The Health Bill’s Fiscal Bonus
The Wall Street Journal
March 14, 2017
The furor over the Congressional Budget Office’s report on the House GOP health bill is concentrated on predictions about insurance coverage, which suits Democrats fine. Lost amid the panic is that CBO shows the bill is a far-reaching advance for the market principles and limited government that conservatives usually favor.
The CBO is not omniscient, but if its projections are even close to accurate then ObamaCare repeal and replacement is the most significant government reform in perhaps three decades. Under conventional (static-revenue) scoring, the bill cuts spending on net by $1.22 trillion and eliminates a raft of new taxes worth $883 billion through 2026.
Despite this tax reform and new refundable tax credits for individual insurance purchases, the bill still reduces the deficit by $337 billion. Reducing spending, the tax burden and further debt generation is an enormous pro-growth fiscal bonus.
Absent reform, the brutal budget math is that the U.S. is headed for a debt crisis; major tax increases that subtract from GDP and living standards; or deep and immediate cuts to entitlements that Americans have planned their lives around—or maybe all three. The longer Washington waits, the more painful and politically convulsive the corrections will be.
Taxpayers will save $880 billion in Medicaid alone over the decade as states search for efficiencies. Relative to current law, that’s a 17.6% cut over 10 years. In 2026 Medicaid will be 25% smaller than the CBO otherwise projects on present trend.
The health-care bill also zeroes out almost all ObamaCare tax increases. The targets include the 10-year, $144.7 billion tax on the health insurance industry, which is merely passed through to consumers, and the $19.6 billion medical device excise tax, which undermines life-saving innovation.
Conservative critics are discounting these and other benefits because the bill isn’t everything they imagine, but they’re missing the larger and rarer opportunity. ObamaCare was designed to expand over time, reaching deeper and deeper into the middle class and displacing ever-more private health insurance. This private market decomposition has been slower than expected because the Obama Administration botched the law’s design.
If conservatives fumble this repeal-and-replace moment, they won’t get another chance. And they’ll have squandered their best opening in a generation to control the size and scope of the federal Leviathan.