Rarely has a measly footnote been so significant. In April, the Congressional Budget Office published an updated look at the ACA’s coverage provisions (which include the subsidies, the employer and individual mandates, and several other measures). It found that the law would save the U.S. even more money than initially expected. The CBO forecasted that the revenue from the penalties that the mandates exacted would drop, but the cost of subsides would fall even more. But that wasn’t the most interesting thing about the CBO report.Reporters belatedly combing through the document brought to light a footnote containing a startling admission: Although the CBO has revised its estimate of the budget effects of the coverage provisions, it can no longer measure the impact of the law as a whole. In the CBO’s words:
CBO and JCT can no longer determine exactly how the provisions of the ACA that are not related to the expansion of health insurance coverage have affected their projections of direct spending and revenues. The provisions that expand insurance coverage established entirely new programs or components of programs that can be isolated and reassessed. In contrast, other provisions of the ACA significantly modified existing federal programs and made changes to the Internal Revenue Code. Isolating the incremental effects of those provisions on previously existing programs and revenues four years after enactment of the ACA is not possible.
A translation for non-bureaucrats: We’re flying blind here.The ACA is more than just an insurance expansion program; it also contains provisions that affect hospitals, the tax code, and other federal programs. In this footnote, the CBO is now saying that it cannot figure out how those other parts of the law affect the budget—and thus that we don’t know how the law as a whole does either.Even more importantly, some of the CBO’s uncertainty is caused by Obama Administration decisions to change, delay, or abandon parts of the law during implementation. First came the news that census questions were altered, making it far more difficult for us to determine whether the ACA has reduced the numbers of the uninsured, and now there’s this. As time goes on, we’re becoming less and less capable of answering basic questions about whether the ACA is working.