<p>The main revenues are $318B of higher taxes on the people with incomes >$200K, a $102B tax on insurers, the Cadillac tax starting in 2018 ($111B), the employer mandate penalty ($96B) and the individual mandate penalty ($55B). (All figures over 10 years.)</p>
<p>A summary specific to the health care projections is here:
[CBO</a> | CBO?s Estimate of the Net Budgetary Impact of the Affordable Care Act?s Health Insurance Coverage Provisions Has Not Changed Much Over Time](<a href=“http://www.cbo.gov/publication/44176]CBO”>http://www.cbo.gov/publication/44176)
and you can see the data table with the baseline changes at the bottom of the document. </p>
<p>If we look historically at the last medical care program expansion, Medicare Part D, the actual costs are much much more than the CBO scoring. Both the number of enrollees and the cost per enrollee were substantially off. Now people might note that there could have been more prescription cost containment built into D, but the point is that the CBO was projecting based on what was in the Bill and knew that it didnt contain the vendor price negotiation. </p>
<p>So the CBO’s track record on predicting large program expansions is not good.</p>
<p>What are the odds that everything will go even close to what the CBO guessed? If insurers are allowed to charge the high prices that they do on the exchange, but most people who get insurance aren’t paying for the full cost…it still will be paid to the insurers. They will still make out like bandits, with very few signing up on the exchanges that will actually be paying the full amount themselves. If they underestimated that (and so far it sounds like they did by a long shot), the cost goes way up.</p>
<p>Estimating the Cadillac tax at 111B could also be way off if most companies use that as an excuse to ditch all their Cadillac plans (except for the top execs, of course). Anyone heard of any companies raising salaries because they are ditching or lowering insurance benefits due to the excuse of the ACA?</p>
<p>Well it is already significantly more expensive for some of us. </p>
<p>So acting as if its not is silly. </p>
<p>Lets just say its expensive. We all hope the affordable part will be true. </p>
<p>Flossy, that part about parent plus loans and houses being underwater? I’m sorry if you are facing that plus a significant premium increase. I know this is going to be a hardship for some in the middle class.</p>
<p>I’m skeptical that this is the right way to view things. That is, I don’t see that insurers are charging high prices on the exchanges (to us older folks) because they’re evil profiteering business. They are, for sure, businesses trying to make as much as they can (sometimes, historically, in ways I view as evil) but in this case, the premium prices can be explained more simply: health care costs a lot of money. And if Evil Acme Insurance Company charges a high premium, people will just buy from Not-So-Evil Insurance Company instead. And if Evil Acme siphons off too much money from premiums, they have to pay it back.</p>
<p>I really don’t look at it as the evil insurers. If I ever say that, it is in jest. They are just trying to achieve what the industries top goal is, which is to make a profit. Certainly that is not evil, nor immoral, but as consumers and taxpayers, we don’t want too much of it coming out of our pockets. And yes, health care costs a lot of money, but it seems that in some states at least, they are charging so much on the exchange that those who’d actually have to pay the full premium aren’t interested. But those who are getting great subsidies are happy to sign up for them, and really aren’t concerned with what the actual cost is. It doesn’t mean they’re good policies, it just means the taxpayers are on the hook for it. So why should the insurers lower their prices on the exchanges? Uncle Sam will cover the load.</p>
<p>If Evil Acme siphons too much on the exchanges, who does the money go back to? The government, or the people who are paying very little for the policies?</p>
<p>If Evil Acme siphons off too much, the money goes back to the premium payers.</p>
<p>
</p>
<p>Maybe. But let’s look at who is going to be facing those big and unsubsidized premiums: older people who make more than 400% of the poverty line. In other words, us! Parents at CC Parent Cafe are likely to be older people who make more than 400% of the poverty line. How many of us are likely to say we want to go without health insurance? Not so many, I would guess. We’ve been around the block a time or two, and those of us who have been lucky in the health lottery have seen all too well that our luck might suddenly vanish.</p>
<p>Personally, my only issue is we were told it would be better for everyone. It’s not. Now, I guess we are being told it will be better for everyone someday. Ugh!</p>
<p>ACA is projected to bring in over 100 billion more than is spent over a 10 year period that has already started.</p>
<p>So…we have some room for problems and we are going to have problems. The technology costs are a little dot on a chart. If healthy
people don’t sign up…that is a problem.
The projected revenues from the cadillac tax have already been cut. However, the elimination of the cadillac tax would have an impact. People complain about programs that aren’t paid for…this is a program that has been budgeted to be paid for. If some of
the taxes are eliminated…then yes…deficits may grow. </p>
<p>You get rid of the cadillac tax and the medical device tax and the surplus is gone…</p>
<p>If the projections are off…we could have issues. There is a range of possibilities…</p>
<p>This is what I wanted to highlight from the prior link…</p>
<p>“What Is the Impact of Repealing the ACA on the Federal Budget?
Assuming that H.R. 6079 is enacted near the beginning of fiscal year 2013, CBO and JCT estimate that, on balance, the direct spending and revenue effects of enacting that legislation would cause a net increase in federal budget deficits of $109 billion over the 2013–2022 period. Specifically, we estimate that H.R. 6079 would reduce direct spending by $890 billion and reduce revenues by $1 trillion between 2013 and 2022, thus adding $109 billion to federal budget deficits over that period.”</p>
<p>Please point to a statement that said it will be better for everyone. </p>
<p>It was always obvious that premiums would rise for people fortunate enough to have gotten preferred rates. Anyone who thought about the situation for more than a millisecond could predict that.</p>
<p>actingmt, I don’t think the majority of American’s actually believe it will be “better.” Most polling shows we all understand we are going to pay a price, either in care, or money, or both.</p>
<p>I’m a bit disappointed, personally, that there will still be 30 million uninsured, and that the prices have gone up so significantly. However, I’m not really that surprised.</p>
<p>I object to the rosy scenario painting. </p>
<p>It is what it is. There are some pluses and some minuses.</p>
<p>"Maybe. But let’s look at who is going to be facing those big and unsubsidized premiums: older people who make more than 400% of the poverty line. In other words, us!’</p>
<p>True. But if those people decide private health insurance is cheaper and more comprehensive off the exchange (likely scenario), they won’t buy from the exchange at all.</p>
<p>Well, I didn’t believe it either, but it was promised. There was the whole if you like your insurance you can keep your insurance stuff, same with doctors. People are having trouble finagling networks to keep their docs. Even sick people. Now, I suppose they will say they ACA didn’t do that rather the insurance companies did but it’s fallout and people are surprised. I also remember hearing the average family will save a $2500 a year in health care costs. Of course, what’s average? I’m not na</p>
<p>At this point, the data don’t show that premium costs have gone up significantly. In fact, the data show that premium increases are much slower than they were before.</p>
<p>How will that help them? Are you saying that there will be two different risk pools, an unhealthy exchange risk pool and a healthy off-exchange risk pool? Are the insurance companies allowed to do that?</p>