CBO Updates Estimate of Reconciliation Bill
CBO Updates Estimate of Reconciliation Bill
DOCUMENT ATTRIBUTES
- Institutional AuthorsCongressional Budget Office
- Cross-ReferenceRestoring Americans' Healthcare Freedom Reconciliation Act of 2015
.
Consolidated Appropriations Act, 2016. - Code Sections
- Subject Area/Tax Topics
- Industry GroupsInsuranceHealth care
- Jurisdictions
- LanguageEnglish
- Tax Analysts Document NumberDoc 2016-64
- Tax Analysts Electronic Citation2016 TNT 2-27
ESTIMATE OF DIRECT SPENDING AND REVENUE EFFECTS OF H.R. 3762, THE
RESTORING AMERICANS' HEALTHCARE FREEDOM
RECONCILIATION ACT, AS PASSED BY THE SENATE ON DECEMBER 3, 2015, AND
FOLLOWING ENACTMENT OF THE CONSOLIDATED
APPROPRIATIONS ACT, 2016
(Billions of Dollars, by Fiscal Year)
______________________________________________________________________
ESTIMATED CHANGES WITHOUT MACROECONOMIC FEEDBACK
Changes in Direct Spendinga
Coverage Provisions in Titles I and IIb
Estimated Budget Authority
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-22.1 -26.2 -111.1 -147.9 -156.7 -165.3 -174.4
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-182.5 -190.6 -197.7 -464.1 -1,374.6
Estimated Outlays
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-22.1 -26.2 -111.1 -147.9 -156.7 -165.3 -174.4
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-182.5 -190.6 -197.7 -464.1 -1,374.6
On-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-22.1 -26.2 -110.5 -147.0 -155.8 -164.3 -173.4
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-181.5 -189.6 -196.6 -461.6 -1,366.9
Off-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0 0 -0.6 -0.9 -0.9 -1.0 -1.0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-1.0 -1.1 -1.1 -2.5 -7.7
Title I -- Health, Education, Labor and Pensions
Sec. 101 - Prevention and Public Health Fund
Estimated Budget Authority
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-1.0 -1.0 -1.3 -1.3 -1.5 -1.5 -2.0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-2.0 -2.0 -2.0 -6.0 -15.5
Estimated Outlays
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-0.2 -0.5 -0.9 -1.1 -1.3 -1.4 -1.6
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-1.8 -1.9 -2.0 -4.1 -12.7
Sec. 102 -- Community Health Center Program
Estimated Budget Authority
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0.2 0.2 0 0 0 0 0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
0 0 0 0.5 0.5
Estimated Outlays
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0.1 0.2 0.1 * 0 0 0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
0 0 0 0.5 0.5
Sec. 103 -- Territories
Estimated Budget Authority
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0 0 -0.1 -0.1 0 0 0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
0 0 0 -0.2 -0.2
Estimated Outlays
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0 0 -0.1 -0.1 0 0 0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
0 0 0 -0.2 -0.2
Sec. 104 -- Reinsurance, Risk Corridor, and Risk Adjustment
Programs
Estimated Budget Authority included in coverage estimate
Estimated Outlays included in coverage estimate
Sec. 105 -- Support for State Response to Substance Abuse Public
Health Crisis
Estimated Budget Authority
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0.8 0.8 0 0 0 0 0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
0 0 0 1.5 1.5
Estimated Outlays
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0.1 0.4 0.5 0.3 0.1 * 0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
0 0 0 1.4 1.5
Title II -- Finance
Sec. 201 -- Recapture Excess Advance Payments of Premium
Tax Credits
Estimated Budget Authority
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-1.8 -3.3 -1.1 0 0 0 0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
0 0 0 -6.1 -6.1
Estimated Outlays
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-1.8 -3.3 -1.1 0 0 0 0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
0 0 0 -6.1 -6.1
Sec. 202 -- Premium Tax Credit and Cost Sharing Reductions
Estimated Budget Authority included in coverage estimate
Estimated Outlays included in coverage estimate
Sec. 203 -- Small Business Tax Credit
Estimated Budget Authority included in coverage estimate
Estimated Outlays included in coverage estimate
Sec. 204 -- Individual Mandate
Estimated Budget Authority included in coverage estimate
Estimated Outlays included in coverage estimate
Sec. 205 -- Employer Mandate
Estimated Budget Authority included in coverage estimate
Estimated Outlays included in coverage estimate
Sec. 206 -- Federal Payment to States
Estimated Budget Authority
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-0.2 * * * * * *
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
* * 0 -0.2 -0.2
Estimated Outlays
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-0.2 * * * * * *
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
* * 0 -0.2 -0.2
Sec. 207 -- Medicaid (Coverage)
Estimated Budget Authority included in coverage estimate
Estimated Outlays included in coverage estimate
Sec. 207 -- Medicaid (Non-Coverage)
Estimated Budget Authority
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0 0 -1.6 -2.3 -1.6 -1.7 -1.8
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-1.9 -2.0 -2.1 -5.5 -15.0
Estimated Outlays
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0 0 -1.6 -2.3 -1.6 -1.7 -1.8
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-1.9 -2.0 -2.1 -5.5 -15.0
Sec. 208 -- Repeal of DSH Allotment Reductions
Estimated Budget Authority
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0 0 1.5 2.4 3.4 4.3 5.3
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
6.2 7.2 7.2 7.2 37.5
Estimated Outlays
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0 0 1.5 2.4 3.4 4.3 5.3
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
6.2 7.2 7.2 7.2 37.5
Sec. 209 -- Repeal of the Tax on Certain Employee Health
Insurance Premiums and Health Plan Benefitsb
Estimated Budget Authority included in coverage estimate
Estimated Outlays included in coverage estimate
Sec. 223 -- Budgetary Savings for Extending Medicare
Solvency
Estimated Budget Authority
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0 0 0 0 0 0 0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
0 0 0 0 0
Estimated Outlays
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0 0 0 0 0 0 0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
0 0 0 0 0
Total Changes in Direct Spending
Estimated Budget Authority
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-24.2 -29.5 -113.7 -149.2 -156.5 -164.2 -172.9
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-180.2 -187.4 -194.6 -473.0 -1,372.3
Estimated Outlays
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-24.3 -29.3 -112.7 -148.7 -156.1 -164.0 -172.5
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-179.9 -187.4 -194.6 -471.2 -1,369.6
On-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-24.3 -29.3 -112.1 -147.8 -155.2 -163.1 -171.5
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-178.9 -186.3 -193.4 -468.7 -1,361.9
Off-budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0 0 -0.6 -0.9 -0.9 -1.0 -1.0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-1.0 -1.1 -1.1 -2.5 -7.7
Changes in Revenuesc
Coverage Provisions in Titles I and IIb
Estimated Revenues
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-18.0 -14.4 -26.6 -35.1 -39.4 -49.7 -55.5
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-61.3 -67.6 -74.0 -133.4 -441.5
On-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-19.2 -18.0 -21.9 -26.8 -30.2 -39.1 -43.6
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-48.3 -53.3 -57.7 -116.1 -358.0
Off-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
1.2 3.5 -4.6 -8.3 -9.1 -10.6 -11.9
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-13.1 -14.3 -16.3 -17.3 -83.5
Title II -- Finance
Sec. 201 -- Recapture Excess Advance Payments of Premium Tax Credits
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0.2 1.2 1.1 0 0 0 0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
0 0 0 2.6 2.6
Sec. 202 -- Premium Tax Credit and Cost
Sharing Reductions included in coverage estimate
Sec. 203 -- Small Business Tax Credit included in coverage estimate
Sec. 204 -- Individual Mandate included in coverage estimate
Sec. 205 -- Employer Mandate included in coverage estimate
Sec. 209 -- Repeal of the Tax on
Certain Employee Health Insurance
Premiums and Health Plan Benefitsb included in coverage estimate
Sec. 210 -- Repeal of Tax on Over-the-Counter Medications
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-0.3 -0.5 -0.6 -0.6 -0.6 -0.7 -0.7
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-0.8 -0.9 -0.9 -2.7 -6.7
Sec. 211 -- Repeal of Tax on Health Savings Accounts
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
* * * * * * *
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
* * * * -0.1
Sec. 212 -- Repeal of Limitations on Contributions to Flexible
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-1.4 -2.4 -2.7 -2.9 -3.1 -3.4 -3.6
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-3.9 -4.4 -4.4 -12.6 -32.0
Sec. 213 -- Repeal of of Tax on Prescription Medications
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-2.9 -3.9 -4.0 -2.7 -2.7 -2.7 -2.7
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-2.7 -2.7 -2.7 -16.1 -29.6
Sec. 214 -- Repeal of Medical Device Excise Taxd
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0 0 -1.5 -2.2 -2.3 -2.5 -2.6
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-2.8 -2.9 -3.1 -6.1 -20.0
Sec. 215 -- Repeal of Health Insurance Taxc
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-9.9 -1.0 -11.3 -13.1 -13.8 -14.6 -15.5
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-16.4 -17.0 -17.5 -49.0 -130.0
Sec. 216 -- Repeal of Elimination of Deduction for Expenses
Allocable to Medicare Part D Subsidy
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-0.1 -0.2 -0.2 -0.2 -0.2 -0.2 -0.2
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-0.2 -0.2 -0.2 -0.8 -1.8
Sec. 217 -- Repeal of Chronic care Taxe
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-0.6 -2.0 -3.4 -3.7 -4.1 -4.5 -4.9
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-5.3 -5.7 -6.1 -13.7 -40.0
Sec. 218 -- Repeal of Medicare Tax Increase
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-6.4 -8.9 -10.1 -10.9 -11.7 -12.7 -13.8
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-14.9 -16.1 -17.6 -48.0 -123.0
Sec. 219 -- Repeal of Tanning Tax
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-0.1 -0.1 -0.1 -0.1 -0.1 -0.1 -0.1
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-0.1 -0.1 -0.1 -0.4 -0.8
Sec. 220 -- Repeal of Net Investment Tax
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-15.1 -7.7 -20.8 -21.8 -22.9 -24.1 -25.5
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-26.8 -28.2 -29.7 -88.4 -222.8
Sec. 221 -- Remuneration
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
* -0.1 -0.1 -0.1 -0.1 -0.1 -0.1
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-0.1 -0.1 -0.1 -0.3 -0.6
Sec. 222 -- Economic Substance Doctrine
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-0.3 -0.5 -0.5 -0.6 -0.6 -0.6 -0.6
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-0.7 -0.7 -0.7 -2.5 -5.8
Total Changes in Revenues
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-54.8 -40.6 -80.7 -93.9 -101.5 -115.8 -125.8
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-136.0 -146.5 -157.0 -371.5 -1,052.1
On-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-55.6 -43.2 -75.0 -84.6 -91.2 -104.1 -112.5
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-121.5 -130.7 -139.3 -349.4 -956.8
Off-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
0.8 2.6 -5.8 -9.4 -10.3 -11.8 -13.2
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-14.5 -15.8 -17.8 -22.1 -95.3
Net Increase or Decrease (-) in the Deficit
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
30.5 11.3 -32.0 -54.8 -54.6 -48.2 -46.7
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-43.9 -40.8 -37.5 -99.7 -317.5
On-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
31.3 13.9 -37.2 -63.2 -64.0 -59.0 -58.9
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-57.4 -55.6 -54.2 -119.3 -405.1
Off-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-0.8 -2.6 5.1 8.5 9.4 10.8 12.2
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
13.4 14.7 16.6 19.6 87.7
ESTIMATED BUDGETARY IMPACT OF MACROECONOMIC FEEDBACK
Effects on Outlaysa
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
* 0.3 0.2 -0.2 0.8 2.3 3.4
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
4.2 4.6 4.8 1.0 20.3
Effects on Revenuesc
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
3.1 5.5 6.6 13.2 22.8 28.0 30.4
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
33.0 36.5 39.8 51.2 218.9
Net Decrease (-) in the Deficit
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-3.1 -5.2 -6.4 -13.4 -22.1 -25.7 -27.0
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-28.8 -31.9 -35.0 -50.2 -198.6
On-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-2.9 -4.7 -5.1 -9.9 -16.0 -18.4 -19.2
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-20.2 -22.3 -24.4 -38.5 -143.1
Off-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-0.2 -0.6 -1.3 -3.4 -6.1 -7.3 -7.8
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-8.6 -9.6 -10.6 -11.7 -55.5
TOTAL ESTIMATED CHANGES, INCLUDING MACROECONOMIC FEEDBACK
Effects on Outlaysa
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-24.3 -29.1 -112.6 -148.9 -155.4 -161.8 -169.1
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-175.8 -182.7 -189.7 -470.2 -1,349.3
Effects on Revenuesc
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-51.7 -35.2 -74.1 -80.7 -78.7 -87.8 -95.3
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-103.0 -110.1 -117.2 -320.3 -833.2
Net Increase or Decrease (-) in the Deficit
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
27.4 6.1 -38.4 -68.1 -76.7 -73.9 -73.7
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-72.8 -72.7 -72.5 -149.9 -516.0
On-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
28.4 9.3 -42.2 -73.1 -80.0 -77.5 -78.2
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
-77.6 -77.8 -78.6 -157.9 -548.2
Off-Budget
2016 2017 2018 2019 2020 2021 2022
______________________________________________________________________
-1.0 -3.2 3.8 5.0 3.3 3.5 4.4
2016- 2016-
2023 2024 2025 2020 2025
______________________________________________________________________
4.8 5.2 6.1 8.0 32.2
______________________________________________________________________
Sources: Congressional Budget Office; staff of the Joint Committee on
Taxation.
Notes: Numbers may not add up to totals because of rounding; DSH =
Disproportionate Share Hospital; * = an increase or decrease between
zero and $50 million. CBO and the staff of the Joint Committee on
Taxation (JCT) have updated their estimate of the budgetary effects
of H.R. 3762, the Restoring Americans' Healthcare Freedom
Reconciliation Act, as passed by the Senate on December 3, 2015.
Since that estimate was completed, the Consolidated Appropriations
Act, 2016 was enacted on December 18, 2015. It contained several
provisions -- including a delay of the medical device tax, a one-year
moratorium on the health insurance tax, and a delay of the tax on
certain employee health insurance premiums and health plan benefits
along with changes to the deductibility of that excise tax -- that
affected CBO and JCT's estimate for H.R.3762. Over the 2016-2025
period, estimated savings are $36 billion larger, without
macroeconomic feedback, and $42 billion larger, with macroeconomic
feedback, relative to CBO and JCT's prior estimate for H.R. 3762. The
change in the estimate of macroeconomic feedback also reflects some
technical revisions to the previous estimate. For additional
information on the estimated effects of H.R. 3762, see
https://www.cbo.gov/publication/51090
FOOTNOTES TO TABLE
a For outlays, a positive number indicates an increase
(adding to the deficit) and a negative number indicates a decrease
(reducing the deficit).
b Differs from CBO and JCT's prior estimate because of
provisions included in the Consolidated Appropriations Act, 2016 that
delayed the tax on certain employee health insurance premiums and
health plan benefits for two years and made changes to the
deductibility of that excise tax.
c For revenues, a positive number indicates an increase
(reducing the deficit) and a negative number indicates a decrease
(adding to the deficit).
d Differs from CBO and JCT's prior estimate because of
a two-year moratorium on the medical device tax that was enacted as
part of the Consolidated Appropriations Act, 2016.
e Differs from CBO and JCT's prior estimate because of
a one-year moratorium on the health insurance tax for 2017 that was
enacted as part of the Consolidated Appropriations Act, 2016.
END OF FOOTNOTES TO TABLE
DOCUMENT ATTRIBUTES
- Institutional AuthorsCongressional Budget Office
- Cross-ReferenceRestoring Americans' Healthcare Freedom Reconciliation Act of 2015.
Consolidated Appropriations Act, 2016. - Code Sections
- Subject Area/Tax Topics
- Industry GroupsInsuranceHealth care
- Jurisdictions
- LanguageEnglish
- Tax Analysts Document NumberDoc 2016-64
- Tax Analysts Electronic Citation2016 TNT 2-27
