CBO estimates $ 553 billion price tag for health care benefits in reconciliation package

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If the health care provisions of the reconciliation bill are passed, deficits would increase by $ 553.2 billion from 2022 to 2031, according to cost estimates from the Congressional Budget Office.

The number of people without health insurance would decline by about 3.9 million people, CBO Director Phillip Swagel said in the Oct. 19 letter to Rep. Jason Smith, R-Mp., Ranking member of the commission. of the House budget.

By 2031, 23.6 million people under 65 would be uninsured, compared to 27.7 million people today. It is estimated that 4 million people are covered by Medicaid.

The CBO has considered some health care provisions in the $ 3.5 trillion reconciliation bill that continues to be debated in Congress. These provisions include reducing premium costs, expanding tax credits for low-income populations, introducing a special rule for unemployed people, and reducing the Medicaid coverage gap.

The estimated net increases in the deficit for each of these provisions are:

  • $ 209.5 billion to improve affordability by reducing premium costs.
  • $ 323.1 billion to expand Medicare premium tax credits for populations that are 138% of the federal poverty line and to close the Medicaid coverage gap for states that do not have not extended Medicaid.
  • $ 10.6 billion to cover the special rule for people receiving unemployment benefits.
  • $ 10.8 billion for the change in affordability of employer-sponsored coverage.

The special rule for unemployed persons applies to those who receive a tax credit on health insurance premiums through the Affordable Care Act which is equal to the difference between the referral premium and a maximum contribution specified as a percentage of household income.

The provision for employer-sponsored coverage applies to the percentage of income that a person pays for the coverage. The provision of the reconciliation bill decreases the percentage of income required to obtain subsidized coverage through ACA, from 9.5% of income to 8.5%. Employees whose contribution exceeds 8.5% may purchase subsidized coverage under the provision.


The reconciliation package would increase the number of Americans under 65 who have health insurance coverage. Other proposals would add visual, hearing and dental benefits to the original Medicare and give Medicare the ability to negotiate drug prices.

The Senate and House have passed a budget resolution for fiscal 2022 that authorizes the $ 3.5 trillion reconciliation bill. The passage was along the party lines. But within the Democratic Party there is disagreement over the price to be paid. Almost unanimous democratic support is needed for the promulgation of the reconciliation package.

House Speaker Nancy Pelosi has indicated Oct. 31 will be the date for a breakthrough in the reconciliation deadlock, Intelligencer said, but Politico said today that Pelosi and Majority Leader Chuck Schumer wanted to get together a framework for reducing social spending by the end of the week.


The Congressional Budget Office has been asked to provide information on estimating the costs of health care provisions in reconciliation legislation. The CBO said it had not yet finished estimating the costs of the full reconciliation bill.


Ways and Means Committee Chairman Richard E. Neal, D-Mass., And Energy and Trade Committee Chairman Frank Pallone, Jr., DN.J., said, “The analysis from today’s CBO confirms that the Build Back Better law would have a transformative advantage. for millions of Americans who work hard by expanding access to affordable health care coverage. The independent analysis found that about 4 million uninsured Americans would get coverage and an additional 7.6 million would get subsidized coverage by making the Care Act premium tax credit improvements permanent. affordable and closing the Medicaid coverage gap. ”

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Eleanor C. William