CBO: judge and jury of healthcare legislation

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As lawmakers pitch their ideas about healthcare reform, there is one agency that is not so easily swayed by political rhetoric.

That is the Congressional Budget Office. This public-sector think tank, which is made up of economists, public policy experts and others, pins a price tag on healthcare legislation and determines how it would affect the federal budget.

This week, the CBO splashed cold water on the Democrats, tagging one healthcare reform plan at $1.6 trillion. It also said the president’s plan could force the United States into further debt unless certain politically unpopular changes are made.

Also recently, the CBO found that the much-touted Title 1 universal healthcare portion of the “Affordable Health Choices Act” from the Senate Committee on Health, Education, Labor and Pensions (HELP) would cost $1 trillion over 10 years and could still leave 36 million Americans uninsured.

Because of the CBO’s credibility, it clearly has the power to catapult or torpedo legislation.

Barbara Manard, vice president of the American Association of Homes and Services for the Aging, explained that the CBO has the final say on a piece of legislation.

“There’s no appeal from that,” she said of the agency’s cost estimates and scoring on healthcare reform legislation. “It’s kind of a mysterious process, but they are very talented people and one needs a kind of arbiter [of healthcare reform models].”

The CBO wades through the assumptions of the legislation and determines fact from fiction, she added. Of course, then lawmakers can change the legislation, based on the findings of the CBO.

AAHSA, she noted, is waiting on a CBO verdict on the Community Living Assistance Services and Supports (CLASS) Act, which is part of the HELP bill. It would create a disability insurance program.

The bill’s sponsors and AAHSA believe the bill will pay for itself because the money would come out of workers’ paychecks, Manard said.

“There may be small administrative expenses … but the bulk of it is intended to be actuarially sound and not to demand anything from the federal budget and over time, [it will, in fact] create Medicaid savings.”

We’ll just have to see if the CBO agrees with her.

Not a replacement for Medicaid

In case you were wondering if the CLASS Act part of the HELP bill is a replacement for Medicaid, the answer is absolutely not, according to Manard.

In fact, it has nothing to do with the state-federal welfare program, she said adamantly.

“It grows out of the understanding that the nation needs not only a strong safety net, but it needs an affordable alternative to Medicaid,” she said.

The plan would offer those who buy into the program a daily allowance of around $50 a day in the event they become disabled. Workers would have to be vested in the program for five years before being able to collect.

While it would help pay for nursing home care, that is not the intent of the program, Manard explained. Instead it would offer an accessible disability insurance plan for millions of Americans. It is geared to those for whom private long-term care insurance is not available and people who don’t want to go into a managed care program.

“We've gotten positive reactions [toward the plan] because people see the tremendous need," she stated.
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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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