CBO's Affordable Care Act predictions 'reasonably accurate'

Though they were not perfect, the Congressional Budget Office's predictions about Affordable Care Act enrollment and costs were still reasonably accurate, according to an analysis by The Commonwealth Fund.

That's "reassuring," given the key role the CBO projections play in the formation of healthcare policy amid the ever-shifting variables of healthcare reform, the analysis says.

Here's how some of the agency's estimates match up with that of other groups and with the actual figures:

  • The CBO projected in 2010 that average marketplace would be 8 million by 2014 and that 7 million would be receiving subsidies, a generally lower forecast than that of other groups including the Centers for Medicare & Medicaid Services, RAND Corporation and the Lewin Group. The actual enrollment was lower than any group's prediction, with only 6 million enrolled by the end of 2014 and about 5 million of them receiving subsidies--though the total enrollment jumped to 8 million by the end of the sign-up period due to a last-minute surge.
  • In 2010, the CBO projected that 10 million people would enroll in Medicaid expansion by 2014, a figure it revised to 7 million when the Supreme Court ruled that states could opt out of expanding the program. The actual increase in Medicaid enrollment due to the ACA was about 8 million, the analysis found, making CBO's projection and the Urban Institute's the two most accurate after adjusting other groups' predictions on the same scale the CBO used.
  • The CBO estimated in 2015 that the ACA had reduced the number of uninsured by 12 million, leaving a remaining 42 million uninsured. Though it uses a somewhat different metric than the CBO uses, the estimate from the National Health Interview Survey (NHIS) was that 36 million people lacked health insurance in 2014. The latest data from the NHIS, meanwhile, shows the uninsured rate is down to an all-time low of 9 percent.
  • In 2010, nearly all groups overestimated the average premium of a "benchmark"--or second-lowest cost--silver plan in 2014. For example, the CBO estimated $4,700 per year, and Urban Institute projected $4,618, while the actual figure was $3,800.

Overall, most errors in the CBO's predictions can be traced back to the fact that its estimates were made before taking into account the effects of the ACA, the analysis concludes. Once it adjusted its estimates to account for healthcare prices being lower than expected and incomes being higher, the CBO's estimates came within 18 percent of the actual figures. This accuracy, The Commonwealth Fund says, "should allay concerns of some critics that its forecasts were biased in favor of the [Obama] administration."

To learn more:
- here's the analysis

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