While much of the reaction to the most recent CBO Budget and Economic Outlook (released earlier this month) focused on the labor market impacts of the Affordable Care Act, it’s important to note that this report actually contained a multitude of interesting findings and updated projections. Among the most important is CBO’s revised projection of the costs of federal health care programs—Medicare, Medicaid, ACA subsidies, and some smaller programs as well—over the next decade. For the fourth year in a row, CBO revised these cost projections downward. The figure below shows CBO’s projections of these costs in the decade following each Budget and Economic Outlook published since 2011.
While health care costs remain the fastest growing portion of the federal budget, and are still projected by CBO to grow significantly faster than the overall economy over the next decade, the downward revisions of the past three years are quite significant. Put simply, since 2011, CBO’s projection of what the level of federal health spending will be in 2021 has dropped by $183 billion, or about 10.4 percent.
To put this in perspective, when lawmakers passed the counterproductive, indiscriminate sequestration spending cuts as part of 2011’s Budget Control Act (BCA), they were looking at projections of federal health spending over the following decade that the latest estimates indicate were $900 billion too high. The $1.2 trillion in “sequestration” cuts over the decade, with their damaging effect to public investment and to the still-incomplete economic recovery, look even more unnecessary in this light.
Genuinely informed budget wonks know that the BCA cuts were particularly perverse because they took an ax to the portion of the budget— discretionary spending—that is not projected to grow in coming years, relative to the economy. To the extent that long-run budget projections highlight a need for restraining spending, this is entirely driven by the rapid rise in health care costs—both public and private. And these health care costs have rapidly decelerated in recent years. This deceleration began even before the provisions of the Affordable Care Act (ACA) meant to restrain cost-growth went into effect. Health care costs are so important in driving long-run budget trends that if the cost-growth slowdown of the past five years continues, there will be no long-run budget deficit problem. Lawmakers who actually cared about long-run budget deficits, not to mention living standards of typical Americans, would reverse the damaging cuts to discretionary spending and instead continue to press for efficiencies that further slow health care cost growth.