Numbers Matter: A Guide to Cost and Coverage Estimates in Health Reform Debates

Skocpol T. , Boomerang: Clinton's Health Security Effort and the Turn Against Government in U.S. Politics (New York: W.W. Norton & Company, 1996).

Davis K. , “Universal Coverage in the United States: Lessons From Experiences of the 20th Century,” Journal of Urban Health 78, no. 1 (2001): 46–58; Birn A. E. , “Struggles for National Health Reform in the United States” American Journal of Public Health, 93, no. 1 (2003): 86–91.

Johnson H. and Broder D. S. , The System: The American Way of Politics at the Breaking Point (New York: Little, Brown and Company, 1996).

Mebane F. , “Bradley vs. Gore: How Media Covered Proposals for Health Insurance Reform in the Context of the 2000 Presidential Campaign,” Journal of Health Communication 8 (2003): 283–293.

See Collins S.R. Davis K. , and Lambrew J.M. , Health Insurance Coverage Returns to the National Agenda: The Health Insurance Expansion Proposals of the 2004 Presidential Candidates (New York: The Commonwealth Fund, 2003).

Kerry J. , Affordable Health Care for Every American, John Kerry President Website at <http://www.johnkerry.com/issues/healthcare/> (last visited June 1, 2004).

Thorpe K.E. , Federal Costs and Savings Associated with Senator Kerry's Health Care Plan, at <http://www.sph.emory.edu/hpm/thorpe/kerry4-4-04final1.htm> (last visited June 1, 2004).

Bush G.W. , Offering Health Care and Prescription Drug Choices, Bush-Cheney '04 Website, at <http://www.georgewbush.com/HealthCare/Brief.aspx> (last visited June 1, 2004).

U.S. Office of Management and Budget, Budget of the United States Government, Fiscal Year 2004 (Washington, D.C.: U.S. Government Printing Office, 2003): at 5; U.S. Office of Management and Budget, Budget of the United States Government, Fiscal Year 2005(Washington, D.C.: U.S. Government Printing Office, 2004): at 6.

“Discretionary” programs are those whose funding is determined annually through the Congressional appropriations process. “Mandatory” programs are those, like entitlement programs, whose funding is determined by laws (other than appropriation laws) that create eligibility criteria and payment formulas that obligate the Federal government to fund program activities irrespective of their cost, the budget situation, or whether Congress has appropriated their funding. “Revenue” refers to money taken in by the Federal government through its taxation. Health reform proposals typically modify and create mandatory programs and Federal revenue.

See, e.g., Schick A. , The Federal Budget: Politics, Policy, Process (Washington, D.C.: Brookings Institution Press, 1995); U.S. Senate Committee on the Budget, The Congressional Budget Process: An Explanation (Washington, D.C.: U.S. Government Printing Office, 1998).

In recent years, the definition of baseline spending for discretionary programs has been changed. After the subsequent fiscal year, (which is subject to the current year's Congress appropriation process) discretionary spending is projected to keep pace with inflation and wage growth.

Note that the positive and negative signs are reversed when assessing policies that affect revenue: a positive change in revenue adds revenue to the Federal Treasury and is thus more analogous to a savings proposal.

U.S. Department of the Treasury, General Explanation of the Administration's Fiscal Year 2005 Revenue Proposals (Washington, D.C.: U.S. Department of the Treasury, 2004).

Thorpe , supra note 7.

In some cases, coverage is projected (e.g., in the Medicare prescription drug cost estimates). However, even in those cases, the distribution of who has what type of coverage in the baseline is typically static, based on what occurred in a recent year rather than projecting change in an area that is notoriously unpredictable.

Estimated based on Census Bureau estimate of the population uninsured rate for 2002 at <http://www.census.gov/hhes/hlthins/historic/hihistt1.html> (last visited June 10, 2004) and projections of population growth, at <http://www.census.gov/ipc/www/usinterimproj/> (last visited June 10, 2004).

U.S. Congressional Budget Office, Haw Many People Lack Health Insurance and for How Long? (Washington, D.C.: U.S. Congressional Budget Office, 2003).

Kaiser Commission on Medicaid and the Uninsured, Health Insurance Coverage in America: 2002 Data Update (Washington, D.C.: The Henry J. Kaiser Family Foundation, 2003).

The Kaiser Family Foundation and Hospital Research and Educational Trust, Employer Health Benefits 2003 Annual Survey (Menlo Park, CA: The Henry J. Kaiser Family Foundation, 2004).

The Henry J. Kaiser Family Foundation, Cost and Coverage Impacts of the President's Health Insurance Tax Credit and Tax Deduction Proposals (Menlo Park, CA: The Henry J. Kaiser Family Foundation, 2004).

Glied S. Remler D.K. , and Zivin J.G. , “Inside the Sausage Factory: Improving Estimates of the Effects of Health Insurance Expansion Proposals,” The Milbank Quarterly 80, no. 4 (2002): 603–636.

Congressional Budget Office, supra note 18.

Pauly M.V. , “The Problem with Estimates,” The Milbank Quarterly 81, no. 1 (2003): 155–159; Glied , supra note 22.

U.S. Congressional Budget Office, Letter to the Honorable Michael Bilirakis regarding CBO's estimate of the cost of a prescription drug benefit in Medicare, August 10, 2001, at <http://www.cbo.gov/showdoc.cfm?index=2989&sequence=0> (last visited June 1, 2004).

U.S. Congressional Budget Office, The Budget and Economic Outlook: Fiscal Years 2004–2013 (Washington, D.C.: U.S. Congressional Budget Office, 2003).

Kohn L.T. Corrigan J.M. Donaldson M.S. , eds., To Err Is Human: Building a Safer Health Care System (Washington, D.C.: National Academy Press, 1999); Institute of Medicine, Care Without Coverage: Too Little, Too Late (Washington, D.C.: The National Academies Press, 2002).

U.S. Congressional Budget Office, Cost Estimate of H.R. 1, The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, November 20, 2004, at <http://www.cbo.gov/showdoc.cfm?index=4808&sequence=0> (last visited June 1, 2004).

U.S. Congressional Budget Office, Issues in Designing a Prescription Drug Benefit for Medicare (Washington, D.C.: U.S. Congressional Budget Office, 2002).

Medicare Reform: Providing Prescription Drug Coverage for Seniors: Hearing before the U.S. House of Representatives, Committee on Energy and Commerce, May 16, 2001 (testimony by Lambrew J.M. ).

See for example Lueck S. , “Medicare Bills' Price Tags Top $400 Billion Cap,” The Wall Street Journal, July 23, 2003, and Lemieux J. , “On Medicare and Budget Numbers, CBO Is Failing,” Roll Call, July 7, 2003.

U.S. Congressional Budget Office, Cost estimate of H.R. 1: Medicare Prescription Drug and Modernization Act of 2003 as passed by the House of Representatives on June 27, 2003 and S.1: Prescription Drug and Medicare Improvement Act of 2003, as passed by the Senate on June 27, 2003, with a modification requested by Senate conferees, July 22, 2003, at <http://www.cbo.gov/showdoc.cfm?index=4468&sequence=0> (last visited June 1, 2004).

U.S. Office of Management and Budget, 2003, supra note 9.

U.S. Office of Management and Budget, 2004, supra note 9.

Pear R. , “Medicare Official Testifies on Cost Figures,” New York Times, March 25, 2004.

Pugh T. , “Bush Administration Ordered Medicare Plan Cost Estimates Withheld,” Knight Ridder/Tribune Business News, March 11, 2004.

Welch W. M. , “Medicare Cost Estimates are No Shock to Some,” USA Today, March 19, 2004.

Pierce E. , “Session Pushes Medicare Cap,” Roll Call, February 11, 2004.

Brownstein R. , “Democrats Can't Seem to Shake the Pack on Health Care,” Los Angeles Times, January 29, 2004.

Collins S.R. , The Affordability Crisis in U.S. Health Care: Findings from the Commonwealth Fund Biennial Health Insurance Survey (New York: The Commonwealth Fund, March 2004).