Year Five of the Affordable Care Act: The Budgets, Deficit and Spending

Five years following enactment of the Affordable Care Act, the Congressional Budget Office now states that the total fiscal effects of the legislation can no longer be determined. Nonetheless, its major provisions are still in the early stages of being enforced, while millions of Americans face higher premiums, deductibles, and increased tax burdens. Moreover, millions of Americans have already had their health insurance cancelled, and employer-based coverage is declining. Congress’s “deficit fixation” drove the law’s development and distracted Members from the right budgetary concern: how much the law would spend. The certainty of the Affordable Care Act’s massive spending combined with the uncertainty of revenues from politically unpopular taxes and unlikely Medicare cost savings is a virtual guarantee of future deficits. In short, the law’s reckless overreach threatens to hasten the deterioration of Washington’s fiscal condition.