Earlier this year, we discussed how the prospects for a permanent fix to the Sustainable Growth Rate formula had improved given CBO's dramatic reduction in its estimate of the cost of a fix.
As the conferees met yesterday, any doubt that we can afford to wait on the long-term debt problem should have quickly been erased after CBO Director Doug Elmendorf's testimony to the conference committee. While the budget outlook has improved somewhat in the short term, little progress has been made on the long-term problem. And fixing the long term will likely require greater reforms to entitlement programs and the tax code.
It's no secret that a significant portion of the federal budget is devoted to our national defense and insurance programs like Social Security, Medicare, and Medicaid. As Ezra Klein wrote almost three years ago, the federal government can be thought of as essentially "an insurance conglomerate protected by a large, standing army." But the army's getting smaller too.
The Senate Finance and House Ways & Means Committees, last week, released a bipartisan, bicameral discussion draft of a proposal to permanently replace Medicare’s sustainable growth rate (SGR) formula, which is set to cut physician payments by nearly 25 percent next year.
Yesterday, the Social Security Administration announced that beneficiaries will be receiving a 1.5 percent Cost-of-Living Adjustment (COLA) this year. Although this update is below the 1.7 percent increase provided this year and the 3.6 percent increase provided for 2012, it is reflective of the relatively low inflation experienced over the past year.
In an op-ed in POLITICO yesterday, former Senate Majority Leader Tom Daschle argued that the upcoming conference committee was the perfect time to enact entitlement reforms. While conventional wisdom has suggested that a bigger deal involving reforms may seem to be elusive, Daschle suggested that there is more agreement between the two parties than meets the eye.
There are two major reasons why this decision makes sense now.
Yesterday, the Congressional Budget Office (CBO) dramatically lowered its estimate of savings if policymakers chose to increase the Medicare eligibility age from 65 today to match Social Security's full retirement age of 67. Last year, CBO estimated that increasing the age would generate $113 billion in savings over 10 years.
As we explained this morning, the House of Representatives recently passed a continuing resolution funding the government at FY 2013 levels through mid-December. In order to garner support from enough House Republicans, the bill also contains three Affordable Care Act-related provisions – it delays implementation of the Affordable Care Act for a year, it includes a provision that delays for a year the requirement that insurance plans cover contraception, and it permanently repeals the medical device tax.
Update: The second graph has been corrected to show the correct year for each line.
It is no secret that the growth of federal health care spending is key to the government’s long-term fiscal outlook. With evidence growing that at least some portion of the recent slowdown in health care cost growth represents structural changes in the health care system, the Congressional Budget Office (CBO) revised downward their estimates of health care spending over the coming years from their last Long-Term Budget Outlook in 2012. Despite improved projections in the near term, however, CBO’s projected long-term growth rates remain nearly unchanged and still far in excess of per capita economic growth. Moreover, the short-term gains actually erode over time due to increased projections of longevity.
In fact, while spending on Medicare is now estimated to be 4 percent lower over the next decade than it was last year, CBO actually increased its projections of program growth after 2023 (from an average annual rate of 6.4% from 2023-2050 to 6.5%). Even within a decade, though excess cost growth (the per beneficiary growth above economic growth per capita) for Medicare is expected to average only 0.3 percent (in part due to the effects of the 24 percent physician payment cut dictated by the Sustainable Growth Rate formula), it is expected to rise back to 1.4 percent by 2023, which has been a more typical level in the past.
Part of the explanation is that CBO now expects higher per beneficiary spending growth in the 2020s and only slightly lower growth thereafter. Looking at the causes of the recent slowdown, CBO explains that “even the portion of the recent slowdown that reflects structural changes in payment mechanisms or in how care is delivered may represent [a] one-time downward shift in costs rather than a persistent reduction in the growth rate.”