October 25, 2014

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Wednesday, December 23, 2009 - 4:07 PM

With the House having passed its version of health care reform (H.R. 3962) and the Senate on the verge of passing its version (H.R. 3590), the outline of a final bill is beginning to take shape. In our new Issue Brief, we look ahead at the fiscal considerations that will likely be the subject of conference committee discussions and “end game” negotiations. These include the cost of expanding coverage, the methods used to prevent that cost from adding to the deficit, and the prospects for systemic reforms to reduce cost growth over time. 

This issue brief gives The Concord Coalition’s perspective on how the bills measure up, what the risks are and how these risks could be lessened. We conclude that:

•    Both bills establish...
Tuesday, December 22, 2009 - 11:46 AM

U.S. House Speaker Nancy Pelosi and other members of Congress got a lot of good advice recently when representatives of The Concord Coalition’s fiscal advisory councils visited Capitol Hill to present their recommendations.

The basic message: Elected officials must make some dramatic changes to put the country on a more responsible fiscal course, protect our economic future and avoid saddling our children and grandchildren with massive debt.

Advisory council members from across the country -- Atlanta, Iowa, Milwaukee, Northern California and Philadelphia -- met with members of Congress and their staffs as part of The Concord Coalition’s National Conference of Fiscal Stewardship this month in Washington. The Fiscal Advisory Council of Northern Virginia had already met with several members of Congress in the fall. Representatives from the University of Denver, where the Fiscal Stewardship Project featured a special student engagement initiative this year, also attended the conference and met with elected officials.

In the conference’s opening...

Thursday, December 17, 2009 - 1:48 PM

As mentioned in the last post, the Senate dramatically weakened the Independent Medicare Advisory Board in the health care legislation currently being debated.

Today, Concord released an issue brief discussing this and highlighting the fact that there is an amendment being proposed by Senator Rockefeller that would restore the board's potential for cost control and delivery system reform. 

The legislative process right now is quite a jumble and it is unknown whether any amendments still have a chance to be voted on or folded into the final "manager's amendment." Hopefully, Senators concerned about cost control will see the wisdom in still altering the bill to strengthen its provisions on that score. Ruth Marcus at the Washington Post had a good column about this in the paper yesterday.

Tuesday, December 1, 2009 - 10:51 PM

As you have read here, here, and here, The Concord Coalition firmly believes that having an independent Medicare commission is one of the most important elements being considered in current health care reform legislation. Without the commission -- which would be empowered to continuously evaluate Medicare costs and propose changes to the delivery of care that might be able to help reduce system-wide health care costs -- it is doubtful that current legislation will succeed in reducing long-term health care inflation. 

Unfortunately, the bill currently being debated in the Senate has effectively neutered the commission's powers (and the House didn't even have a commission in their bill). As pointed out by David Leonhardt in the New York Times, the Senate directs that the commission leave doctors and hospitals untouched by its recommendations for the first four years of its...

Monday, November 16, 2009 - 12:29 PM

For the last few weeks, members of Congress have been increasingly pushing for a bipartisan commission to tackle the nation's fiscal challenges. The impetus has been the need to raise the debt limit as the national debt rapidly approaches the $12 trillion statutory ceiling. Because legislation to raise the debt limit is must-pass, lawmakers are trying to tie commission creation to the legislative language. Senator Evan Bayh highlighted this issue in a letter to Majority Leader Harry Reid, which was co-signed by nine additional senators. The Blue Dog coalition of Democrats in the House also recently announced their support for a commission.

Last week, Budget Committee Chairman Senator Kent Conrad held...

Thursday, November 5, 2009 - 4:18 PM

The news from Thursday’s Washington Post:

The Senate voted Wednesday to renew the government’s $8,000 tax credit for first-time home buyers through the first six months of next year as part of a broader bill designed to extend unemployment benefits.

For the first time, the tax credit program would also enable many homeowners who buy a new primary residence to receive a $6,500 refund.

The measure was attached to a bill that would provide 20 weeks of unemployment benefits in more than two dozen states with jobless rates above 8.5 percent and up to 14 weeks elsewhere. Another provision in the bill would allow businesses that had operating losses in 2008 and 2009 to seek refunds for taxes paid on profits over the past five years.

Why this legislation now?  Because despite signs that the economy as a whole, as measured by GDP, is growing again, most American households are still feeling the pain of a very weak labor market which all economists expect will be unusually slow to recover this time around.  Hence, the extension of unemployment benefits is easy to justify.

But what about the ...

Friday, October 30, 2009 - 11:52 AM

Here are a few initial thoughts from The Concord Coalition about the House of Representatives health care bill (H.R. 3962) and the preliminary scoring of that bill by the Congressional Budget Office (CBO):

  • It does not appear that this bill would alter the unsustainable trend of federal health care spending, often referred to as “bending the cost curve.” [1] According to CBO, “On balance, during the decade following the 10-year budget window, the bill would increase both federal outlays for health care and the federal budgetary commitment to health care, relative to the amounts under current law.” [2]
  • CBO does not make a projection of national health care expenditures (public and private) and it’s unclear if the bill would have a major impact on lowering private costs. All the usually discussed efforts to accomplish that are present in the bill, (accountable care demonstration project; medical home pilot, comparative effectiveness research and wellness,) but these score as a cost in the first 10 years. CBO does not include a specific analysis of how these initiates might play out over time and it would, in fact, be very difficult to do so. Thus, the long-term effect of these policies is highly uncertain, at best. This is the risk of expanding...
Monday, October 19, 2009 - 10:23 PM

I have written a lot in this blog about the Congressional Budget Office and their estimates (here is the latest example). Today, the Washington Post has another great article explaining the process.

Reading it, I thought about how many things we do here at Concord that depend on CBO. We have been working over the last few weeks updating all of our education exercises with CBO information and data. Next week we will be unveiling a new online budget game that also is based on CBO publications. As is our plausible baseline, chart talks and many of our issue briefs.

We do this not because CBO can see the future, but because having a neutral umpire (especially one easily searchable online!), makes what we have to say stand out--because we don't have to spend as much time worrying or...

Wednesday, October 7, 2009 - 10:37 AM

Well, it took a couple months, but those with a stake in health care reform have finally figured out that the idea of an excise tax on insurance companies instead of an any alternative tax on “real people” was no magic cure for the want-more-revenue-but-don’t-want-higher-taxes blues. From a story by Ben Smith and Patrick O’Connor in today’s Politico (emphasis added):

More than half of the Democrats in the House have signed on to a letter denouncing a key element of the Senate Finance Committee’s health care legislation as labor unions draw a line in the sand on paying for reform.

The Democrats are attacking a plan to finance expanded health care by taxing expensive health insurance plans. The plan, sometimes cast as a tax on “Cadillac” plans, would in fact include the health care plans of many public employees and union members and has triggered a revolt from Obama’s labor supporters and their many allies on the Hill.

The letter from 154 House Democrats to Speaker Nancy Pelosi urges her “to reject proposals to enact an excise tax on high-cost insurance plans that could be potentially passed on to middle-...

Thursday, September 17, 2009 - 10:28 PM

The big news this week on the health care front was the release of the Senate Finance Committee's initial draft of its health care legislation. The big interest in the budget world with this development is that it marked the first complete reform legislation with a score from CBO that shows deficit reduction, not only during the 10-year budget window but also in the years beyond.

While this is encouraging, there are a lot of caveats to keep in mind about where we are in the process. One is that the bill leaves out a quite expensive item--a fix to doctor payments under Medicare--that costs hundreds of billions. That "fix" is included in the House bill where it is not paid for. Another caveat is that the proposed Medicare Commission, an idea we at Concord support, is seemingly having more restrictions placed on it at every turn. Finally, the legislation still has a long way to go and just one amendment at some point could change the CBO scoring dramatically. Furthermore, the other bills the Finance Committee's have to be merged or conferenced with do not appear as fiscally responsible (...