The Congressional Budget Office (CBO) scored the Senate Finance Committee’s health care reform proposal and, to no one’s surprise, the proposal comes in under that of other committee bills. But at what cost?

The CBO issued a cost estimate of the health care reform bill under consideration by the Senate Finance Committee, concluding that it would increase federal spending by $829 billion over 10 years but be offset by enough spending cuts and tax increases to reduce the budget deficit by $81 billion. The net number of legal U.S. residents without health insurance would be reduced by 29 million over 10 years. This bill is lower in cost, at $829 billion, but that lower cost comes at the expense of affordability.

The Senate Finance Committee has taken longer than any other committee to complete its bill and has yet to vote on it. The longer the process drags on, the less effective it appears to be at helping the population Congress is said to be most concerned about — those people who are in the individual market, such as people who are self-employed or working for a small businesses.

The Senate Finance Committee bill includes a mandate that individuals carry insurance, but does not provide enough subsidy to help people pay for that mandated coverage, nor does it effectively curb costs to keep insurance affordable to those who already have it. In fact, the bill creates a penalty structure for people who do not buy coverage even if they cannot afford it. Sen. Olympia Snowe co-sponsored an amendment to waive that penalty for families who would spend more than 8 percent of their income on premiums — a valiant attempt to rectify this problem — but still leaves those families without insurance.

Creating a bill that doesn’t add to the deficit is essential, but passing one that doesn’t curb costs over time for families and businesses will lead to a faltering economy down the road. The piece missing from the proposal is cost containment.

Cost containment is the key to finding funds to pay for affordability, but is difficult to score because it assumes savings that are not easily quantifiable, and the CBO is restricted to that which is quantifiable. For this reason, bills approved by other committees ultimately could save more money and cover more people, but don’t score as well under CBO calculations.

The CBO estimates are subject to changes in consumer behavior and economic conditions, and do not permit assumptions that do not generate hard and fast numbers. While it may be reasonable to attempt to measure the savings that result from the elimination of particular tests or procedures, for example, it is difficult to measure the savings accrued in moving to a system that spends more resources on prevention than triage. Such changes may exact significant savings, but because the CBO cannot account for those savings they are not included in the CBO score.

Sen. Snowe has dedicated countless hours to seeing meaningful reform come to fruition. She has stood up for Maine people under strong pressure from both her colleagues and the insurance companies. She has held listening sessions, consulted experts, and negotiated in good faith. It would be a shame if all that work leads to the passage of a bill that fails to actually lower health care costs.

When Senate leadership begins work on merging the committee bills together, they should focus on truly important considerations such as cost containment, access and the affordability that creates access, rather than the politics that have stalled desperately needed reform.

Health care reform is critical to the well-being of Maine people and the success of Maine businesses, but real reform must be about creating affordability which leads to better access. The Senate Finance Committee finally has a bill to vote on, and it should do so before outside influences further erode the bill’s ability to achieve real health care reform. However, leadership would do well to remember that cheaper is not always better.We need quality reform that will change the trajectory of future spending.

What we don’t need is a bargain bill that fails to get the job done.

Nicole Witherbee is the federal budget analyst at the Maine Center for Economic Policy.


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