Now I will confess that I really like the CMS Office of the Actuary. CBO, while highly professional, has had a tone of wanting to help the Administration reform efforts, or at least not hurt them. The Office of the Actuary shows no such compunction and I am sure they are on a certain unpleasant list with both Secretary Sibelius and the White House. (That probably explains why it is virtually impossible to find these analyses directly on the CMS website.) After knocking the House bill last month, the OA turned to the Senate attempt, releasing a memo on its financial effects. (OA Letter)
The analysis is similar to that for the House bill–it will significantly expand coverage, mostly through Medicaid and individual policies, with some reduction in employer-based coverage; it will increase total national health expenditures beyond what would otherwise occur; and the Medicare payment rate reductions based on productivity improvements are unlikely to be sustainable. The analysis is full of caveats that suggest national health expenditures will likely be even higher than the OA estimate contained in the memo. The OA also comes as close as an agency probably could to telling Congress that the CLASS program is doomed to failure.
The pell-mell rush to get some bill done means that these analyses are probably not being taken seriously by many in Congress. The totality of CBO and OA analysis, coupled with credible outside expert reports, should, however, lead everyone to take a deep breath and start over. There are well-advised reforms that could be enacted; neither the Senate nor the House bill reflects those.