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The Evolution of Affordable Care Act Cost and Coverage Impact Estimates, Summarized on One Table

Posted on December 6, 2013 | No Comments
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By Sara Rosenbaum and Nikki Hurt

Since the 2010 enactment of the Affordable Care Act (ACA), the Congressional Budget Office (CBO) has issued a series of cost and coverage impact estimates. Evolving cost estimates are, of course, a reflection of changing economic and social conditions such as labor and employment patterns, the cost of goods and services in the economy generally and health care costs in particular, and choices by sponsors of public and private health insurance coverage, such as employers, government programs, about what and whom to cover or how much to pay for care. Impact estimates also reflect changes in law and public policy, such as the 2012 decision by the United States Supreme Court to bar the federal government from enforcing the Act’s Medicaid expansion for low income adults, thereby effectively turning the expansion into a state option.

In addition, the methods used to calculate impact have an important effect. In this vein, it is important to note that with each subsequent estimate, CBO alters its assumption methods as well as the baseline for its projections. For example, between the 2010 and 2011, the CBO cost estimate rose nearly 50%, a seemingly large jump given the relatively small increase in the number of individuals anticipated to gain coverage between the two estimate time frames. But of the 10-year timeframe covered in the 2010 CBO estimate, full implementation of the ACA accounts only for six of those years (2014-2019). The 2011 estimate, by contrast, includes projections from 2012-2021 time period, thereby adding two years of full implementation. The differences in the estimation timeframe, as well as the increased costs of the ACA post-implementation, account for some of the variation seen among the CBO estimates.

The table below summarizes these evolving CBO cost and impact estimates which consider the ACA through a rolling 10-year framework.

aca cost table

Below are links to the CBO estimates:


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