Candace Stuart, Editor, Cardiovascular Business

When the Congressional Budget Office (CBO) released its analysis of the Supreme Court’s ruling in the Patient Protection and Affordable Care Act (PPACA), many reports focused on the cost savings: $84 billion. Few pointed out the nuances within the 21-page document.

The CBO reassessed its projection of costs from the PPACA after the Supreme Court upheld the individual mandate. The High Court’s ruling in effect allowed states to opt out of an expansion of Medicaid in 2014, which had appeared to be a requirement for receiving existing federal matching funds. As a result, the CBO wrote that it anticipated some states may not participate in the expansion, some may try to negotiate a partial expansion and still others may delay expansion.

That raises many questions, CBO acknowledged.

“Under other provisions of Medicaid law that specify options for states, they may cover ‘reasonable categories’ of individuals with income below a specified threshold. Whether the Court’s decision allows for that flexibility, or whether the current Administration or future ones will allow such flexibility, will have a significant impact on the choices that state governments make.”

After weighing a variety of factors, the CBO projected the PPACA now will: 

• Reduce the number of nonelderly people without health insurance coverage by 14 million in 2014 and later by 29 million or 30 million;
• Leave 30 million nonelderly residents uninsured by the end of the period (the prior estimate was 27 million);
• The share of legal nonelderly residents with insurance will to rise from 82 percent in 2012 to 92 percent by 2022;
• From 2016 on, between 23 million and 25 million people will receive coverage through the exchanges;
• Ten million to 11 million additional people will be enrolled in federal aid programs, and
• Between 4 million and 6 million fewer people are estimated to have coverage through an employer, a similar projection to prior to the court’s decision.

Don’t count on this being the final word, though.

“CBO and JCT’s [Joint Commission on Taxation’s] estimates reflect an assessment of the probabilities of different outcomes (without any explicit prediction of which states make which choices) and are, in their judgment, in the middle of the distribution of possible outcomes,” according to the report. “Future legal or administrative actions will probably change the scope of what is possible under the PPACA and the Court’s decision; CBO and JCT’s assessments should not be viewed as representing a single definitive interpretation of those possible outcomes.”

Candace Stuart
Cardiovascular Business, editor
cstuart@trimedmedia.com