Gruber Presentation
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This document summarizes modeling done by Dr. Jonathan Gruber on the impact of the Affordable Care Act in Colorado. The modeling estimates that in 2016: - 460,000 fewer Coloradans will be uninsured under the ACA - 620,000 people will gain coverage through the reformed individual market - 160,000 more people will be covered by Medicaid/CHP+ - The average household in Colorado will see $840 in additional benefits from the ACA due to lower premiums and out-of-pocket costs offsetting slightly higher taxes.
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CONGRESS OF THE UNITED STATESCONGRESSIONAL BUDGET OFFICE
CONGRESS OF THE UNITED STATES
CONGRESSIONAL BUDGET OFFICE
CBO
Social Security
Policy Options
JULY 2010
Pub. No. 4140
A
S T U D Y
CBO
Social Security Policy Options
July 2010
The Congress of the United States O Congressional Budget Office
CBO
Notes
Unless otherwise noted, all years are calendar years.
Numbers in the text and tables may not add up to totals because of rounding.
Preface
Social Security is the federal government’s largest single program, and as the
U.S. population grows older in the coming decades, its cost is projected to increase more
rapidly than its revenues. As a result, under current law, resources dedicated to the program
will become insufficient to pay full benefits in 2039, the Congressional Budget Office (CBO)
projects. Long-run sustainability for the program could be attained through various
combinations of raising taxes and cutting benefits; such changes would also affect the
Social Security taxes paid and the benefits received by various groups of people. This CBO
study examines a variety of approaches to changing Social Security, updating an earlier work,
Menu of Social Security Options, which CBO published in May 2005. In keeping with CBO’s
mandate to provide objective, impartial analysis, the current study makes no
recommendations.
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CBO’s Health and Human Resources Division, under the direction of Joyce Manchester and
Bruce Vavrichek. Research assistance was provided by Philip Armour, Sarah Axeen, and
L. Daniel Muldoon. James Baumgardner, Sheila Dacey, Benjamin Page, David Rafferty,
Jonathan Schwabish, and Julie Topoleski provided helpful comments on earlier drafts.
Andrew Biggs of the American Enterprise Institute and Paul Van de Water of the Center for
Budget and Policy Priorities also provided useful comments. (The assistance of external
reviewers implies no responsibility for the final product, which rests solely with CBO.)
Kate Kelly edited the manuscript, and Leah Mazade and Sherry Snyder proofread it.
Maureen Costantino took the cover photograph and designed the cover, and Jeanine Rees
prepared the study for publication. Jonathan Schwabish provided help with graphics.
Monte Ruffin produced the initial printed copies, Linda Schimmel coordinated the print
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(www.cbo.gov).
Douglas W. Elmendorf
Director
July 2010
CBO
www.cbo.gov
http://www.cbo.gov/doc.cfm?index=6377
MaureenC
Doug Elmendorf
Contents
Summary ix
Introduction 1
An Overview of Social Security 1
Social Security Projections 4
Assessing Options for Changing Social Security 7
Key Elements of Social Security 8
Scope of the Options 9
Effects of the Options on the System’s Finances 11
Effects of the Options on Payroll Taxes Paid and Benefits Received by
Various Groups 13
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Notes
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Preface
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U.S. population grows older in the coming decades, its cost is projected to increase more
rapidly than its revenues. As a result, under current law, resources dedicated to the program
will become insufficient to pay full benefits in 2039, the Congressional Budget Office (CBO)
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combinations of raising taxes and cutting benefits; such changes would also affect the
Social Security taxes paid and the benefits received by various groups of people. This CBO
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mandate to provide objective, impartial analysis, the current study makes no
recommendations.
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Bruce Vavrichek. Research assistance was provided by Philip Armour, Sarah Axeen, and
L. Daniel Muldoon. James Baumgardner, Sheila Dacey, Benjamin Page, David Rafferty,
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Andrew Biggs of the American Enterprise Institute and Paul Van de Water of the Center for
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reviewers implies no responsibility for the final product, which rests solely with CBO.)
Kate Kelly edited the manuscript, and Leah Mazade and Sherry Snyder proofread it.
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prepared the study for publication. Jonathan Schwabish provided help with graphics.
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Introduction 1
An Overview of Social Security 1
Social Security Projections 4
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Key Elements of Social Security 8
Scope of the Options 9
Effects of the Options on the System’s Finances 11
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(1.41) (0.03)
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Medicare
It is the government insurance for elder that is 65+, and it covers the fee that is related to sickness (doctors’ office visits, the drug costs, and etc.), which is financed by the payrool tax
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b. What changes in behavior explain these patterns?
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Labor demand ln L = 2.98 – 0,11 ln W R2 = 0.65
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Labor supply ln L = 2.63 + 0.10 ln W R2 = 0.58
(1.28) (0.04)
a. Which coefficients are statistically significant and which are not?
b. If the minimum wage is $7.25, how many workers will firms want to hire, how many people will want to work, and what is the unemployment rate in this labor market?
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d. If the average worker in this labor market works 30 hours per week and 50 weeks per year, what are the total earnings of all minimum wage workers at $7.25 and $10.00? Give your answers in billions of dollars.
e. Compare the average annual earnings for all people in this labor market and the unemployment rate when the minimum wage is $7.25 and $10. Given these numbers, should the minimum wage be raised to $10?
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The proposed rule outlines several changes to the 2020 Quality Payment Program:
1. The MIPS performance threshold will increase from 30 to 45 points. Eligible clinicians must score at least 45 points to avoid a penalty and 80 points to receive an exceptional performance bonus.
2. CMS will post 2018 MIPS performance scores on Physician Compare in late 2019. Scores will include minimum, maximum and final scores.
3. Category weights have been modified, with Quality decreasing from 45% to 40% and Cost increasing from 15% to 20% in 2020.
4. Data completeness thresholds are increasing for all measure types to 70% of applicable patients.
CMS QPP Proposed Rule 2020
The proposed rule outlines several changes to the Quality Payment Program for 2020:
1. The MIPS performance threshold will increase from 30 to 45 points, meaning clinicians need to score at least 45 points to avoid a penalty. The top bonus is awarded at 80 points.
2. CMS will post 2018 MIPS performance scores on Physician Compare in late 2019. Scores will include minimum, maximum and final scores.
3. Category weights have been adjusted, with Quality decreasing from 45% to 40% and Cost increasing from 15% to 20% for 2020.
4. Data completeness thresholds are increasing for quality measures to 70% of patients.
2020 MIPS Proposed Rule: Key Highlights
The proposed rule outlines several changes to the 2020 Quality Payment Program:
1. The MIPS performance threshold will increase from 30 to 45 points. Eligible clinicians must score at least 45 points to avoid a penalty and 80 points to receive an exceptional performance bonus.
2. CMS will post 2018 MIPS performance scores on Physician Compare in late 2019. Scores will include minimum, maximum and final scores.
3. Category weights have been modified, with Quality decreasing from 45% to 40% and Cost increasing from 15% to 20% in 2020.
4. Data completeness thresholds are increasing for all measure types to 70% of patients.
2020 MIPS Proposed Rule: Key Highlights
The proposed rule outlines several changes to the 2020 Quality Payment Program:
1. The MIPS performance threshold will increase from 30 to 45 points. Eligible clinicians must score at least 45 points to avoid a penalty and 80 points to receive an exceptional performance bonus.
2. CMS will post 2018 MIPS performance scores on Physician Compare in late 2019. Scores will include minimum, maximum and final scores.
3. Category weights have been modified, with Quality decreasing from 45% to 40% and Cost increasing from 15% to 20% in 2020.
4. Data completeness thresholds are increasing for all measure types to 70% of applicable patients.
Opportunites for change
The document discusses strategies for employers to prepare for healthcare reform by making their medical plans more efficient. It recommends analyzing claims data to understand utilization patterns and design incentives to encourage employees to use lower-cost providers and services. Specific tactics mentioned include promoting generic drugs, free clinic programs, and wellness incentives to reduce costs and catch issues early through preventative care.
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Gruber Presentation
- 1. Summary of Dr. Jonathan Gruber’s Health Insurance Exchange Modeling Jeff Bontrager Colorado Health Institute Marketing, Enrollment and Outreach Workgroup (MEOW) Meeting September 21, 2011 bontragerj@coloradohealthinstitute.org
- 2. Background and caveats • This presentation was given by Dr. Jonathan Gruber from MIT to the Colorado Health Benefit Exchange Board on Sept 16, 2011 • Data source is the 2008-09 Colorado Household Survey and the Gruber Microsimulation Model • All numbers are estimates, limited to ages 0-64 • The final report, including narrative, methods and assumptions, is planned for release within the next month
- 3. Table 1: Colorado Enrollments Insurance Category 2011 % of population Employer-Sponsored Insurance (ESI) 2,650,000 62.3% Small Firm ESI (1-50 employees) 570,000 13.4% Large Group ESI 2,080,000 49.0% Individual Market Insurance 310,000 7.2% Public Insurance 440,000 10.3% Uninsured 850,000 20.1%
- 14. Table 2: Estimate of ACA Effect, 2016 No Reform With ACA ACA Impact ESI 2,630,000 2,600,000 -30,000 Small Firm ESI (1-50 employees) 560,000 540,000 -20,000 Other ESI 2,070,000 2,060,000 -10,000 Unreformed Non-group 340,000 60,000 -280,000 Reformed Non-group 0 620,000 620,000 Tax Credit Recipients 0 470,000 470,000 Non-Recipients 0 150,000 150,000 Public Insurance 550,000 710,000 160,000 Uninsured 860,000 400,000 -460,000 Total 4,390,000 4,390,000
- 19. Table 3: Summary of Previously Uninsured, 2016 Post-ACA Adult females 19- 44 Adult females 45- 64 Adult males 19-44 Adult males 45-64 Children Ages 0-18 Medicaid/C HP+ 39,000 21,000 41,000 11,000 19,000 Reformed or Unreformed Non-group 30,000 41,000 72,000 40,000 29,000 Employer Sponsored Insurance 38,000 12,000 53,000 17,000 36,000 Total Newly Insured 111,000 74,000 170,000 68,000 85,000 Remaining Uninsured 90,000 43,000 88,000 49,000 84,000 Baseline Uninsured 202,000 117,000 259,000 116,000 170,000
- 20. Table 4: Movements due to ACA: 2016 Ex-ante ESI Nongroup Public Uninsured Total ESI 2,440,000 - - 160,000 2,600,000 Ex-Post Reformed or Unreformed Nongroup 130,000 330,000 0 220,000 680,000 Public 30,000 - 550,000 130,000 710,000 Uninsured 40,000 - 0 350,000 400,000 Total 2,630,000 330,000 550,000 860,000 4,390,000 Note: “-” indicates a movement that is less than 10,000 but greater than 0.
- 25. Table 5: Reformed Market Participation and Tax Credit Uptake: 2016 # of individuals Cumulative # of individuals Tax credit recipients in individual reformed market 470,000 - Employees (& dependents) of firms receiving tax credit 120,000 590,000 Non-tax credit recipients in individual reformed market 150,000 740,000 Employees (& dependents) of non-tax credit firms with <50 employees 420,000 1,160,000
- 26. Table 6: Premiums and Actuarial Values for those Remaining on Nongroup: 2016 Ex-Ante Ex-Post (No Subsidies) Ex-Post (With Subsidies) Average Nongroup Premium $5,580 $6,610 $4,060 Average Nongroup Actuarial Value .608 .676 .675 Note: The changes in this table do not reflect removal of pre-existing conclusions restrictions, reuse of any funds that fund the high risk pool (which is now folded into the reformed market), or reinsurance/risk adjustment/risk corridor mechanisms.
- 27. Figure 19: Nongroup Premium Changes (including tax credits) for those Remaining on Nongroup: 2016 34% 11% 5% 0% 6% 7% 14% 18% 5% <-50% -50% to -25% -25% to -10% -10% to 0% 0% 0% to 10% 10% to 25% 25% to 50% >50%
- 28. Table 7: Household Budget Effects: 2016 Status Quo (in billions) After ACA (in billions) ACA Effect (in billions) Per Household Effect Wages $162.1 $162.4 $0.3 $130 Exchange Credits $0.0 $1.0 $1.0 $440 Public Insurance $0.0 $0.6 $0.6 $270 Additional Benefits $1.9 $840 ESI Contribution $4.0 $3.8 -$0.2 -$90 Non-group Premium $1.8 $1.8 $0.0 $0 OOP Spending $2.6 $2.4 -$0.2 -$90 Taxes $37.0 $37.4 $0.4 $180 Additional Costs $0.0 $0 Net Effects $1.9 $840
- 29. $1,500*
- 31. $1,150*