A few weeks ago, the Senate Health, Education, Labor and Pensions set off an uproar when it submitted a work-in-progress for scoring by the Congressional Budget Office. The bill was missing major pieces, including a requirement that employers contribute towards the cost of their workers' coverage. And the resulting estimates looked awful: It would reduce the number of people without insurance by less than half, in part because a ton of people would drop or lose their employer-sponsored coverage.

It was a meaningless set of numbers. You couldn't really tell much until the final bill, with all of the component parts, was submitted. But opponents of reform seized on the estimate anyway--and used it to claim that reform was going to be an unaffordable, ineffective boondoggle.

Well, now the HELP committee has submitted a full bill. And the results are quite a bit better.

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.

(On the plus side, also outside HELP's jurisdiction--and thus not part of the CBO estimate--are Medicare/Medicaid savings. Those would offset some of the price tag, even before factoring in new revenue.)

As for the public plan, the bill language is a bit confusing--although, in a letter to colleagues, Senator Ted Kennedy refers to it as "national" plan. I'll try to get a more definitive description soon--or, at least, link to one.*

There are obviously all sorts of questions still to answer. I'll be particularly interested to see how good the benefits are--and how generous the financial assistance for those who can't buy insurance on their own. Those are two of the obvious places the committee would have tried to cut, in order to get a more favorable score.

Stay tuned. 

*Update: I've rewritten the passages about cost and the public plan, to reflect the latest information I have as of late Wednesday night/early Thursday morning.

The Congressional Budget Office analysis (click to enlarge):


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