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Explosion Of Medicaid And ACA Spending: Lessons From The CBO/JCT Health Subsidies Report

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Brian Blase
PresidentatParagon Health Institute

Brian Blase, Ph.D., is the President of Paragon Health Institute. Brian was Special Assistant to the President for Economic Policy at the White House’s National Economic Council (NEC) from 2017-2019, where he coordinated the development and execution of numerous health policies and advised the President, NEC director, and senior officials. After leaving the White House, Brian founded Blase Policy Strategies and serves as its CEO.

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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.

The full article can be found in Health Affairs Forefront.

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