Monday, January 27, 2020

Comprehensive Enrollment and Cost Estimates for the Biden Health Plan, the Buttigieg Health Plan, the Warren Health Plan, and the Sanders Health Plan

In this hyper-partisan environment, I can't think of an organization that better fits the definition of bipartisan than the Committee for a Responsible Federal Budget.

Their mission is to keep the federal budget process honest and responsible. 

Its current board members include a veritable who's who of Washington, DC adults; Mitch Daniels, Leon Panetta, Tim Penny, Erskine Bowles, Kent Conrad, Vic Fazio, and Bill Gradison.

The Committee has just released a comprehensive evaluation of the leading Democratic candidates' health care plans.

It is required reading for any serious health policy wonk. Disbelieve their work at your own peril.

Here are their two summary charts on coverage and budget impact:


This first chart summarizes the net fiscal impact of each candidates plan on the deficit between 2021 and 2030:
"Under our central estimate, we find that Vice President Biden's health plan would increase the deficits by $800 billion over a decade, Mayor Buttigieg's plan would reduce deficits by $450 billion, Senator Sander's plan would increase deficits by $13.4 trillion, and Senator Warren's plan would increase deficits by $6.1 trillion."
The primary reason Buttigieg's plan has a lower cost than the similar Biden plan is that Buttigieg is more aggressive in controlling drug and provider prices.

The Committee has also qualified its estimates:
"Our estimates are rough and rounded, based on our best understanding of how campaign-level detail translates into specific policies, and subject to change as more details are made available."
That is a reasonable qualifier since the candidates' proposals are typically a few pages long in outline form––not the sort of legislative proposals that would follow later and could be scored by the CBO.

The second chart estimates the impact on coverage each plan would have:


From the report:
"Over the next decade, an estimated 30 to 35 million people will lack comprehensive health insurance at some point in a given year, depending on the year, estimator, and definition of coverage. All four plans we analyzed would reduce the number of uninsured individuals substantially. We estimate Biden would reduce the number of uninsured by 15 to 20 million, mainly by improving the affordability of health coverage and auto-enrolling low-income Americans. We estimate Buttigieg would reduce the number of uninsured by 20 to 30 million by improving affordability and implementing auto-enrollment as well as retroactively enrolling and charging premiums to those who lack coverage – essentially establishing a stronger version of an individual mandate. Finally, both Warren and Sanders would reduce the number of uninsured by 30 to 35 million by offering universal Medicare for All coverage to virtually every U.S. resident."

Taking this report at face value, Buttigieg would appear to offer voters the best bang for their buck––Buttigieg covers almost as many people as Sanders and Warren and does so as the only candidate that pays for his program.

However, Buttigieg's rosier outlook depends upon his taking substantially more money from the drug industry and health care providers than does the similar Biden plan and Buttigieg also brings back the very unpopular individual mandate––all very politically problematic.
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