Health Bill Increases Discretionary Spending by At Least $65-$75 billion

When we have discussed health care reform, in the past, we have charted and graphed the effects of the bills on direct spending (general mandatory spending) and on revenues. But the bills also authorize a considerable amount of discretionary spending, which future Congresses can spend through the appropriations process. Although CBO has still not accounting for all of this authority, they have begun to measure it here.

According to CBO, there are three types of discretionary costs:

  • Implicit authorization of discretionary costs associated with implementing the new policies established under the legislation; although no provisions in the legislation specifically authorize such spending, it would be necessary for agencies to carry out the responsibilities that would be required of them by the bill.
  • Explicit authorizations for a variety of grant and other programs for which specified funding levels for possible future appropriations are set in the act for one or more years. (Such cases include provisions where a specified funding level is authorized for an initial year along with the authorization of such sums as may be necessary for continued funding in subsequent years.)
  • Explicit authorizations for a variety of grant and other programs for which no funding levels are specified in the legislation.

CBO estimates $5 to $10 billion (over ten years) in implicit authorization for the IRS to implement the bill, and at least another $5 to $10 billion for the Department of Health and Human Services for the same purpose.

In addition, the CBO estimates that the bill authorizes at least $56 billion in explicit funds. This includes $34 billion for grants to Federal Qualified Health Centers between 2010 and 2015 (presumable more would be authorized at that point). But it excludes all the grants and programs which are funded with "such sums as may be necessary" rather than a specific number.

Here is their chart (excluding the implicit IRS and HHS funds):