That certainly means that the ten-year price tag goes up, but so do the new revenues and savings in the law – but nothing significant has changed; it’s exactly what the law has been projected to do all along.
In fact, when it comes to fiscal effects, the only change is that the projected surplus generated by ACA has gone up another $50B. Not deficit, but surplus.
Now, if Republicans wanted to complaint that the original 10-year spending estimate was artificially low because of slow implementation, I’d agree with them – as long as they would accept that the bill continues to be fully paid for going forward, and in fact is still projected to generate larger surpluses in the future than it does in next few years. And that the original spending estimates are still, basically, right on track.
But they won’t, because this is the GOP War on Budgeting – when Republicans talk about deficits, they’re usually not talking about federal government revenues compared with federal government outlays. So Charles Krauthammer, on Fox News today:
As we approach the beginning of the program and the no-spending period fades behind us, we get a real appreciation of the ten-year spending which will kick in in two years and extend until the end of time…Think about that. It means on the average every year — again, until the end of time — we are going to add at least a quarter of a trillion dollars in entitlement spending onto a deficit that already was crushing us in the absence of Obamacare.
See that? It’s as if the pay-fors just didn’t exist. Because, for Republicans, more money spent adds to the deficit…as does more money coming in. Because by “deficit” they (usually) just mean stuff they don’t like. So they can bash the taxes and spending cuts in health care reform and also claim that it adds to the “deficit,” as if the two have nothing to do with each other.
Of course, for those who use the normal definition of a federal budget deficit – and that presumably includes anyone concerned with economic effects of fiscal policy – it matters very much whether new spending is paid for or not. And, two years after it was passed, the bottom line is that the budget projections for ACA are holding up just fine. Including those that show it’s going to cut, not increase, the overall government deficit.