Discretionary spending could push health reform costs past $1 trillion, CBO says

Discretionary spending related to the Patient Protection and Affordable Care Act could cost an additional $115 billion over the next 10 years, pushing the total cost of health reform over the $1 trillion mark, the Congressional Budget Office said on Tuesday. 

Implementation costs alone could run anywhere from $10 billion to $20 billion over the next 10 years, said CBO Director Douglas Elmendorf in a May 11 letter to Rep. Jerry Lewis (Calif.), ranking Republican member on the House Appropriations Committee. Those costs could include up to $10 billion for the Internal Revenue Service to begin implementing the law, and as much as $10 billion for the Centers for Medicare and Medicaid Services and the Office of Personnel Management to implement changes to Medicare, Medicaid and the Children's Health Insurance Program, wrote Elmendorf.

Other significant expenditures could include $9 billion to fund the National Health Service Corps, $34 billion for federally qualified health centers and $39 billion for the Indian health improvement act. The legislation identifies several additional programs for which it specifies no funding levels, thus potential costs can't be estimated.

The initial gross cost for reform estimated by the CBO came to $940 billion. 

"The law establishes a number of new programs and activities, as well as authorizing new funding for existing programs," Elmendorf wrote. "By their nature, however, all such potential effects on discretionary spending are subject to future appropriations actions, which could result in greater or smaller costs than the sums authorized by the legislation." 

House Minority Leader John Boehner (R-Ohio) called the Democrats "irresponsible" for passing the legislation in March. "The American people wanted one thing above all from healthcare reform: lower costs, which Washington Democrats promised, but they did not deliver," he said, according to Politico

Jennifer Hing, spokeswoman for Republicans on the House Appropriations Committee, echoed those sentiments. 

"If Congress were to approve all of this new discretionary funding authorized in the healthcare bill, almost all of the administration's highly touted savings would be made null and void," said Hing, according to the Associated Press

Kenneth Baer, a spokesman for the White House budget agency, countered by pointing out that the authorizations for discretionary spending are not officially expenditures because "Congress does not always act on authorizations that are put into legislation by drafters." He also said that cuts to other programs would be made should such costs go into effect. 

To learn more:
- here are the CBO's findings
- read this Associated Press piece
- check out this Politico article