ACA Scoring Window Games

When framing the Affordable Care Act, the Obama administration combined two sensible budget goals with one ridiculous one. The first sensible goal was to slow the rate of increase of economy-wide health care spending. The second sensible goal was to reduce the long-term budget deficit. The ridiculous goal was to keep the headline cost below $900 billion in a 10-year CBO scoring window. This was accomplished largely by delaying implementation of the vast majority of the bull until 2014 so that spending would register as very low during the early portion of the window. Now it’s 2012 and the “window” looks different, so the 2012 to 2022 estimate is way higher than the 2010 to 2019 estimate was. Some conservatives are now running around pretending to believe this means the costs of ObamaCare have doubled, but this is total nonsense the bill is costing what it was always projected to cost—the window is just shifting.

That said, I’m having a bit of trouble sympathizing with Team Obama on this one. All it really goes to show was how dumb their efforts to game the scoring window were in the first place. There’s no getting around the fact that providing health insurance to millions of Americans who currently lack it is an expensive undertaking. If insurance were cheap, there wouldn’t be all these uninsured people! Delaying implementation has created a lot of substantive and political problems, and what we’re seeing with this round of attacks as the window shifts is that it doesn’t really have the upside that the ACA’s framers seem to have thought it had.