A new cost analysis of the health care overhaul law was issued this week. It was the third in as many weeks — and it won’t be the last.

Two of the reports were requested by Republican lawmakers, part of a steady stream of inquiries to the Congressional Budget Office (CBO) and to the actuary for the Centers for Medicare and Medicaid Services (CMS) about the health care overhaul (PL 111-148, PL 111-152) and its cost to the government.

Republicans are using the results as fodder for their election year assault on the law and what they say is its uncontrolled cost. “There will be more to come on this,” said Rep. Michael C. Burgess, R-Texas. “We do need to stay engaged. This law has not gone away.”

A CBO aide, who asked not to be named, agreed with Burgess’ assertion. Reports on health care “will be coming forever,” the aide said.

In fact, CBO Director Douglas Elmendorf last month told a Senate panel considering his agency’s annual appropriations that much of CBO’s workload is related to health care, and that will not stop.

The latest reports contain no new revelations. But health care financial projections are notoriously hard to make — and even more so when laws are changing. There are also many sides to every cost equation, and both supporters and opponents of the law can seize on parts that support their argument.

The report released this week, for instance — requested several months ago by Jerry Lewis of California, the top Republican on the House Appropriations Committee — showed that discretionary costs from the health care law could reach $115 billion over 10 years, more than twice the size of CBO’s estimate released shortly before President Obama signed the law.

Republicans said the report proved that Democrats’ $900 billion price tag was unrealistic. “The lesson learned here is: Don’t trust what Washington’s saying on Obama-care,” said Sen. Orrin G. Hatch of Utah.

But a Democratic aide for the Senate Finance Committee said the bulk of the discretionary spending is for programs, such as American Indian health care, “that were not created under health care reform and would have been funded through the appropriations process, like they have for decades, with or without health care reform.” CBO issued a clarification making the same point.

Another recent CBO report estimated that in 2016, nearly 4 million people could pay a fine under the law for not buying health insurance. Republicans argued that the penalty contradicts Obama’s promise not to raise taxes on families making less than $250,000 a year. Democrats said the numbers were not surprising, and that those paying penalties amounted to 1.5 percent of the population.

The third report, from CMS actuary Richard Foster in late April, found that while millions more Americans would be covered under the law, the nation’s costs would go up $311 billion, or less than 1 percent.

Democrats offered their own spin on that report, too. “The chief actuary confirms what we’ve been saying — those on Medicare benefit from health reform,” said Rep. Pete Stark, D-Calif., chairman of the Ways and Means Subcommittee on Health.


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