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The ref.article was posted in July,2012 as part of the Dem campaign! There have been several later CBO postings with different numbersand history has shown CBO predictions are seldom accurate. the predictions are based on inputs including such things as the large Medicare payment reduction which has not worked in the past many years.
The point is that is a bald faced lie that has gotten a lot of traction among the right. The CBO predictions are all over the map as far as the effect of the ACA on the budget. But among all the crystal ball gazing and projections, it is clear that repealing the ACA would add considerably to the deficit. The reality is no one actually knows what the actual effect of the ACA on the federal budget will actually be in the future. All the predictions and prognostications are nothing but taking trends and today's figures and projecting them into the future.
I believe that the ACA will have a net positive effect on the federal budget in the long term, but not much in the short term. In the short term there will be much more money spent on subsidies and the Medicaid expansion as it begins to cover the massive number of uninsured Americans. Many of those previously uninsured will seek medical treatment that was either denied or postponed because they lacled health insurance. This would cause the cost of health care to increase. Also I expect that more people who are eligible for a premium subsidy will be enrolling through the health insurance exchanges than who are not eligible because of their income. This is particulrly true among the younger and healthier people as I expcet that many will decide that it is more cost effective for them to pay the penalty than get insured.
But as people adjust to the act and some portions of the act are modified (like increasing the penalties for not getting insured); the cost of health care and its effect on the budget will stabilize. As more of the uninsured are receiving necessary medical care, they will be healthier and more productive. Thus this may have the effect of increasing revenues. Since preventative care is much more cost effective and many serious illnesses can be caught in the earlier stages, medical costs may drop.
The health care industry will also adapt. One major adaption is the establishment of retail walk in clinics for treatment of acute illnesses and minor injuries. These clinics are usually staffed by nurse practitioners and physician assistants and their cost will be substantially lower than a full blown medical practice. Physicians could then be freed up to concentrate on those patients who have more serious and complicated illnesses and injuries.
Reducing the number of uninsured and the amount of uncompensated care for hospitals and medical practices will also allow costs to stabilize since there would be much less cost shifting to those with the ability to pay to cover the cost of uncompensated care. It is my belief that after ten years (think about 2024); the ACA will have made a significant difference on the cost and efficiency of health care in the United States.
Of course this rosy prediction makes the assumption that eventually those red states will come around or that the federal government will change Medicaid and remove the states from the program and completely federalize the program. It also assumes that most of the young and healthy will enroll through the health insurance exchanges as well and that the exchanges fulfill their mission of providing an easily navigable marketplace to shop for health insurance.
By 2017 we will have a good idea of whether nr not the ACA is working to fullfill its objectives and how it is affecting the cost of health care. My belief is that if the ACA is working fine, it will stand with few major changes. But if the act is not working. If there are still too many uninsured Americans and health care costs are still increasing three times faster then incomes; then the idea of single payer will gain traction.
I also expect that by 2017 that either the Republican party will have cnaged its tune and actually begin governing rather than posturing and passing ridiculous acts like some recent acts coming out of congress. No doubt that by 2017 the GOP may be reduced to a smaller minority and that the next president will be a Democrat (Hillary Clinton?). The right wing nuts will still be around, but they will have very few supporters in congress.