Officials at the Congressional Budget Office (CBO) have no good way to estimate the overall, long-term effect of doing away with implementation funding for the Patient Protection and Affordable Care Act of 2010 (PPACA).
CBO Director Douglas Elmendorf comes to that conclusion in a letter sent to Rep. Henry Waxman, D-Calif.
Some members of Congress already have asked analysts at the CBO and the Joint Committee on Taxation (JCT) to analyze the effects of temporarily taking away funding for implementation of PPACA and its companion act, the Health Care and Education Reconciliation Act of 2010.
The CBO and JCT analysts already have determined that taking implementation funding away for fiscal year 2011, which began Oct. 1, 2010, would reduce the budget deficit by about $1.4 billion in 2011 but increase deficits by about $6 billion between now and 2021, Elmendorf says.
JCT analysts believe a permanent ban on implementation would lead to a significant loss of revenues, Elmendorf says.
"CBO cannot determine whether changes in spending under a permanent prohibition would produce net costs or net savings relative to its baseline projection, which assumes full implementation," Elmendorf says. "CBO and JCT do not have sufficient basis to provide a comprehensive estimate of the budgetary effects of legislation that would prohibit the use of funding to implement the 2010 health laws, yet would not repeal any provisions of that law."
It is not clear, for example, how taxpayers and their tax advisors would proceed if they owed new taxes — such as a tax on health insurers that is supposed to take effect in 2013 — but the Internal Revenue Service (IRS) had not explained how to pay the tax, Elmendorf says.
"Taxpayers' willingness to adhere to PPACA and Reconciliation Act provisions would depend in part on factors such as whether the change in law would be clearly reflected on the form to be submitted to the IRS, whether it would be reflected in regulations and tax filing instructions, and, over time, whether the IRS would appear to be enforcing compliance with the provisions," Elmendorf says.
- Allison Bell
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