Health Care Forecasting Conference James Baumgardner Deputy Assistant Director for Health Policy Congressional Budget Office February 21, 2008

CBO Baseline Not a forecast of the future. Assumes that current law and policies remain unchanged. Consistent with CBO’s job of scoring proposals relative to current law. Special treatment of discretionary spending.

CBO Baseline Assumptions Tax provisions expire as scheduled. No modification of the Alternative Minimum Tax. Discretionary spending grows with inflation. No fix of Medicare physician payment. War funding remains $88 billion (real).

Budget Outlook Under Current Policies (In billions of dollars)

Budget Outlook Under Current Policies (As a percentage of GDP)

The Total Deficit or Surplus as a Share of GDP, 1968 to 2018 (As a percentage of GDP) Percentage of GDP

Projected Baseline Effects of the Individual Alternative Minimum Tax Millions of ReturnsBillions of Dollars

The Budgetary Effects of Policy Alternatives Not Included in CBO’s Baseline (In Billions of Dollars) Increase Regular Discretionary Spending by the Growth Rate of Nominal GDP Baseline Reduce Number of Troops to 30,000 by 2010 Source: Congressional Budget Office Note: Additional debt service included in alternatives. Index AMT and Extend Expiring EGTRRA and JGTRRA Tax Provisions Index AMT

Uncertainty of CBO’s Projections of the Budget Deficit or Surplus Under Current Policies Deficit or Surplus as a Percentage of Gross Domestic Product

Medicare Baselines: Net Outlays, Average Annual Increase: 6.8% Without Part D: 6.1%

Medicaid Baselines: Mandatory Outlays, Average Annual Increase: 7.9%

The Population Age 65 or Older as a Percentage of the Population Ages 20 to 64 ActualBaseline Projection Percent

Total Federal Spending for Medicare and Medicaid Under Different Assumptions About the Health Cost Growth Differential (Percentage of gross domestic product)

Revenues and Spending Excluding Interest, by Category, as a Percentage of GDP Under CBO’s Long-Term Budget Scenarios

Use of Selected Procedures by People Aged 50 or Older (Millions)

APPENDIX

CBO’s Projections of Spending for Medicare Part D (In billions of dollars)