way.]

Under the proposal, increases in payment rates for many other providers would be held below the rate of inflation (in expectation of ongoing productivity improvements in the delivery of health care). The projected longer-term savings for the proposal also assume that the Medicare Commission is relatively effective in reducing costs—beyond the reductions that would be achieved by other aspects of the proposal—to meet the targets specified in the legislation. The long-term budgetary impact could be quite different if those provisions were ultimately changed or not fully implemented.

Nonetheless, the Wall Street Journal reports that "The widely awaited report paves the way for the Senate Finance Committee to approve its bill as soon as this week." Damn the torpedoes, full steam ahead.

Modern Healthcare reports that the House leadership plans to complete work on the final version of its bill, H.R. 3200, the Affordable Health Choices Act, this week and send the bill to the CBO for scoring.