HELP Committee Number Confusion…Again

Yesterday Jane posted about the HELP Committee Bill and CBO score. We’ve been a little slow to get up an analaysis because the numbers are, well, confusing to say the least.

So, after review of what some of the smarter folks out there have to say about this bill, here’s what we’ve learned.

From Ezra:

The short version is this: CBO estimates that by 2019 the bill will cover 21 million people at a cost of $597 billion. But — and this is important — the HELP Committee’s bill doesn’t include the Medicaid expansion, because Medicaid is under the sole jurisdiction of the Finance Committee. But if Medicaid is expanded to 150 percent, it will cover an additional 20 million at a cost of about $1 trillion. Add in the savings that Finance is expected to get from reforming Medicare and you’re looking at a bill that will cost $1 trillion to $1.3 trillion and cover 42 million people (which would mean 97 percent of the legal population in 2019 would have health insurance) by 2019.

As for the confusion? Ezra explains:

The importance of this set of numbers can be understood only in terms of the catastrophe that was the last set of numbers. On June 15, the Congressional Budget Office scored an incomplete version of this bill. The office estimated that it would cost $1 trillion over 10 years and cover 16 million people. It would’ve cost, in other words, 70 percent more and covered 20 percent fewer people. The big question, then, is what accounts for the change? And luckily, there’s a simple answer: the employer mandate.

From Jon Cohn:

According to the official CBO estimate, which a Capitol Hill source provided late Wednesday afternoon, the provisions over which HELP has some jursidiction–which include employer contributions and subsidies to people who can’t fully pay for insurance on their own–would bring insurance to 21 million additional people by 2019, the end of the ten-year budget window. (Erosion of job-based coverage would be virtually zero.) An expansion of Medicaid, something HELP supports but can’t officially legislate–because of committee jurisdiction–would cover another 20 million.

So what does that mean in context? The official CBO projections suggest that, given current trends, there’d be 54 million uninsured people in America by 2019. Therefore, the reforms HELP envisions would reduce that number by three-quarters. Overall, if my math is correct, 95 percent of the population would have health insurance; more than 97 percent if you discount undocumented workers.

OK, how about the cost? CBO says the net outlays are around $600 billion. But that’s based strictly on what’s in the bill. It doesn’t appear to include the cost of the Medicaid expansion, because–again–that is outside HELP jurisdiction and thus not in the legislation HELP submitted.

So if you want the true cost of reform, you have to account for that Medicaid expansion, too. If my back-of-the-envelope calculations are correct, that puts real price tag somewhere between $1 and $1.3 trillion. Again, that’s a rough guess, based on just a few conversations, although it is is more or less what the experts have predicted all along.

And Tim Foley on the Public Option:

Among the plans offered will be the new “Community Health Insurance Option,” aka the public plan (sec 3106). It’s open to those without coverage through their employers, and small businesses (under 50 employees), and would be entirely voluntary. Similar to the House and the Schumer model, it would rely on negotiated rates with providers, and would be self-sustaining through premiums and the same subsidies available to any other plan in the Gateway. The government would give it a loan to get started, which it would pay back once it was actuarially sound. It’s not as generous as the original Kennedy version, but it still has enough leverage, cost savings and incentive to offer a real choice between public and private.