A bipartisan deal to stabilize the ACA marketplaces would reduce the federal deficit by $3.8 billion over the next decade without significantly affecting ranks of insured Americans, according to the latest score from the Congressional Budget Office and the Joint Committee on Taxation.
The Bipartisan Health Care Stabilization Act, colloquially called Alexander-Murray for Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., who brokered the deal, would adjust the ACA innovation waiver process, fund cost-sharing reduction payments through 2019, require insurers to pay rebates in exchange for CSRs, and expand the availability of catastrophic health plans. CSRs are paid to insurers to offset the discounts they provide to eligible low-income individuals to make co-pays and deductibles affordable.
The CBO estimate assumes the legislation would be enacted in early 2018 and its estimate is measured against the June 2017 baseline, with adjustments from September 2017. CSR payments were already included in this baseline projection; therefore, funding them through 2019 would have no effect on direct spending or revenues, according to the CBO.
However, a previous CBO estimate found terminating these payments would increase the federal deficit by $194 billion by 2026, increase premiums for silver plans on the exchanges by 20 percent in one year and increase the number of uninsured by 1 million in 2018. Both estimates were compared to a baseline with fully funded CSRs. Directly comparing the effects of terminating and paying CSRs, the report states: "CBO and JCT expect that federal costs in 2018 would be higher with funding for CSRs because premiums for 2018 have already been finalized and rebates related to CSRs would be less than the CSR payments themselves. In contrast, premiums in 2019 would be lower with funding for CSRs than without it, and federal costs would probably be lower as well."
Changes made to the Section 1332 waivers are not estimated to have a substantial budgetary effect, according to the CBO.
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