GOP to stupidly claim ACA "costs have doubled year over year!!" in 3...2...1...
2018 MIDTERM ELECTION
Time: D H M S
This is really more for budget wonks than healthcare wonks, but still kind of interesting: The Congressional Budget Office just issued their September 2015 Monthly Budget Review report. Since the fiscal year runs from October through September each year, this means that they're basically closing the books on 2015 from a budgetary POV:
The federal government ran a budget deficit of $435 billion fiscal year 2015, the Congressional Budget Office estimates—$48 billion less than the shortfall recorded in fiscal year 2014, and the smallest deficit recorded since 2007. Relative to the size of the economy, that deficit—at an estimated 2.4 percent of gross domestic product (GDP)—was slightly below the average experienced over the past 50 years, and 2015 was the sixth consecutive year in which the deficit declined as a percentage of GDP since peaking at 9.8 percent in 2009. By CBO’s estimate, revenues were about 8 percent higher and outlays were about 5 percent higher in 2015 than they were in the previous fiscal year. CBO’s deficit estimate is based on data from the Daily Treasury Statements; the Treasury Department will report the actual deficit for fiscal year 2015 later this month.
There are 2 ACA-related parts, however. The first relates to 2 of the "3 R's" set up to help stabilize the individual health insurance market for the first few years of the ACA's implementation:
Receipts from miscellaneous fees and fines rose by $15 billion (or 42 percent). A little over half of that amount was from new collections from health insurers under the reinsurance and risk adjustment programs established in the Affordable Care Act (ACA).
I don't really understand the "3 R's" well enough to comment on this bit. More notably, however:
Subsidy payments for health insurance purchased through exchanges created under the ACA increased by $14 billion. Those subsidies first began in January 2014, and so were in effect for only nine months of fiscal year 2014, whereas they were in place for all of fiscal year 2015.
The accompanying table shows that total FY2014 ACA subsidies totalled $13 billion, vs. $27 billion (preliminary) for FY2015. This last highlighted part above is important. I have no idea whether any right-wing outlets will try to make hay out of this report, but if they do, it'll no doubt be along the lines of "OBUMMERCARE PRICE TAG MORE THAN DOUBLES YEAR OVER YEAR!!" or somesuch nonsense.
Divide $13B by 9 months period and you get about $1.44 billion per month. Around 5.1 million people were enrolled, on average, the first 9 months of 2014. 87%, or around 4.4 million of them received APTC payments + Cost Sharing Reduction assistance, or around $325 apiece.
For 2015 (actually the last 3 months of 2014, plus the first 9 months of 2015), it's $27 billion divided by 12 months...or $2.25 billion per month, or about 56% higher than last year.
However, here's the thing: If you add up the last 3 months of 2014 and the first 9 months of 2015, the total enrolled in exchange policies is likely to end up being roughly 8.8 million. 84% of that is 7.4 million people receiving APTC + CSR. Divide $2.25B into 7.4M and you get around $303 per enrollee per month.
Now, Both of these numbers are a bit higher than the "$276 average APTC" numbers included in articles like this one in the Fiscal Times, mainly because the CBO subsidies appear to include both APTC and CSR payments. In addition, some of my estimates may be slightly off (especially for the 3rd quarter of 2015, since that number hasn't been released yet), so I'm not necessarily saying that the average subsidy has decreased. My point is that the average per person enrolled has remained fairly consistent.
Shorter version: The reason why the total subsidies doled out has gone up year over year is because a lot more people are now enrolled and receiving subsidies, which is kind of what the CBO has been projecting all along.
None of this is unexpected or out of line with earlier projections.