CONGRESSIONAL BUDGET OFFICE
Douglas W. Elmendorf, Director
U.S. Congress
Washington, DC 20515
July 17, 2009
Honorable Charles B. Rangel
Chairman
Committee on Ways and Means
U.S. House of Representatives
Washington, DC 20515
Dear Mr. Chairman:
The Congressional Budget Office (CBO) and the staff of the Joint Committee on
Taxation (JCT) have completed a preliminary analysis of H.R. 3200, the America’s
Affordable Health Choices Act of 2009, as introduced on July 14, 2009. This
analysis does not reflect any modifications or amendments made after that date.
Among other things, the legislation would establish a mandate for legal residents to
obtain health insurance; set up insurance “exchanges” through which some
individuals and families could receive subsidies to substantially reduce the cost of
purchasing insurance; significantly expand eligibility for Medicaid; make
modifications to the Medicare and Medicaid programs; and impose an income-tax
surcharge on high-income individuals.
CBO’s and JCT’s preliminary assessment of the impact on the federal deficit for the
bill as introduced is summarized in the following table. The enclosures with this
letter provide estimates of the changes in the nonelderly U.S. population with health
insurance coverage, the primary budgetary components of the bill’s major
provisions related to insurance coverage, and a detailed table of the other
provisions’ impact on federal direct spending. The estimated impact of the
provisions related to health insurance coverage is based on specifications provided
by the committee staff, rather than on a detailed analysis of the legislative language;
the estimates for other provisions reflect the specific legislative language. (JCT has
separately published its estimates of the effects of revenue provisions contained in
H.R. 3200 as introduced.1)
1 The Joint Committee on Taxation posted its estimate of revenue effects for the introduced v