Every summer, the Congressional Budget Office (CBO) and the House-Senate Joint Committee on Taxation (JCT) release a report on enrollment and spending in federal health care programs. The reports include enrollment in employer-sponsored insurance as well as the associated budgetary cost, since employer-provided coverage is not subject to federal income or payroll taxes. Since the reports focus only on people under the age of 65, they exclude most Medicare spending and some Medicaid spending.
These reports provide actual spending and enrollment for the previous year and projected spending and enrollment for the current year and subsequent years; projected spending for a given year does not typically change significantly from the previous year’s projections. However, actual 2021 spending in this year’s report featured several major differences from the projections for 2021 in last year’s report. The most notable differences: Medicaid enrollment and spending is much higher than expected, as is Affordable Care Act (ACA) spending. Enrollment in multiple sources of coverage is far higher than CBO previously projected, and total ACA spending will exceed $200 billion this year.
