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Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act

A maintenance culture, which means that what is built is maintained, does not yet exist in Latin America. There is no reason to expect social funds to ensure maintenance better than any of the other ministries. If this culture is instituted, then projects will be sustained, both by the ministries and by the social funds. Citizen participation is emphasized greatly to achieve sustainable out- comes of projects. There is nothing like money to sustain a project. The idea that money is being transferred to the municipalities, that the mu- nicipalities can pay workers for maintaining projects, as in the case of Bolivia, is an important catalyst | Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act In preparing the March 2012 baseline budget projections the Congressional Budget Office CBO and the staff of the Joint Committee on Taxation JCT have updated estimates of the budgetary effects of the health insurance coverage provisions of the Affordable Care Act ACA .1 That legislation comprises the Patient Protection and Affordable Care Act Public Law 111-148 and the health care provisions of the Health Care and Education Reconciliation Act of 2010 P.L. 111-152 . The insurance coverage provisions of the ACA establish a mandate for most legal residents of the United States to obtain health insurance create insurance exchanges through which certain individuals and families may receive federal subsidies to substantially reduce the cost of purchasing health insurance significantly expand eligibility for Medicaid impose an excise tax on certain health insurance plans with relatively high premiums establish penalties on certain employers who do not provide minimum health benefits to their employees and make other changes to prior law.2 CBO and JCT now estimate that the insurance coverage provisions of the ACA will have a net cost of just under 1.1 trillion over the 2012-2021 period about 50 billion less than the agencies March 2011 estimate for that 10-year period see Table 1 following the text .3 The net costs reflect Gross additional costs of 1.5 trillion for Medicaid the Children s Health 1 See Congressional Budget Office Updated Budget Projections Fiscal Years 2012 to 2022 March 2012 . 2 For more information on the insurance coverage provisions of the ACA see Congressional Budget Office cost estimate for H.R. 4872 the Reconciliation Act of 2010 March 20 2010 . 3 The budgetary effects of the ACA discussed in this report are its effects on federal revenues and mandatory spending they do not include federal administrative costs which will be subject to future appropriation action. CBO .