Rove advances dubious claim that health care reform “would cost $115 billion more than estimated”

Rove: CBO reports shows health care reform “would cost $115 billion more than estimated.” In a June 3 Wall Street Journal op-ed, Fox News contributor Karl Rove claimed “the Congressional Budget Office updated its cost projections. It found that the new health legislation would cost $115 billion more than estimated when it was enacted.”

But Congress must separately vote on provisions included in the $115 billion figure

CBO: Health care reform authorizes at least $115 billion in “discretionary spending” that Congress could choose to approve separately. In a May 11 letter to Rep. Jerry Lewis (R-CA), CBO estimated the “costs that will be incurred by federal agencies to implement the new policies established” by the health care reform legislation, as well as the cost of "[e]xplicit authorizations" for grant and program spending that is not specifically appropriated by the bills. CBO determined that costs of implementation would be at least $10 billion to $20 billion over 10 years, while the costs of the explicit authorizations would be “about $105 billion” over that period, and thus the total would “probably exceed $115 billion over the 2010-2019 period.” The letter makes clear, however, that “By their nature... all such potential effects on discretionary spending are subject to future appropriation actions, which could result in greater or smaller costs than the sums authorized by the legislation.” In other words, Congress must separately approve those funds in order for them to be spent.

Time's Pickert: "[T]his additional discretionary spending will only happen if Congress authorizes it." Time's Kate Pickert wrote on May 12 that “this additional discretionary spending will only happen if Congress authorizes it. The $938 billion in mandatory spending called for in the law, on the other hand, will happen unless Congress acts to change the law.” Pickert further stated:

So the new law says the government will spend $938 billion over ten years on provisions in the Patient Protection and Affordable Care Act. The law also says Congress can spend $115 billion more, but it doesn't have to. In other words, future discretionary spending called for in some new programs, along with expenses incurred by federal agencies charged with overseeing implementation -- like the IRS and Department of Health and Human Services -- is up to Congress.

This is not atypical. This is run-of-the-mill business as usual Congress. Funding to keep the government running -- and the lights on at the IRS -- is often doled out this way, via the budget. There is $34 billion in authorized spending for community health centers in the new CBO health reform estimate. These centers are almost always paid for with discretionary spending. In fact, says Paul Van de Water, of the Center on Budget and Policy Priorities, “Most of things [in the CBO letter] are things traditional [sic] financed through appropriations.”

CBO Director: “CBO's discretionary baseline...already accounts for much of the potential discretionary funding.” In a May 13 statement, Congressional Budget Office Director Doug Elmendorff clarified that the cost increases estimated by CBO were discretionary and “include many items whose funding would be a continuation of recent funding levels for health-related programs or that were previously authorized and that PPACA would authorize for future years.” Further, Elmendorff explained that most of the costs were already included in the cost estimates of the health care bill: “CBO's discretionary baseline, which assumes that 2010 appropriations are extended with adjustments for anticipated inflation, already accounts for much of the potential discretionary spending under PPACA.”

White House: Discretionary health care provisions would have to be offset by comparable spending cuts

White House has reportedly said discretionary spending must be “offset somewhere else in the discretionary budget.” In a May 11 article about the CBO estimate, Politico reported that Office of Management and Budget spokesman Kenneth Baer stated, “If these authorizations are funded, they must be offset somewhere else in the discretionary budget. The president has called for a non-security discretionary spending freeze, and he will enforce that with his veto pen.”

Politico: Democratic aide said discretionary spending “will need to compete for funds within set budgetary limits.” Politico further reported: "[A] Democratic leadership aide on Capitol Hill said the Congress will have to stay within the budget." Politico quoted the aide as saying: “Just like other authorized programs, the discretionary programs in health reform will need to compete for funds within set budgetary limits.”

CNN.com: “Congress requires most discretionary spending to have available resources under so-called 'pay to go' rules.”Reporting on the revised CBO discretionary cost estimate, CNN.com noted that "[i]ncreased costs in discretionary spending would not necessarily offset the estimated deficit reduction. Congress requires most discretionary spending to have available resources under so-called 'pay to go' rules."

CBPP: "[I]ncreases in discretionary funding related to health reform may be accompanied by decisions to provide less funding for some other discretionary accounts." The Center on Budget and Policy Priorities (CBPP) has noted that “Congress operates in most years under a limit, set in the congressional budget resolution, on the total amount of discretionary funding that can be appropriated for that year.” CBPP continued: “As a result, any increases in discretionary funding related to health reform may be accompanied by decisions to provide less funding for some other discretionary accounts, since Congress will need to remain within the operative ceiling on discretionary appropriations.”

Congress often decides not to approve this type of authorized discretionary spending

OMB spokesman: “Congress does not always act on authorizations that are put into legislation by drafters.” The Associated Press reported on May 11 that “the additional spending is not mandatory, leaving Congress with discretion to provide the funds in follow-on legislation -- or not.” The AP quoted Baer as saying: “Congress does not always act on authorizations that are put into legislation by drafters. ... Authorizations for discretionary spending are not expenditures.”

CBPP: “Congress traditionally authorizes spending for many discretionary programs at much higher levels than are actually appropriated.” CBPP wrote on March 25 that “Congress traditionally authorizes spending for many discretionary programs at much higher levels than are actually appropriated; indeed, many authorizations are never funded at all, because the Appropriations Committees cannot find room to fund them within the overall amount they are allowed to appropriate for the year.” CBPP also stated:

CBO treats mandatory spending and discretionary spending separately in estimating the cost of legislation. It does so for good reason. Mandatory spending, such as Medicare and Medicaid, continues from year to year unless new legislation is passed to reduce it. In contrast, discretionary spending, which covers most of the day-to-day operations of federal agencies, is provided for a year at a time in annual appropriations bills and is provided only to the extent that those bills make funding available. The CBO cost estimate for health reform appropriately includes all mandatory spending costs in its calculation of the effects of the legislation on the deficit, and provides a separate tabulation of the possible discretionary spending that could -- contingent on future appropriations legislation -- result from enactment of health reform.