One of the chief Republican objections to health care reform is that it will add too much to the deficit and the nation can't afford it. The problem with this claim is that it's wrong. The Congressional Budget Office has consistently maintained that the Affordable Care Act reduces the deficit by tens of billions of dollars even as it extends health coverage to millions of Americans. Those who are calling for its repeal on the grounds of fiscal responsibility need to explain how they would do better.
The latest CBO estimate says the health care law will reduce the federal deficit by $109 billion over the next 10 years. The budget office factored in changes as a result of the recent ruling by the U.S. Supreme Court upholding the law but giving states flexibility to opt out of its Medicaid expansion provisions. The CBO estimates there will be 6 million fewer people insured under Medicaid, with half of those obtaining insurance on the new state exchanges, leading to a net reduction in cost to the federal government of $84 billion.
It also noted that it will cost the federal government about a third more per person to subsidize low-income people on the state exchanges than to provide them Medicaid coverage. But since fewer will be covered, there will be savings.
Republican leaders, such as House Republican Policy Committee chairman Tom Price of Georgia, say the law is unaffordable by noting that it requires public outlays of $1.7 trillion — a number from the CBO analysis. But he and others conveniently disregard the other side of the ledger where the law balances expenditures through cost controls, new taxes, penalties and fees. As the CBO has repeatedly found, overall there is a net savings to taxpayers. The Affordable Care Act is a deficit-reduction measure.
The CBO said without the law the United States will continue to add to its ranks of the uninsured, increasing from the current 53 million people to 60 million by 2022. Under the law, even with some states opting out of the Medicaid expansion, 30 million uninsured people are expected to get health coverage.
So here's the final tally: the Affordable Care Act adds 30 million people to the insurance rolls while cutting the deficit by $109 billion over 10 years. Republicans who call for its repeal need to show that they have alternative solutions that are equally efficacious and fiscally responsible. So far they've offered nothing of the kind.