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Letter to the Honorable Paul Ryan 1 (March 2010)

handle is hein.congrec/cbo9386 and id is 1 raw text is: CONGRESSIONAL BUDGET OFFICE Douglas W. Elmendorf, Director U.S. Congress Washington, DC 20515 March 19, 2010 Honorable Paul Ryan Ranking Member Committee on the Budget U.S. House of Representatives Washington, DC 20515 Dear Congressman: This letter responds to several questions you have asked about the effects of an amendment in the nature of a substitute to H.R. 4872, the Reconciliation Act of 2010, which was made public on March 18, 2010. That amendment (hereafter called the reconciliation proposal) represents one component of the health care legislation being considered by the Congress; the other component is a bill, H.R. 3590, that the Senate passed in December. The analysis provided in this letter is based on the preliminary estimate of the direct spending and revenue effects of that amendment that was prepared by the Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT).' The Combined Budgetary Impact of Enacting the Reconciliation Proposal, H.R. 3590, and H.R. 3961 You asked about the total budgetary impact of enacting the reconciliation proposal (the amendment to H.R. 4872), the Senate-passed health bill (H.R. 3590), and the Medicare Physicians Payment Reform Act of 2009 (H.R. 3961). CBO estimates that enacting all three pieces of legislation would add $59 billion to budget deficits over the 2010-2019 period. Under current law, Medicare's payment rates for physicians' services will be reduced by about 21 percent in April 2010 and by an average of about 2 percent per year for the rest of the decade.2 H.R. 3961 would increase those payment rates 1 See Congressional Budget Office, lte oteHnrbeNnyPls bu rlmnr (March 18, 2010). 2 The payment rates shown here reflect the March 2009 baseline, updated for a final rule regarding payments to physicians that was promulgated by the Centers for Medicare and Medicaid Services www.cbo.gov

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