Health and Economy Baseline Estimates - Center for Health & Economy

In the second year of the Affordable Care Act’s implementation, focus has shifted from website malfunctions and outreach efforts to the enduring problems of American health care: increasing and unpredictable costs, large numbers of uninsured individuals, and adequate access to care. The Center for Health and Economy (H&E) is dedicated to assessing the impact of proposed reforms that attempt to address these issues. The following report details the most recent updates to the H&E baseline estimates of insurance coverage, federal budgetary impact, plan choice, and the premium landscape of health insurance for Americans under the age of 65.

KEY FINDINGS:

In 2016, the change in average individual market premiums will vary by plan type, with projected premium changes ranging between -4 percent and +4 percent. In 2017, the increase in average premiums is projected to range between 5 and 12 percent.
Average subsidized premiums are expected to fluctuate in 2015 and 2016, as a result of a growing risk pool and increased participation of the young and healthy. After 2017, average subsidized premiums are expected to increase by 5 to 15 percent annually, driven by rising health care costs, indexed subsidy adjustments, and a limited risk pool.
The individual market includes an estimated average of 31 million members in 2015, with 9 million lives covered through subsidized insurance offered in the Marketplace. Subsidized enrollment is projected to grow to 20 million in 2017, and the total size of the individual market is estimated to expand to 39 million by 2016.
As premiums and health care costs rise, plans chosen in the individual market are expected to shift towards lower cost options. High subsidized enrollment in silver plans is projected to fade, as enrollment grows among households that are eligible for subsidies but not silver-plan cost-sharing.
The health insurance coverage provisions under current law for the non-elderly are estimated to increase the Federal deficit by $4.193 trillion between 2016 and 2025.

INSURANCE COVERAGE

Table 1. Health Insurance Coverage (millions)
		2015	2016	2017	2018	2019	2020	2021	2022	2023	2024	2025
Individual Market		31	39	39	38	37	36	35	34	34	33	33
	Subsidized Insurance	9	15	20	19	18	18	17	16	16	15	15
	Other Non-group Insurance	22	24	19	19	19	19	18	18	18	18	18

Employer Sponsored Insurance		146	145	145	145	145	145	145	145	145	145	144

Medicaid		49	50	50	50	51	51	52	52	52	53	53

Other Public Insurance²		9	10	10	11	12	12	13	14	14	15	16

Total Non-Elderly Population		271	273	274	275	277	278	280	281	282	284	285
Total Insured¹		236	244	245	245	245	245	245	245	245	245	245
Uninsured¹		36	29	29	31	32	33	34	36	37	38	40
¹ All insurance coverage estimates refer only to the under-65 population.
² Other Public Insurance includes under-65 Medicare enrollment.

H&E estimates there were 236 million non-elderly US residents with health insurance in 2015—87 percent of the total non-elderly population. Estimates of health insurance coverage encompass four primary categories: the individual market, employer sponsored insurance, Medicaid, and other public insurance. The individual market is divided into two subsets: subsidized and unsubsidized coverage. Subsidized coverage is purchased through the Health Insurance Marketplace, and unsubsidized coverage, is comprised of similar insurance plans purchased either directly from the insurer or through the Marketplace without financial assistance. H&E makes no distinction between unsubsidized enrollees through the Marketplace and households that purchase individual market insurance directly from an insurer. Estimates concerning Medicaid also include beneficiaries of the Children’s Health Insurance Program. Other public insurance is primarily comprised of Medicare coverage for disabled persons, but also includes Tricare, the Indian Health Services, and other federal health care programs for specific populations.

The initial rollout of the Marketplace is based on a four year implementation period and initial estimates of the uninsured population are benchmarked using the Congressional Budget Office (CBO) estimates for 2015 and 2016. By 2017, the number of insured, non-elderly Americans is projected to increase to 245 million—89 percent of the total non-elderly population. The increase in insured Americans is primarily the result of three factors: the expansion of Medicaid, the continuing implementation of the subsidized Marketplace, and an increasingly costly tax penalty for remaining uninsured. The average population of non-elderly Medicaid beneficiaries is estimated to be 49 million in 2015 and will rise to 53 million by the end of the analysis period. These estimates are subject to the uncertainty of each state’s decision regarding Medicaid expansion.

The individual market is estimated to expand from 31 million covered lives in 2015 to 39 million in 2017, driven largely by the rollout of the Marketplace. The increase in coverage through Medicaid and the individual market is in part offset by a decrease in those insured through employer sponsored coverage. As the individual market becomes more robust, more residents are expected to opt for plans offered in the Marketplace or directly by insurers in lieu of employer sponsored plans. Some employers may also decide not to offer health insurance coverage as an employee benefit.

As seen in Table 1, the number of individuals with unsubsidized, individual market insurance is expected to decrease after 2016. In 2017, the discontinuation of non-qualified health plans currently available in the market, as well as the phase out of risk protections for insurance companies, are expected to lead to 5 million fewer individuals with unsubsidized, non-group plans. Rising costs and higher income contributions for subsidized enrollees are estimated to lead to higher uninsured numbers later in the analysis period.

PREMIUMS

Table 2. Average Premiums in the Individual Market
		2015	2016	2017	2018	2019	2020	2021	2022	2023	2024	2025
Single Coverage	Platinum	4,800	5,000	5,300	5,600	5,900	6,300	6,700	7,100	7,500	7,900	8,404
	Gold	3,800	3,900	4,100	4,400	4,600	4,900	5,200	5,500	5,900	6,200	6,615
	Silver²	4,400	4,500	4,800	5,000	5,300	5,700	6,000	6,300	6,700	7,100	7,524
	Silver	3,200	3,200	3,500	3,700	3,900	4,100	4,400	4,600	4,900	5,200	5,468
	Bronze	2,600	2,500	2,700	2,800	2,900	3,000	3,100	3,100	3,200	3,300	3,424
	Catastrophic	1,700	1,700	1,900	1,900	2,000	2,100	2,100	2,200	2,300	2,300	2,397

Family Coverage¹	Platinum	19,400	20,400	21,600	22,900	24,300	25,800	27,300	29,000	30,700	32,600	34,525
	Gold	15,600	16,400	17,400	18,500	19,600	20,800	22,100	23,500	24,900	26,400	28,004
	Silver²	16,600	17,300	18,300	19,500	20,700	21,900	23,300	24,600	26,000	27,500	29,037
	Silver	12,900	13,600	14,600	15,500	16,400	17,400	18,500	19,700	20,900	22,200	23,588
	Bronze	10,700	10,900	11,500	11,800	12,100	12,500	12,900	13,300	13,700	14,100	14,472
	Catastrophic	6,300	6,500	6,400	6,600	6,800	7,000	7,200	7,400	7,600	7,900	8,110
¹ Family coverage estimates are based on a family size of four persons.
² Silver plans offered to low income households receive cost-sharing benefits that alter the effective premium relative to un-assisted silver plans.

Estimates of the subsidy eligible premiums available in the Marketplace are calculated using publicly available data on plans offered in the 36 Federally Facilitated Marketplaces. Premium estimates for unsubsidized health insurance are calculated from a sample of plans available on ehealthinsurance.com. In both cases, H&E uses the default age rating curve put forth by the Department of Health and Human Services to impute the applicable premium for a particular household. For simplification and comparability, H&E uses a standard family size of four (two adults and two children) when estimating family premiums. Subsidy payments and tax revenue are adjusted for the appropriate average family size in budget impact estimates.

Subsidized insurance plans offered in the Marketplace are divided into four categories—Platinum, Gold, Silver, and Bronze—that correspond to four approximate actuarial values—90 percent, 80 percent, 70 percent, and 60 percent. The actuarial value refers to the expected percentage of annual medical expenses covered by the insurance plan.

Table 3. Average Marketplace Premiums After Credits
		2015	2016	2017	2018	2019	2020	2021	2022	2023	2024	2025
Single Coverage	Platinum	4,200	4,300	4,500	4,800	5,100	5,400	5,800	6,100	6,500	6,900	7,400
	Gold	3,300	3,300	3,500	3,800	4,000	4,200	4,500	4,800	5,100	5,400	5,700
	Silver²	1,000	1,100	1,300	1,400	1,600	1,700	1,800	2,000	2,100	2,300	2,500
	Silver	2,800	2,800	2,900	3,100	3,300	3,500	3,700	4,000	4,200	4,500	4,800
	Bronze	2,100	1,900	2,000	2,000	2,100	2,100	2,200	2,200	2,300	2,400	2,400

Family Coverage1	Platinum	15,400	16,100	17,200	18,300	19,500	20,700	22,100	23,500	25,000	26,600	28,300
	Gold	11,700	12,300	13,100	14,000	14,900	15,900	16,900	18,000	19,200	20,500	21,800
	Silver²	4,500	4,800	5,100	5,500	6,000	6,500	7,100	7,600	8,200	8,800	9,500
	Silver	9,900	10,400	11,000	11,700	12,500	13,300	14,200	15,100	16,100	17,200	18,300
	Bronze	6,900	6,900	7,000	7,100	7,300	7,500	7,700	7,900	8,100	8,300	8,500
¹ Family coverage estimates are based on a family size of four persons.
² Silver plans that receive cost-sharing assistance have exceptionally low, after-credit premiums, primarily because they are only offered to households that receive generous premium subsidies.

Eligible households may purchase subsidized coverage for a specified percentage of household income that ranges from 2.01 to 9.56 percent in 2015, depending on income. A federal subsidy pays the remaining portion of the premium that is not covered by the household’s specified income contribution. This specified income contribution is also subject to annual increases if the annual increase in health insurance costs exceeds a measure of household income growth. H&E also projects an additional cost control measure, which prescribes further increases in the income contribution if total subsidy spending exceeds .504 percent of GDP, will be triggered after 2018, the first year in which it is eligible to take effect.

It is important to note that, because of additional cost-sharing assistance, the plan designs categorized as Silver vary significantly in actuarial value across different income categories. For enrollees in the marketplace that earn between 100 and 150 percent of the Federal Poverty Level (FPL), Silver plans have an actuarial value of 94 percent, the highest of any plan offered in the Marketplace. For enrollees earning between 150 and 200 percent of FPL, Silver plans have an actuarial value of 87 percent, and for enrollees earning between 200 and 250 percent of FPL, Silver plans have a 73 percent actuarial value. H&E estimates the unsubsidized premiums for these high-value silver plans using the true actuarial value of the plan, rather than the Silver plan price.

Unsubsidized insurance plans, purchased in the Marketplace or directly from an insurer, are similar in design and price to those eligible for subsidies. The ACA requires that all health insurance plans meet certain requirements in order to certify as qualified coverage. However, some non-qualified health plans already in existence are available to consumers until 2017. Before the qualified health plan regulations are enforced, lower cost plan options are available to consumers who seek unsubsidized health insurance coverage outside of the Marketplace.

H&E assumes an underlying health insurance cost growth of 6 percent throughout the ten-year window. Actual year on year premium growth estimates vary as a result of changes in the enrollment mix and size of the insured risk pool. For example, the growing size of the individual market between 2014 and 2016—associated in part with increased participation of the young and healthy—leads to lower estimated increases in average premiums for many plan design categories. After 2017, premiums in the individual market are projected to grow annually at rates closer to the underlying growth rate of 6 percent. Due to growing applicable income contribution rates, subsidized premium growth for some plan designs is expected to exceed the underlying health insurance growth rate.

PLAN CHOICE

Table 4. Plan Choice Distribution in the Individual Market¹
	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024	2025
Platinum	6%	5%	4%	4%	3%	3%	3%	2%	2%	2%	1%
Gold	15%	12%	11%	10%	9%	8%	7%	6%	5%	4%	3%
Silver²	44%	47%	54%	51%	47%	43%	37%	32%	26%	22%	17%
Bronze	14%	21%	29%	33%	38%	43%	49%	55%	60%	65%	70%
Catastrophic	20%	15%	2%	2%	3%	4%	5%	6%	7%	8%	8%

Total Enrollment (millions)	31	39	39	38	37	36	35	34	34	33	33

Table 5. Plan Choice Distribution in the Health Insurance Marketplace
	2015	2016	2017	2018	2019	2020	2021	2022	2023	2024	2025
Platinum	2%	3%	3%	3%	3%	2%	2%	2%	2%	1%	1%
Gold	5%	4%	4%	4%	3%	3%	3%	2%	2%	2%	2%
Silver²	73%	68%	63%	59%	53%	47%	40%	34%	27%	22%	17%
Bronze	19%	25%	29%	35%	41%	48%	55%	62%	69%	75%	80%

Total Enrollment (millions)	9	15	20	19	18	18	17	16	16	15	15
¹ The Individual Market refers to the commercial, non-group market and includes sales of insurance within the Marketplace and direct sales by insurers.

² Silver plans include plans that receive cost-sharing assistance.

H&E uses the subsidized and unsubsidized Marketplace enrollment in each metal level after the first year to calibrate plan preferences in the individual market and estimate plan choices throughout the ten-year analysis window.

H&E estimates that the large enrollment in Silver plans in 2014 among subsidized insurance plans will give way to higher enrollment in Platinum, Gold, and Bronze plans in 2015 and 2016. The large majority of Silver plan enrollment is estimated to be largely comprised of households eligible for extra cost-sharing benefits. As the risk pool grows to include more households that are eligible for premium credits but not cost sharing assistance (earning between 250 and 400 percent of FPL), the distribution of subsidized enrollment among the four metal levels is expected to become more evenly distributed.

Beyond 2016, lower cost insurance plans are estimated to gain market share, shifting away from more generous plans in response to the steadily rising cost of health insurance. Bronze plans are expected to dominate the individual insurance market by 2020. Under the ACA, catastrophic coverage is not certified as qualified health insurance coverage for adults over the age of 30. However, that provision is not enforced for adults over the age of 30 that are already enrolled in catastrophic coverage until 2017.

BUDGET

Table 6. Cost of Current Law Coverage Provisions (billions)¹														2016 – 2025
			2015	2016	2017	2018	2019	2020	2021	2022	2023	2024	2025	2016 – 2025
Sources of Funds²
	Tax on Employer Sponsored Health Insurance		0	0	0	21	21	21	21	21	20	19	17	163
	Individual and Employer Mandate Taxes		6	10	11	12	14	16	18	21	23	27	31	182
	Subtotal		6	10	11	33	35	37	40	42	44	46	48	345

Uses of Funds³
	Health Insurance Marketplace
		Cost Sharing Benefits	12	17	20	19	17	15	13	11	9	7	5	133
		Premium Tax Credits	53	86	107	109	109	110	111	112	114	117	121	1,097
	Medicaid		194	203	205	212	219	225	233	241	250	259	270	2,316
	Medicare		71	75	83	88	93	98	103	107	111	115	119	992
	Subtotal		331	380	415	427	438	448	459	471	484	499	515	4,538

Net Budgetary Impact⁴			-324	-371	-404	-394	-403	-411	-420	-429	-440	-453	-467	-4,193
¹ Cost estimates refer only for the under-65 population.
² Positive values denote increases in revenue; negative values denote decreases in revenue.
³ Positive values denote increases in spending; negative values denote decreases in spending.
⁴ Positive values denote surplus; negative values denote deficit.

H&E estimates the impact on the federal budget of the major health insurance coverage provisions of current law with regards to the non-elderly population. Budget impact estimates do not include estimates for non-ACA tax expenditures encoded in current law, such as the employer sponsored health insurance tax expenditure.[i] H&E does, however, estimate the additional revenue gained by removing the tax exclusion for high-cost employer sponsored insurance plans implemented by the ACA, known as the Cadillac tax.

Medicaid coverage and expenditure estimates are calculated based on the number of states that had chosen to expand Medicaid by May 1, 2015. These predictions are sensitive to future state-level decisions on expansion as well as new program waivers that alter the design of a state’s Medicaid program.

Over the decade spanning between 2016 and 2025, H&E estimates that non-elderly coverage provisions under current law will cost $4.538 trillion. The cost is partially off-set by $352 billion in increased revenue through the tax on high-cost employer sponsored insurance, the individual shared responsibility tax, and the employer shared responsibility tax. The ACA introduced a number of taxes that are not directly related to the health insurance coverage of the non-elderly population. In 2012, CBO estimated non-coverage provisions of the ACA to reduce the deficit by $1.28 trillion over 10 years.[ii]

PRODUCTIVITY AND ACCESS

In an effort to shed light on how health care policy and consumer choices affect health care quality, H&E estimates two measures: the Medical Productivity Index (MPI) and the Provider Access Index (PAI). Health insurance plan designs are associated with varying degrees of access to desired physicians and facilities as well as incentives that promote or discourage efficient use of resources. H&E estimates each index by attributing productivity and access scores to the range of plan designs available and exploits changing plan choices to project the evolution of health care quality.

Table 7. Medical Productivity Index
		2015	2016	2017	2018	2019	2020	2021	2022	2023	2024	2025
Individual Market		2.5	2.4	2.2	2.2	2.3	2.3	2.4	2.4	2.4	2.5	2.5
	Marketplace	2.0	2.1	2.1	2.2	2.2	2.2	2.2	2.2	2.2	2.3	2.3
	Other Non-Group Insurance	2.8	2.7	2.3	2.4	2.4	2.5	2.6	2.7	2.8	2.9	3.0

Employer Sponsored Insurance		2.3	2.3	2.3	2.4	2.4	2.4	2.5	2.5	2.5	2.6	2.6

Private Insurance		2.3	2.3	2.3	2.3	2.4	2.4	2.4	2.4	2.5	2.5	2.5

Medicaid		1.5	1.5	1.5	1.5	1.5	1.5	1.5	1.5	1.5	1.5	1.5

Total Insured¹		2.1	2.2	2.1	2.2	2.2	2.2	2.2	2.2	2.3	2.3	2.3
¹ Productivity and access estimates refer only to the under-65, non-disabled population

The Medical Productivity Index is designed to reflect the expected gains in health status in return for medical expenditures. Plan designs that encourage patients to consider the price of treatment when making health care decisions, such as high deductible plans, are ascribed high MPI scores, while plans with low cost-sharing requirements or first dollar coverage are ascribed low scores. The index ranges from a low of 1.0 to a high of 4.0.

Table 8. Provider Access Index
		2015	2016	2017	2018	2019	2020	2021	2022	2023	2024	2025
Individual Market		3.2	3.1	2.8	2.7	2.6	2.5	2.5	2.4	2.3	2.2	2.2
	Marketplace	3.1	3.0	2.9	2.8	2.7	2.6	2.5	2.3	2.2	2.1	2.0
	Other Non-Group Insurance	3.3	3.1	2.5	2.5	2.5	2.5	2.5	2.5	2.5	2.5	2.6

Employer Sponsored Insurance		3.8	3.8	3.8	3.7	3.7	3.7	3.7	3.7	3.7	3.6	3.6

Private Insurance		3.7	3.7	3.6	3.6	3.5	3.5	3.5	3.5	3.5	3.5	3.4

Medicaid		1.0	1.0	1.0	1.0	1.0	1.0	1.0	1.0	1.0	1.0	1.0

Total Insured¹		3.1	3.1	3.0	3.0	2.9	2.9	2.9	2.9	2.8	2.8	2.8
¹ Productivity and access estimates refer only to the under-65, non-disabled population

The Provider Access Index is designed to reflect the availability of primary and specialty physicians and facilities. Plans with large networks, such as Platinum plans offered in the individual market, are ascribed high scores for providing exceptional access. Bronze and other low cost plans that afford access only to limited networks are ascribed low PAI scores. The index ranges from a low of 1.0 to a high of 5.0.

CHANGES FROM PREVIOUS BASELINE ESTIMATES

H&E is constantly reevaluating the assumptions and technical methods that are used to create baseline and proposed estimates of health insurance coverage provisions under current law. This publication is the second comprehensive baseline report of 2015. H&E currently projects that the under-65 coverage provisions of current law will increase the deficit by $324 billion in 2015, a decrease of $30 billion from the February 2015 baseline estimate. H&E also projects that, on average, 236 million individuals under the age of 65 will be insured during the year of 2015, representing a decrease from an estimate of 239 million in the February 2015 baseline. The updates to baseline predictions are, in part, a result of growing information concerning the rollout of the ACA that inform many of the underlying assumptions in H&E’s modeling, as well as a reflection of technical improvements to the model.

The estimates in this report take into account new demographic information published by the US Census Bureau in 2014, which includes updates to the Census methodology of counting uninsured individuals. These updates have led H&E to lower estimates for the total under-65 population in 2015 to 271 million from 275 million in the February 2015 baseline. The estimate of the number of uninsured individuals has also been reduced from 37 million to 36 million in 2015 and reduced from 31 million to 29 million in 2016. Our estimates of the uninsured population are benchmarked to CBO estimates, which were also revised as a result of new demographic information.

Table 9. Change in Budgetary Impact Estimates (billions)¹													2016 – 2025
		2015	2016	2017	2018	2019	2020	2021	2022	2023	2024	2025	2016 – 2025
Change in Sources of Funds Baseline Estimates²
	Tax on Employer Sponsored Health Insurance	*	*	*	*	*	*	*	*	*	*	*	-2
	Individual and Employer Mandate Taxes	*	*	*	*	*	*	*	-1	-1	-1	-1	-5
	Subtotal	*	*	*	-1	-1	-1	-1	-1	-1	-1	-1	-6

Change in Uses of Funds Baseline Estimates³
	Cost Sharing Benefits	-7	-2	1	*	*	-1	-2	-2	-2	-2	-1	-10
	Premium Tax Credits	-23	-16	3	1	-2	-5	-8	-10	-12	-14	-16	-79
	Medicaid	1	-6	-8	-8	-8	-8	-8	-8	-9	-10	-10	-85
	Medicare	-1	-1	1	2	3	5	6	7	7	8	8	44
	Subtotal	-30	-24	-4	-5	-7	-9	-12	-14	-16	-18	-19	-130

Feb 2015 Net Budgetary Impact⁴		-355	-395	-408	-399	-410	-420	-431	-443	-456	-470	-486	-4,316
May 2015 Net Budgetary Impact4		-324	-371	-404	-394	-403	-411	-420	-429	-440	-453	-467	-4,193
¹ Cost estimates refer only for the under-65 population.
² Positive values denote increases in revenue; negative values denote decreases in revenue.
³ Positive values denote increases in spending; negative values denote decreases in spending.
⁴ Positive values denote surplus; negative values denote deficit.
* Difference between baseline estimates is between 0 and 1 billion.

H&E incorporated recent state-level Medicaid enrollment information for early 2015 in order to better estimate the effect of expansion decisions, the interaction between Marketplace and Medicaid enrollment, and the population of Medicaid enrollees that are funded at a higher federal matching rate. The combination of new enrollment information, demographic updates, and other technical updates to the model involving under-65 Medicaid coverage leads to a total spending estimate of $2.316 trillion over the next decade down from the February 2015 estimate of $2.401 trillion.

H&E estimates for subsidized health insurance have been substantially reduced from 15 million to 9 million for 2015. After the second year of open enrollment, H&E has lengthened the implementation period for the Health Insurance Marketplace from 3 years to 4 years, and has also lowered estimates of the maximum number of subsidized enrollees in the Marketplace from 25 million to 20 million.

Table 10. Change in Coverage Estimates (millions)
		2015	2016	2017	2018	2019	2020	2021	2022	2023	2024	2025
Individual Market		-1	1	3	3	2	2	2	1	1	1	*
	Health Insurance Marketplace	-6	-10	-4	-4	-4	-4	-4	-4	-4	-4	-4
	Other Non-group Insurance	5	10	7	7	6	6	6	5	5	5	4

Employer Sponsored Insurance		-2	-2	-2	-3	-3	-3	-3	-2	-2	-2	-2

Medicaid		*	-1	-1	-1	-1	-1	-1	-1	-1	-1	-1

Other Public Insurance		*	*	*	*	*	*	*	*	*	*	*

Feb 2015 Total Insured¹		239	247	246	246	247	247	247	248	248	248	249
May 2015 Total Insured¹		236	244	245	245	245	245	245	245	245	245	245
¹ All insurance coverage estimates refer only to the under-65 population.
* Difference between baseline estimates is between 0 and 1 million

UNCERTAINTY IN THE PROJECTIONS

H&E uses a peer-reviewed micro-simulation model of the health insurance market to analyze various aspects of the health care system.[iii] And as with all economic forecasting, H&E estimates are associated with substantial uncertainty. While the estimates provide good indication on the nation’s health care outlook, there are a wide range of possible scenarios that can result from policy changes, and current assumptions are unlikely to remain accurate over the course of the next ten years. For instance, the uncertainty surrounding the implementation of the ACA and similar obstacles facing the implementation of new health care overhauls affect the accuracy of short-term coverage estimates. Importantly, this uncertainty does not lead to biased results. H&E attempts to depict an unbiased, middle -ground representation of the future should the policy and economic environment remain constant. While the goal is to project the most likely scenario, actual events may differ significantly from published predictions.

PDF Version

[i] The CBO estimates that the tax exclusion for employer sponsored insurance will cost $3.4 trillion over 10 years. See Distribution of Major Tax Expenditures in the Individual Income Tax System, Congressional Budget Office, May 2013, at: http://www.cbo.gov/sites/default/files/cbofiles/attachments/43768_DistributionTaxExpenditures.pdf

[ii] Elmendorf, Douglas W., “Letter to the Honorable John Boehner providing an estimate for H.R. 6079, the Repeal of Obamacare Act,” Congressional Budget Office, July 24, 2012, available at: http://www.cbo.gov/sites/default/files/cbofiles/attachments/43471-hr6079.pdf

[iii] Parente, S.T., Feldman, R. “Micro-simulation of Private Health Insurance and Medicaid Take-up Following the U.S. Supreme Court Decision Upholding the Affordable Care Act.” Health Services Research. 2013 Apr; 48(2 Pt 2):826-49.