In it, but not of it. TPM DC
"Several provisions under current law, including provisions in the Patient Protection and Affordable Care Act (PPACA) were designed to control the growth of health care costs," GAO notes. "The full implementation and effectiveness of these cost-control provisions, which are reflected in the Baseline Extended simulation, would slow the growth in federal health care spending over the long term.... However, the Trustees, CBO, and the CMS Actuary have expressed concerns about the effective implementation of certain cost-control measures over the long term."
For example, they have noted that reductions in physician payment rates scheduled to occur under current law have routinely been overridden. They have also questioned whether a provision in PPACA that would restrain spending growth by reducing the payment rates for certain Medicare services based on productivity gains observed throughout the economy is sustainable over the long term. These concerns are reflected in our Alternative simulation, which, consistent with CBO's and CMS Actuary's alternative projections, assumes the Medicare physician rate reductions do not occur and that certain cost- containment mechanisms intended to slow the growth of health care costs are not sustained over the long term.
If Republicans get their way and repeal this and other provisions -- and if Congress keeps passing temporary "doc fixes" to prevent payment cuts to doctors who see Medicare patients -- then Medicare costs will continue to soar, and eventually overwhelm the federal budget.
Here's what the CBO shows happening if current law is left intact:
And here's what happens if key provisions of Obamacare, and other scheduled savings, are repealed:
Republicans' answer to this problem is contained in the controversial budget framework they adopted this past spring. It would phase out Medicare as a single government insurance payer and replace it with a private insurance system -- with subsidies for beneficiaries that grow much slower than the cost of health care. Democrats reject this approach -- but Republicans aren't interested in playing ball with the liberal approach of hacking away at health care costs in a way that ultimately makes Medicare affordable.
You can read the GAO's full report below.