http://thefederalist.com/2014/07/29/the-cbo-is-using-enron-style-accounting-on-obamacare/
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In its final cost estimate of Obamacare (released on March 20, 2010), under a section labeled "Key Considerations," the CBO cautioned that the legislation would "maintain and put into effect a number of policies that might be difficult to sustain over a long period of time." Thus, CBO asserted: "the long-term budgetary impact could be quite different if key provisions… were ultimately changed or not fully implemented" (emphasis added). Specifically, CBO mentioned the sustainable growth rate formula for paying doctors in Medicare that was not addressed in the bill, but—more importantly—here's what CBO said about Medicare payment rates for other health care providers:
Just the day before, CBO had released a sensitivity analysis (at Paul Ryan's request) that illustrated a similar point. Ryan asked what the budget impact of Obamacare would be in its second decade if several provisions were altered. Two of the four provisions he inquired about were IPAB and the additional indexing for exchange subsidies. In that analysis, CBO found that (emphasis added):
"If the changes described above were made to the legislation, CBO would expect that federal budget deficits during the decade beyond 2019 would increase relative to those projected under current law—with a total effect during that decade in a broad range around one-quarter percent of GDP."
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