Health Care Reform Now Actually Adds 

$110 billion to the Deficit

CBO Estimate of H.R. 3590 and H.R. 4872
  (dollars in billions)

Unified Deficit Impact (health and education) ‐143
Remove Savings from Student Loan Provisions 19
Subtotal (health provisions alone) ‐124

Unified Deficit Impact (health alone) ‐124
Remove Off‐Budget Effect of Social Security 29
Remove CLASS ACT premiums (which are dedicated to 
paying future CLASS Act long term care benefits) 70
Add discretionary spending per CBO estimate (IRS, 
HHS, future approps for new programs) 115
Deficit spending for physician update and health 
provisions in HR 4213 (as passed by the House May 
28, 2010) 20

TOTAL (increase in the deficit) $      110
Estimate of Effects on Direct Spending for H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, Title V, Subtitle B
Based on HR 4213 EAH1S.
Assumed enactment July 1, 2010
By fiscal year, in billions of dollars.
2010- 2010-
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2015 2020

Section 1/
511 Extension of Sec. 508 reclassifications 0 0.3 * 0 0 0 0 0 0 0 0 0.3 0.3
512 Repeal of delay of RUG-IV 0 0 0 0 0 0 0 0 0 0 0 0 0
513 Limitation on reasonable cost payments for certain clinical diagnostic laboratory tests furnished
to hospital patients in certain rural areas Need *decision *on policy.
0 0 0 0 0 0 0 0 0 * *
514 Funding for claims reprocessing 0.1 0.1 0 0 0 0 0 0 0 0 0 0.2 0.2
515 Medicaid and CHIP technical corrections 0 0 0 0 0 0 0 0 0 0 0 0 0
516 Addition of inpatient drug discount program to 340B drug discount program 0 * * * * * * * * * * * *
517 Continued inclusion of orphan drugs in definition of covered outpatient drugs with respect to
children's hospitals under the 340B drug discount program 0 0 0 0 0 0 0 0 0 0 0 0 0
518 Conforming amendment related to waiver of coinsurance for preventive services 0 0 0 0 0 0 0 0 0 0 0 0 0
519 Establish a CMS-IRS data match to identify fraudulent providers 0 0 * * -0.1 -0.1 -0.1 -0.1 -0.1 -0.1 -0.1 -0.2 -0.4
520 Clarification of effective date of Part B special enrollment period for disabled TRICARE
beneficiaries 0 * * * * * * * * * * * *
521 Physician payment update 3.1 16.6 5.5 0 0 0 0 0 0 0 0 25.2 25.2
522 Adjustment to Medicare payment localities 0 0 * 0.1 0.1 0.1 0.1 * 0 0 0 0.3 0.4
523 Clarification of 3-day payment window -3.2 -1.1 0 0 0 0 0 0 0 0 0 -4.2 -4.2

INTERACTIONS

Medicare Advantage Interaction 0 0 1.1 * * * * * 0 0 0 1.2 1.2

Premium Interactions 0 -2.1 -1.1 0.2 * * * * * * * -3.1 -3.1
Medicaid Interactions with Medicare Part B Provisions 0 0 0 0 0 0 0 0 0 0 0 0 0
TRICARE Interaction * 0.3 0.1 * * * * * 0 0 0 0.3 0.3
IPAB Interaction 0 0 0 0 0 0 0 0 * 0.1 0.1 0 0.2

Total, Changes in Direct Spending - Title V, Subtitle B * 14.1 5.6 0.2 * * * * * * * 19.9 20.0

NOTES:
" * " is between $50 million and -$50 million.
Components may not sum to totals because of rounding.

1/ Estimates for individual sections do not include MA, Part B premium, Medicaid, TRICARE, or IPAB interactions.

CHIP = Children's Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; IPAB = Independent Payment Advisory Board; IRS = Internal Revenue Service;
MA = Medicare Advantage; RUG-IV = Resource Utilization Group, version four; TRICARE is the health plan operated by the Department of Defense.

Total Spending for Section 521: Physician payment update - including estimated interactions with
Medicare Advantage, Medicaid, TRICARE, and Part B Premiums 3.1 14.5 5.3 0 0 0 0 0 0 0 0 22.9 22.9

Congressional Budget Office Page 1 of 1 June 7, 2010