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The CBO's Crystal Ball: How Well Did It Predict the Effects of the Affordable Care Act?

December 16, 2015

The Congressional Budget Office (CBO), a nonpartisan agency of Congress, made official projections of the Affordable Care Act's impact on insurance coverage rates and the costs of providing subsidies to consumers purchasing health plans in the insurance marketplaces. This analysis finds that the CBO overestimated marketplace enrollment by 30 percent and marketplace costs by 28 percent, while it underestimated Medicaid enrollment by about 14 percent. Nonetheless, the CBO's projections were closer to realized experience than were those of many other prominent forecasters. Moreover, had the CBO correctly anticipated income levels and health care prices in 2014, its estimate of marketplace enrollment would have been within 18 percent of actual experience. Given the likelihood of additional reforms to national health policy in future years, it is reassuring that, despite the many unforeseen factors surrounding the law's rollout and participation in its reforms, the CBO's forecast was reasonably accurate.

Predictable Unpredictability: The Problem with Basing Medicare Policy on Long-Term Financial Forecasting

July 13, 2015

The authors assess how Medicare financing and projections of future costs have changed since 2000. They also assess the impact of legislative reforms on the sources and levels of financing and compare cost forecasts made at different times. Although the aging U.S. population and rising health care costs are expected to increase the share of gross domestic product devoted to Medicare, changes made in the program over the past decade have helped stabilize Medicare's financial outlook—even as benefits have been expanded. Long-term forecasting uncertainty should make policymakers and beneficiaries wary of dramatic changes to the program in the near term that are intended to alter its long-term forecast: the range of error associated with cost forecasts rises as the forecast window lengthens. Instead, policymakers should focus on the immediate policy window, taking steps to reduce the current burden of Medicare costs by containing spending today.

How Will the Affordable Care Act Affect the Use of Health Care Services?

February 25, 2015

In January 2014, the Affordable Care Act extended access to health insurance coverage to an estimated 30 million previously uninsured people. This issue brief provides state-level estimates of the increased demand for physician and hospital services that is expected to result from expanded access and assesses the sufficiency of the existing supply of providers to accommodate the anticipated increase in demand. We project that primary care providers will see, on average, 1.34 additional office visits per week, accounting for a 3.8 percent increase in visits nationally. Hospital outpatient departments will see, on average, 1.2 to 11.0 additional visits per week, or an average increase of about 2.6 percent nationally. Increases of the magnitude likely to be generated by the Affordable Care Act will have modest effects on the demand for health services, and the existing supply of providers should be sufficient to accommodate this increased demand.

Achieving Universal Coverage Through Comprehensive Health Reform: The Vermont Experience -- Report of Findings

September 30, 2010

Presents findings on the role of Vermont's health reform programs in increasing insurance coverage between 2005 and 2009. Examines changes by insurance type, contributing factors such as outreach campaigns, financial sustainability, and implications.

Achieving Universal Coverage Through Comprehensive Health Reform: The Vermont Experience

October 16, 2009

Provides an overview of Vermont's comprehensive health reform and the interim results of a two-year evaluation of its impact on the affordability of coverage and access to services, as well as its sustainability. Discusses lessons learned.

Analysis of Five Health Insurance Options for New York State

January 16, 2009

Estimates the increase in coverage, private insurance crowd-out, net cost, and change in overall health spending of five options for expanding health insurance, including a single-payer program, "building block" proposals, and a market-oriented option.