Madam Speaker, I yield myself such time as I may consume. Madam Speaker, on a rainy September day in 2008, a constituent of mine named Ingrid was badly injured after a terrible fall in her home. She…
Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, on a rainy September day in 2008, a constituent of mine named Ingrid was badly injured after a terrible fall in her home. She was rushed to the emergency room, where she was cared for and her life was spared, yet Ingrid came out of that experience stuck with a $23,000 hospital bill because she couldn't afford to have health insurance. A few months later, Ingrid was forced to sell her home to pay off that enormous hospital bill.
Today, on a rainy day in April of 2014, there is a different story to tell. It is a rainy day in Seattle, not here. It is the story of the Affordable Care Act, the story of 7.1 million mothers and sons, fathers and daughters, who have a newfound sense of health security and peace of mind.
That is 7.1 million honest, hardworking Americans, in addition to the 2 million young adults who are protected by staying on their parents' plan, in addition to the millions more who are now covered through the Children's Health Insurance Program and Medicaid expansion. One of them is Ingrid.
Ingrid's life is vastly different now from what it was in 2008. She still is one of the hardest working people her friends and neighbors have ever met. She still loves the outdoors and drives a pickup truck, but today, she is happy, healthy, and covered because of the ACA.
So as this Chamber, for the 52nd time, considers a radical and extremist Republican bill to kill the Affordable Care Act, I stand with millions of people who have been covered because of the ACA and the millions who still need health security. I stand in opposition to the idea that this Nation is incapable of guaranteeing health security for all its citizens.
Republicans have no plan to cover the American people. Speaker Boehner earlier this week would not commit to releasing a Republican plan until after the election. How transparent can you be? Proof that this is political.
So the introduction of this bill is simply surrender in the face of the health care crisis in America. How else can you explain the Republicans' introduction of a bill that cancels the health insurance policies of 1 million Americans? That sounds like surrender to me.
How else can you explain a bill that raises the deficit by $75 billion? More surrender.
How else can you explain a bill that puts five times the number of American workers at risk of losing hours at work? How else do you explain a bill that does anything but dare employers to slash work hours for workers in order to avoid the responsibility to offer health insurance coverage?
How can they say this bill solves a problem of employers cutting hours and refusing benefits when it really only makes it worse?
It is unconditional surrender by the Republicans, pure and simple, to force yet another vote on a bill that has no chance of becoming law. There isn't one chance in a million.
One thing I learned in medicine was you never say never, but this is one time I can say it. It will never, ever pass the Congress. It is a bill crafted purely to appeal to the Koch brothers and the producers of FOX News, rather than forged to protect honest Americans like Ingrid.
The latest Republican bill also denies a confirmed truth; the ACA is succeeding in its primary mission to expand access to quality health care for each and every American.
So make no mistake. I have got news for you. The ACA is not going away. It is not going away. It is here to stay.
The mission before the Congress now should be--in fact, must be--to move forward to further implement the ACA and to improve the law, where needed.
I talked to Bill Frist about a year ago, former Republican leader of the Senate. He said: Don't repeal; fix.
That is what we ought to be about doing--but we are not doing that-- in order to guarantee not just access for each and every American, but to lower health care costs across the board; yet this rather perverse bill raises health care costs for everyone by increasing the number of uninsured. That is surrender, pure and simple surrender.
It is surrendering to an idea that our Nation is no longer capable of accomplishing great things and surrendering to the idea that America, the richest and the most advanced country on the Earth, can't guarantee that its citizens won't lose their homes when they get sick. That is what you are admitting by this bill.
You are saying they have to choose between food on the breakfast table instead of medicine on their bedside table. That, in my view, is a situation that has no explanation, other than the fact that you have surrendered. You have given up the idea that America can take care of its own people.
It was a choice that Ingrid once had to make, but she will never have to make again. That is what is true about the ACA. She has health care coverage. That is what is right about the ACA, and this bill under consideration, H.R. 2575, has nothing to do with what is either true or right.
I urge my colleagues to vote ``no,'' and I reserve the balance of my time.
Madam Speaker, I yield 4 minutes to the gentleman from Maryland (Mr. Van Hollen).
Madam Speaker, I reserve the balance of my time.
Madam Speaker, I yield myself such time as I may consume.
A little history might be helpful here. There was a time in this country where people worked 60 hours a week, 7 days a week, 6 days a week. The only reason we have a 40-hour week at all were labor unions who went out and struck and forced the process to get a 40-hour workweek.
They also were the ones who created the health care system in this country after the Second World War. People didn't have health insurance prior to that. When the President said, we can't have an increase in wages, that we can't have an increase in benefits, that prices can't go up, the labor unions said, well, let's have something called a benefits package.
The benefits package that was created in the middle forties included health care and pensions. It came from the union movement. They are the ones that stood in the rain and the sleet and the snow on the picket lines to get these changes.
Now, we have a law that comes in and says, let's deal with everybody in this country, and the judgment of this Congress was that an employer had the responsibility to provide health insurance for his or her employees if they worked 30 hours a week. That was considered full time.
It doesn't change the other laws, the labor laws or any of the other things. It is for the purpose of this act that employers must consider their people full time if they work 30 hours.
Now, if employers don't care, if they say, well, let me figure out how I can cheat my people out of any benefits, I am going to drop them down to 29 hours--well, you know, there are people like that. But the law says, if do you that, then you have to pay a penalty for everybody you didn't cover.
So we tried in every way possible to make it possible to give people flexibility. But this law will not work, according to the American Enterprise Institute, without a mandate that everybody be covered.
We are not changing the labor law. We are not changing overtime rules. We are not changing any of that stuff. We are saying, for the purpose of this law, an employer must cover anybody who works 30 hours. And if they don't care about their employees, if they run a restaurant, and they don't want their employees to be healthy, knock them all down to 29 hours, and let them come in sick. Then you have got a restaurant where you are going to eat lunch, and the employees haven't been able to see a doctor. That is what you are asking for.
We are saying everybody in this country ought to have health insurance, and they ought to have the access to go to a doctor when they need it. So this business about we are somehow destroying the work ethic in this country and all that kind of nonsense is simply nonsense. That is not what this is about. This is about another way to destroy the act. And you know it. We know it. And the world should understand that this is the 52nd attempt to repeal the law, to undermine it so it will not work. I urge people to vote ``no.''
I reserve the balance of my time.
Madam Speaker, I yield 4 minutes to the gentleman from Oregon (Mr. Blumenauer).
I yield an additional 1 minute to the gentleman from Oregon.
Madam Speaker, I yield 4 minutes to the gentleman from California (Mr. Becerra).
I yield the gentleman an additional 30 seconds.
Madam Speaker, I yield 5 minutes to the gentleman from California (Mr. Miller), my good friend.
Madam Speaker, I reserve the balance of my time; but could you give us an accounting of our time?
Madam Speaker, I yield 3 minutes to the gentleman from New Jersey (Mr. Pallone).
Madam Speaker, I yield myself 30 seconds to point out to my colleagues that CBO did not say people would lose their jobs. They said because they have health care, they no longer have to stay in the job that they have, and they will be able to stay home or do something else, and that will reduce the number of hours of work. They did not say the bill cuts them out or knocks them out of work.
Madam Speaker, I yield 2 minutes to the gentleman from Virginia (Mr. Connolly).
Madam Speaker, I yield 2 minutes to the gentleman from Illinois (Mr. Lipinski).
Mr. Speaker, would you give us an accounting of the time?
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I now yield 3 minutes to the gentlewoman from Chicago, Illinois (Ms. Schakowsky).
I yield the gentlelady an additional 1 minute.
Mr. Speaker, I yield myself such time as I may consume.
My colleagues out here today have really had a good time telling personal stories, so I have got a few of them for them.
Last week, the distinguished Senator from Texas, Senator Cruz, put a poll up on his Facebook, asking if people are better off under the law. The responses were not what he expected. The overwhelming number of responses--he got nearly 56,000 responses--were in support of the ACA. If you look at it online, of the most recent 100 comments, there are just two that appear more negative than positive, so that is 2 percent that are against it.
One of them said:
Not only am I better off now, but I have friends who are
better off, too.
The second one said:
Yes. I have MS, and I lost my job, and I wasn't able to get
any other insurance because of my preexisting condition.
Thank you, President Obama.
Another one said:
This Nation is better off for helping people avoid the
devastation that poor health can bring. Thank you, ACA.
I reserve the balance of my time.
Senator Ted Cruz
Quick poll: Obamacare was signed into law four years ago
yesterday. Are you better off now than you were then?
Comment with YES or NO!
Like--Comment--March 24 at 5:45am--
Martha Hall Hansen, Pat White Garcia, Linda Hidy and Top
Comments 10,204 others like this.
5,120 shares
Carol Rietz Gates: Not only am I better off, but I have
friends that are better off. Furthermore, this nation is
better off for helping folks avoid the devastation that poor
health can bring. Thank you, ACA!
1,359--March 25 at 6:46pm
13 Replies--1 hr
Kris Williams: I and a few million other people are a lot
better off. I hope you are enjoying your Cadillac plan given
to you by your wife's employer, Goldman Sachs. Stop trying to
deny the rest of us the peace of mind that quality,
affordable health insurance provides us.
1,342--March 24 at 10:13pm
16 Replies--11 mins
Benjamin Corey Feinblum: Yes. Costs stopped climbing. I'm a
small business guy and I don't have to worry because
insurance companies can't drop us anymore.
2,901--March 24 at 3:14pm
52 Replies--10 mins
Lili Ann Fuller: YES, best law ever! And way overdue! I
spent all my retirement savings on overpriced insurance in
order to save my life when I got cancer in 2005. I had no
income and now have no savings. If it had been in place back
then, I wouldn't be looking at a poor retirement, but at
least I am not worried about having care anymore.
2,300--March 24 at 2:04pm--Edited
25 Replies--7 hrs
Lashawn Bell: Yes I have MS and I lost my job I wouldn't be
able to get any other insurance because of my pre existing
condition thank you President Obama. If people get sick they
will realize how this is good.
1,288--March 24 at 2:00pm
16 Replies--1 hr
Anne Wittig Pryor: I don't have Obamacare, but someone I
know who had bad mouthed it for the past for years, recently
had to get coverage after her husband recently passed away.
The first words out of her mouth, ``Thank God for
Obamacare.'' She is a staunch Republican and believes
everything she hears on Fox News. And those who are saying
they won't comply are cutting off their noses to spite their
faces. Wake up!
2,798--March 24 at 1:49pm
52 Replies--2 hrs
Paige Brennan: Impeach Ted Cruz! He caused the shutdown
that hurt this country badly!
3,188--March 24 at 1:18pm
73 Replies--1 hr
Joe Caparco: Isn't it funny that the govemment ``makes''
you buy car insurance and home owners insurance and no one
says a word. For those of you who say you can't afford health
insurance what will you do when you need your health
insurance. No need to answer I alre . . . see more
1,984--March 24 at 1:11pm
68 Replies
Larry E White: Absolutely better off, now lets push for
universal healthcare for everyone.
2,705--March 24 at 1:08pm
26 Replies--1 hr
Sherry Scott Stewart: Absolutely Yes! I have pre-existing
condition that I was born with but didn't appear until later
in life and could not get health insurance at all. I finally
have decent affordable insurance.
What a huge relief!
1,134--March 24 at 1:05pm
4 Replies
Dave Ninehouser: Yes, my wife's little niece who is very
sick would have hit her lifetime limit by now if not for the
ACA. The nation is better off.
1,684--March 24 at 11:44am
10 Replies
Kris Williams: What is really sad is how the American
people have been kept in the dark as to what the ACA really
is. The whole purpose and driving force behind the ACA was to
Improve care and lower costs. The majority of the law deals
with Medicare. The medical cost . . . See More
1,047--March 25 at 1:08am--Edited
32 Replies
Robin Conrad: Yes, my son has Healthcare for the first time
and I know many friends it is helping. The ACA is awesome.
1,101--March 24 at 7:16pm
18 Replies
Shelley Laysi Peterson: hummm something tells me this isn't
quite the response Mr Cruz was hoping for ROFLMAO
1,828--March 24 at 5:58pm
36 Replies--4 hrs
Shelley Laysi Peterson: YES, YES & YES!! Hands Off My
Obamacare!!
1,076--March 24 at 5:52pm
16 Replies--14 mins
Felicia Willems: Yes! Everyone in my family has a pre-
existing condition that range from minor to serious. We were
uninsurable on the individual market Now we've got
great coverage through healthcare.gov. We did NOT get a
subsidy but it still fits our budget!
2,711--March 24 at 3:19pm
69 Replies
Meredith Stark: Oh Senator Cruz, four years ago we didn't
have health insurance, and now we do. It's helping my husband
and I.
914--March 24 at 2:26pm
11 Replies--1 hr
Laura Eakes: Only in America would people be cursing other
people for finally being able to get health insurance, and
calling them mooches and socialists. I'd rather be a
socialist than a selfish psychopath like many right wingers
on here
1,081--March 24 at 2:09pm
27 Replies--9 hrs
Jeffrey Albuna: Well Mr. Cruz, firstly I want to say, I
think your actions putting our country hostage for your 21
hour publicity stunt were awful and despicable. You stood up
there for 21 hours railing against Obamacare, to show the Tea
Party you ``care'' about their v . . . See More
1,444--March 24 at 1:53pm
18 Replies
Brenda Myrick Yasulevicz: For those of you who think that
anyone who answered yes ``is a part of the problem'', I have
worked hard my entire life and done fairly well. I always had
jobs with insurance. Then I became self employed and found
out I couldn't get insured because of pre-existing
conditions. (None are serious or life threatening, or even
require much care) I am very grateful for this insurance!
997--March 24 at 1:26pm
16 Replies--2 hrs
David C. Brown: Yes Ted. In spite of your empty pandering
rhetoric I am better off now that I was four years ago. I now
have an insurance plan, purchased from a private company,
that must insure me rather than suck profit from me. Before,
I was dumped from insurance f . . . See More
2,071--March 24 at 11:47am
47 Replies--2 hrs
Art Zimmerman: Damn straight I am . . . we all are after
the Bush/Cheney near destruction of our country and the
bullshit trickle-down Republican garbage!!
576--March 24 at 6:34pm--Edited
Joy Williams: Of course we are better off. We will now have
consistent care without it destroying our finances.
491--March 24 at 4:32pm
2 Replies
Chuck Provonchee: Yes, Cruz, you pitiful waste of space, we
are all much better off under the ACA. The only ones who
would not agree with that are the mindless people who blindly
follow the GOP and vote against their own best interests. You
should enjoy your time as senator because I don't think you
will ever win another election.
548--March 24 at 2:45pm
11 Replies--2 hrs
Russ Campbell: Thank God for Obama Care. I now have health
care and they discovered I have cancer. I'm going to have
surgery in one week and I might live. Without Obamacare I
would just die.
576--March 24 at 1:10pm
34 Replies--2 hrs
Terry Kelley-King: YES . . . I have insurance and am very
happy to have it . . . of course it could be better by making
it single payer . . . but this is a republican health plan so
it can't be perfect
1,699--March 24 at 1:05pm--Edited
47 Replies
Dave Posmontier: Definitely YES!. We now have drug coverage
and do pay a little bit more in co-pays but get this--My wife
and I are saving $550 a month in premiums. Thanks you
President Obama . . .
609--March 24 at 1:04pm
4 Replies
Kevin Lawton: Much better off. We'd be even better off if
people like you weren't in the US Senate.
1,736--March 24 at 12:15pm
32 Replies
Barbara J Cobuzzi: Yes, much better off.
1,042--March 24 at 12:06pm
11 Replies--1 hr
LN Winchester: YES, It's great! Not only for myself and my
kids, but for the other five million people who can now get
the medical care they need! I'm actually paying a bit more,
but I don't mind because so many families are getting the
medical services they need, in some cases desperately. That
makes it all worthwhile.
1,169--March 24 at 11:56am
28 Replies
Amanda Rosales: YES . . . I was denied heath insurance
because of having MS as a pre-existing condition and would
soon be going medically bankrupt or stop getting treatment. I
now have excellent coverage and have a brighter future!
1,205--March 24 at 11:52am
33 Replies--6 hrs
Bruce Lindner: I just left my insurance agent's office. He
walked me through my options with the ACA, and to put it
mildly, I'm one happy customer! As a self-employed cancer
survivor and a heart attack survivor--factoring in the
outrageous prices they've been gougin . . . See More
397--March 28 at 3:56pm
11 Replies
Alisha Clark: Obamacare does not regulate health care, it
regulates health insurance companies. Who in their right mind
wouldn't want health insurance companies to be regulated?
472--March 26 at 12:26pm
15 Replies--1 hr
Alisha Clark: This morning I received a private message
from one of my many fb friends This person would like me to
share her story. I can only imagine what this person is going
through and I want her to know that we are now in this fight
together.
Hi Alisha: I am n . . . See More
434--March 26 at 5:48am
23 Replies--4 hrs
Cathy Paganelli Kaelin: YES! Saving $350 per month,
preventative care plus dental & vision. And now my 2 adult
children have health insurance which they went without for 2
years. Yes, this family is grateful for the ACA. Thank you,
President Obama, for taking this country into the direction
of health care for all!
434--March 25 at 5:17am
13 Replies
Bonnie Flournoy: Yes. Previously, I had your plan whereby
the ER was my primary physician. Having a strategy alone to
seek medical help has lifted a burden. The burden was making
me just as sick as my condition. In fact, I think the stress
caused the illness.
874--March 24 at 2:08pm
15 Replies
Kathe Mendelsohn-White: YES! Without the ACA, my 21 year
old autistic son would not have any insurance. Thank you
President Obama.
1,778--March 24 at 1:12pm
66 Replies
Paulina Trefault: At the same time, costs are coming down.
The Congressional Budget Office found the health care law is
making significant contributions to fiscal responsibility.
The CBO's most recent estimates show that repealing the law
would actually increase deficit . . . See More
435--March 24 at 12:15pm
8 Replies
Tricia Barsamian-Wise: Yes . . . I no longer work 2 jobs
and have the security of not being denied, my insurance going
up or being canceled. I clearly understand Ted Cruz's POV on
this, his financial backers only hired him to do their dirty
work. But what I find so hard to comprehend is average
Americans being so cruel and hateful.
950--March 24 at 11:52am
28 Replies--6 hrs
Vik Verma: Yes
404--March 24 at 11:34am
Charles Reff: Yes, it allowed me to get better insurance
then my job was offering and for less.
1,368--March 24 at 6:38am
28 Replies
Chuck Myers: What I'd REALLY like to know, Senator Cruz, is
are you a big enough man to READ the tens of thousands of
comments below and admit that just MAYBE, you were WRONG!!!!!
If you were truly a representative OF THE PEOPLE you would
instantly see how desperat . . . See More
351--March 29 at 10:51pm
13 Replies--4 hrs
Ilene Leftwing: Yes, but would be even better off if my
Republican Governor, Nathan Deal, saw fit to help the
citizens of Georgia by implementing the medicaid expansion.
Anyone who stands against the ACA does not get MY vote.
316--March 25 at 9:26am
11 Replies--33 miss
Sandie Cohen: Please do not take away our health coverage.
357--March 24 at 3:43pm
11 Replies--32 mins
Scotty-Miguel Sandoe: YES! Access to Obamacare saves me
money, and as former cancer patient, it means I can no longer
be denied health insurance because of a pre-existing
condition. This is the best government program since
Medicare--thank heavens we have a President who cares about
American citizens for a change!
1,404--March 24 at 11:38am
54 Replies
Jeanne Carver: Yes I am. I had a junky plan, which paid
nothing until after 7500 per year. I now have affordable
healthcare, which costs much less.
780--March 24 at 1:12pm
14 Replies
David Davis: No. I couldn't afford healthcare before and I
still can't and now will also have to pay a fine. Wish I
could fine the government for making my life hell everyday.
1,458--March 24 at 5:47am
322 Replies--4 hrs
Rick LaCrosse: The politicians that rule should live by
their rules & laws!!!
253--March 24 at 5:52am
13 Replies--1 hr
Elizabeth Dubrulle: What an incredibly stupid and badly
written question! Were you actually trying to start a
discussion about healthcare, in which case your question
should have been: is your health care better today than it
was four years ago? (my answer would have been . . . See More
406--March 24 at 8:05am
23 Replies--2 hrs
Chris Marko: As a concerned Canadian, I apologize for both
Ted Cruz and Justin Beiber, that being said, you can keep
both of them, we have a no return policy for defective
merchandise.
135--March 29 at 8:28pm
Breana Corea: LMAO!!! Nice!
14--March 29 at 9:40pm
Something Liberal: please take them back . . . you can
imprison them or torture them . . . we don't care.
15--March 29 at 10:22pm
View more replies
Lamar Birdsey: In 1995 I had my first heart attack. At that
point I was insured. However, my coverage was immediately
terminated by my insurance company. Six months
later I had my second heart attack and had no insurance.
Subsequently I have had two more attacks and was not covered.
I have spent my life savings attempting to stay alive. In
2014, I purchased a wonderful Florida Blue policy. My premium
is $88.73 per month. My deductible is $600.00 annually and
any co-payments are extremely low. EVERYTHING IS COVERED! The
most out of pocket expense I will have to pay in a given year
is $2250.00. I am much better off now that the ACA has become
law. Senator Cruz, I suggest you pack your bags and go back
to where you came from, Canada. You are a scourge on this
great nation. We do not need or want your ilk here. If you
want to screw up a health care program, by all means return
to Canada and mess with that one. DO NOT TREAD ON MY
Mr. Speaker, I continue to reserve the balance of my time.
Mr. Speaker, can you tell us how much time remains?
Is the gentleman ready to close?
Mr. Speaker, I yield 2 minutes to the gentleman from Massachusetts (Mr. Capuano).
Mr. Speaker, I yield myself such time as I may consume.
It is an old political tactic to use confusion. We have watched for almost 4 years the Republican Party try to confuse the American people about the Affordable Care Act. It was the worst thing that was ever going to happen on the face of the Earth. We would have storms, hurricanes, unemployment, wars, and famines, all because of the Affordable Care Act.
Well, we are up here today with yet another attempt to confuse people about the 40-hour workweek and whether or not we are going to cause people to lose their jobs.
On page 125 of the CBO report on the budget outlook for 2004 to 2024, it says:
In CBO's judgment, there is no compelling evidence that
part-time employment has increased as a result of the ACA.
Everything you have learned out here about losing jobs is not true. There is nothing in the law that says people have to shorten the workweek.
I don't know if anybody on the other side understands the free enterprise system. Businesses are run by entrepreneurs who decide what kind of product they are going to produce. They hire people to do that. They decide the hours. They decide the pay. They decide everything.
You keep saying that ObamaCare came in and it is forcing these entrepreneurs in America to cut their employees' wages and hours. There is no such thing in the law. That is not true.
In fact, my colleague from Washington State (Mr. Reichert) just said, Mr. Speaker, that people's hours were already being cut before ObamaCare.
It is not ObamaCare that decides how much somebody works. It is the person who runs the company. If he doesn't care about his employees and doesn't want to give them health care, that is one thing. There are people like that, but there are a lot of people who would like to give health insurance to their people, and we are trying to help them do that with the subsidies in this bill.
Let me come to one other issue, and that is this whole question of women.
I have flown back and forth across the country every week, 35 flights a year, for 25 years, and I know most of the flight attendants on United Airlines between Seattle and Washington, D.C.
I can't tell you how many of those women are working because they get health care benefits. Their husband has a job, but has no benefits, and if they don't have their job, they simply won't have health care in their family.
United Airlines has been through two bankruptcies. They have lost pay increases. They have lost their pension rights. The only thing they have left is that health care benefit, and that is what is holding the family together.
I am sort of interested to watch what happens to the older flight attendants I know, to see whether they leave flying, because they would like to. Their husband has a job, but before, he couldn't get health insurance, and now, he can under the Affordable Care Act, and they can quit working.
When the CBO talks about people working less, it is because the job lock is gone. People are not locked into their jobs because of the fact that they can't get health insurance anyplace else. It makes it available for any American.
The fact is that the cuts you are seeing--if you see employers that are going to take people down from 40 hours a week to 39 so that they can avoid giving benefits, take a look at the morals. I wonder if that person goes to church and talks about how they take care of the poor and the weak and the sick and all the rest.
No, no. You can't have it both ways. You cannot cut your people down 1 hour just to get out of giving them benefits, and that is what you are suggesting is going to go on in this country.
I don't think that badly of owners of businesses myself. Now, there may be some people out there looking for a
way to get around the law, but this law doesn't make anybody do anything, and this law is going to create more problems.
You hear 1 million people are going to lose their health care benefits, and that is not good. This whole idea of continuing to undermine this law by confusing the American people, and making them think it bad isn't working. 1.7 million joined.
Labor Market Effects of the Affordable Care Act: Updated Estimates
Overview
The baseline economic projections developed by the
Congressional Budget Office (CBO) incorporate the agency's
estimates of the future effects of federal policies under
current law. The agency updates those projections regularly
to account for new information and analysis regarding federal
fiscal policies and many other influences on the economy. In
preparing economic projections for the February 2014
baseline, CBO has updated its estimates of the effects of the
Affordable Care Act (ACA) on labor markets.
The ACA includes a range of provisions that will take full
effect over the next several years and that will influence
the supply of and demand for labor through various channels.
For example, some provisions will raise effective tax rates
on earnings from labor and thus will reduce the amount of
labor that some workers choose to supply. In particular, the
health insurance subsidies that the act provides to some
people will be phased out as their income rises--creating an
implicit tax on additional earnings--whereas for other
people, the act imposes higher taxes on labor income
directly. The ACA also will exert conflicting pressures on
the quantity of labor that employers demand, primarily during
the next few years.
How Much Will the ACA Reduce Employment in the Longer Term?
The ACA's largest impact on labor markets will probably
occur after 2016, once its major provisions have taken full
effect and overall economic output nears its maximum
sustainable level. CBO estimates that the ACA will reduce the
total number of hours worked, on net, by about 1.5 percent to
2.0 percent during the period from 2017 to 2024, almost
entirely because workers will choose to supply less labor--
given the new taxes and other incentives they will face and
the financial benefits some will receive. Because the largest
declines in labor supply will probably occur among lower-wage
workers, the reduction in aggregate compensation (wages,
salaries, and fringe benefits) and the impact on the overall
economy will be proportionally smaller than the reduction in
hours worked. Specifically, CBO estimates that the ACA will
cause a reduction of roughly 1 percent in aggregate labor
compensation over the 2017--2024 period, compared with what
it would have been otherwise. Although such effects are
likely to continue after 2024 (the end of the current 10-year
budget window), CBO has not estimated their magnitude or
duration over a longer period.
The reduction in CBO's projections of hours worked
represents a decline in the number of full-time-equivalent
workers of about 2.0 million in 2017, rising to about 2.5
million in 2024. Although CBO projects that total employment
(and compensation) will increase over the coming decade, that
increase will be smaller than it would have been in the
absence of the ACA. The decline in full-time-equivalent
employment stemming from the ACA will consist of some people
not being employed at all and other people working fewer
hours; however, CBO has not tried to quantify those two
components of the overall effect. The estimated reduction
stems almost entirely from a net decline in the amount of
labor that workers choose to supply, rather than from a net
drop in businesses' demand for labor, so it will appear
almost entirely as a reduction in labor force participation
and in hours worked relative to what would have occurred
otherwise rather than as an increase in unemployment (that
is, more workers seeking but not finding jobs) or
underemployment (such as part-time workers who would
prefer to work more hours per week).
CBO's estimate that the ACA will reduce employment reflects
some of the inherent trade-offs involved in designing such
legislation. Subsidies that help lower-income people purchase
an expensive product like health insurance must be relatively
large to encourage a significant proportion of eligible
people to enroll. If those subsidies are phased out with
rising income in order to limit their total costs, the
phaseout effectively raises people's marginal tax rates (the
tax rates applying to their last dollar of income), thus
discouraging work. In addition, if the subsidies are financed
at least in part by higher taxes, those taxes will further
discourage work or create other economic distortions,
depending on how the taxes are designed. Alternatively, if
subsidies are not phased out or eliminated with rising
income, then the increase in taxes required to finance the
subsidies would be much larger.
CBO's estimate of the ACA's impact on labor markets is
subject to substantial uncertainty, which arises in part
because many of the ACA's provisions have never been
implemented on such a broad scale and in part because
available estimates of many key responses vary considerably.
CBO seeks to provide estimates that lie in the middle of the
distribution of potential outcomes, but the actual effects
could differ notably from those estimates. For example, if
fewer people obtain subsidized insurance coverage through
exchanges than CBO expects, then the effects of the ACA on
employment would be smaller than CBO estimates in this
report. Alternatively, if more people obtain subsidized
coverage through exchanges, then the impact on the labor
market would be larger.
Why Will Those Reductions Be Smaller in the Short Term?
CBO estimates that the ACA will cause smaller declines in
employment over the 2014--2016 period than in later years,
for three reasons. First, fewer people will receive subsidies
through health insurance exchanges in that period, so fewer
people will face the implicit tax that results when higher
earnings reduce those subsidies. Second, CBO expects the
unemployment rate to remain higher than normal over the next
few years, so more people will be applying for each available
job--meaning that if some people seek to work less, other
applicants will be readily available to fill those positions
and the overall effect on employment will be muted. Third,
the ACA's subsidies for health insurance will both stimulate
demand for health care services and allow low-income
households to redirect some of the funds that they would have
spent on that care toward the purchase of other goods and
services--thereby increasing overall demand. That increase in
overall demand while the economy remains somewhat weak will
induce some employers to hire more workers or to increase the
hours of current employees during that period.
Why Does CBO Estimate Larger Reductions Than It Did in 2010?
In 2010, CBO estimated that the ACA, on net, would reduce
the amount of labor used in the economy by roughly half a
percent--primarily by reducing the amount of labor that
workers choose to supply. That measure of labor use was
calculated in dollar terms, representing the approximate
change in aggregate labor compensation that would result.
Hence, that estimate can be compared with the roughly 1
percent reduction in aggregate compensation that CBO now
estimates to result from the act. There are several reasons
for that difference: CBO has now incorporated into its
analysis additional channels through which the ACA will
affect labor supply, reviewed new research about those
effects, and revised upward its estimates of the
responsiveness of labor supply to changes in tax rates.
Effects on Retirement Decisions and Disabled Workers
Changes to the health insurance market under the ACA,
including provisions that prohibit insurers from denying
coverage to people with preexisting conditions and those that
restrict variability in premiums on the basis of age or
health status, will lower the cost of health insurance plans
offered to older workers outside the workplace. As a result,
some will choose to retire earlier than they otherwise
would--another channel through which the ACA will reduce the
supply of labor.
The new insurance rules and wider availability of subsidies
also could affect the employment decisions of people with
disabilities, but the net impact on their labor supply is not
clear. In the absence of the ACA, some workers with
disabilities would leave the workforce to enroll in such
programs as Disability Insurance (DI) or Supplemental
Security Income (SSI) and receive subsidized health
insurance. (SSI enrollees also receive Medicaid; DI enrollees
become eligible for Medicare after a two-year waiting
period.) Under the ACA, however, they could be eligible for
subsidized health insurance offered through the exchanges,
and they cannot be denied coverage or charged higher premiums
because of health problems. As a result, some disabled
workers who would otherwise have been out of the workforce
might stay employed or seek employment. At the same time,
those subsidies and new insurance rules might lead other
disabled workers to leave the workforce earlier than they
otherwise would. Unlike DI applicants who are ineligible for
SSI, they would not have to wait two years before they
received the ACA's Medicaid benefits or exchange subsidies--
making it more attractive to leave the labor force and apply
for DI.
Possible Effects on Labor Supply Through Productivity
In addition to the effects discussed above, the ACA could
shape the labor market or the operations of the health sector
in ways that affect labor productivity. For example, to the
extent that increases in insurance coverage lead to improved
health among workers, labor productivity could be enhanced.
In addition, the ACA could influence labor productivity
indirectly by making it easier for some employees to obtain
health insurance outside the workplace and thereby prompting
those workers to take jobs that better match their skills,
regardless of whether those jobs offered employment-based
insurance.
Some employers, however, might invest less in their
workers--by reducing training, for example--if the turnover
of employees increased because their health insurance was no
longer tied so closely to their jobs. Furthermore,
productivity could be reduced if
businesses shifted toward hiring more part-time employees to
avoid paying the employer penalty and if part-time workers
operated less efficiently than full-time workers did. (If the
dollar loss in productivity exceeded the cost of the employer
penalty, however, businesses might not shift toward hiring
more part-time employees.)
Whether any of those changes would have a noticeable
influence on overall economic productivity, however, is not
clear. Moreover, those changes are difficult to quantify and
they influence labor productivity in opposing directions. As
a result, their effects are not incorporated into CBO's
estimates of the effects of the ACA on the labor market.
Some recent analyses also have suggested that the ACA will
lead to higher productivity in the health care sector--in
particular, by avoiding costs for low-value health care
services--and thus to slower growth in health care costs
under employment-based health plans. Slower growth in those
costs would effectively increase workers' compensation,
making work more attractive. Those effects could increase the
supply of labor (and could increase the demand for labor in
the near term, if some of the savings were not immediately
passed on to workers).
Whether the ACA already has or will reduce health care
costs in the private sector, however, is hard to determine.
The ACA's reductions in payment rates to hospitals and other
providers have slowed the growth of Medicare spending
(compared with projections under prior law) and thus
contributed to the slow rate of overall cost growth in health
care since the law's enactment. Private health care costs (as
well as national health expenditures) have grown more slowly
in recent years as well, but analysts differ about the shares
of that slowdown that can be attributed to the deep recession
and weak recovery, to provisions of the ACA, and to other
changes within the health sector. Moreover, the overall
influence of the ACA on the cost of employment-based coverage
is difficult to predict--in part because some provisions
could either increase or decrease private-sector spending on
health care and in part because many provisions have not yet
been fully implemented or evaluated. Consequently, CBO has
not attributed to the ACA any employment effects stemming
from slower growth of premiums in the private sector.
Effects of the ACA on the Demand for Labor
The ACA also will affect employers' demand for workers,
mostly over the next few years, both by increasing labor
costs through the employer penalty (which will reduce labor
demand) and by boosting overall demand for goods and services
(which will increase labor demand).
Effects of the Employer Penalty on the Demand for Labor
Beginning in 2015, employers of 50 or more full-time
equivalent workers that do not offer health insurance (or
that offer health insurance that does not meet certain
criteria) will generally pay a penalty. That penalty will
initially reduce employers' demand for labor and thereby tend
to lower employment. Over time, CBO expects, the penalty will
be borne primarily by workers in the form of reduced wages or
other compensation, at which point the penalty will have
little effect on labor demand but will reduce labor supply
and will lower employment slightly through that channel.
Businesses face two constraints, however, in seeking to
shift the costs of the penalty to workers. First, there is
considerable evidence that employers refrain from cutting
their employees' wages, even when unemployment is high (a
phenomenon sometimes referred to as sticky wages). For that
reason, some employers might leave wages unchanged and
instead employ a smaller workforce. That effect will probably
dissipate entirely over several years for most workers
because companies that face the penalty can restrain wage
growth until workers have absorbed the cost of the penalty--
thus gradually eliminating the negative effect on labor
demand that comes from sticky wages.
A second and more durable constraint is that businesses
generally cannot reduce workers' wages below the statutory
minimum wage. As a result, some employers will respond to the
penalty by hiring fewer people at or just above the minimum
wage--an effect that would be similar to the impact of
raising the minimum wage for those companies' employees. Over
time, as worker productivity rises and inflation erodes the
value of the minimum wage, that effect is projected to
decline because wages for fewer jobs will be constrained by
the minimum wage. The effect will not disappear completely
over the next 10 years, however, because some wages are still
projected to be constrained (that is, wages for some jobs
will be at or just above the minimum wage).
Businesses also may respond to the employer penalty by
seeking to reduce or limit their full-time staffing and to
hire more part-time employees. Those responses might occur
because the employer penalty will apply only to businesses
with 50 or more full-time-equivalent employees, and employers
will be charged only for each full-time employee (not
counting the first 30 employees). People are generally
considered full time under the ACA if they work 30 hours or
more per week, on average, so employers have an incentive,
for example, to shift from hiring a single 40-hour, full-
time employee to hiring two, 20-hour part-time employees
to avoid bearing the costs of the penalty.
Such a change might or might not, on its own, reduce the
total number of hours worked. In the example just offered,
the total amount of work is unaffected by the changes.
Moreover, adjustments of that sort can take time and be quite
costly--in particular, because of the time and costs that
arise in dismissing full-time workers (which may involve the
loss of workers with valuable job-specific skills); the time
and costs associated with hiring new part-time workers
(including the effort spent on interviewing and training);
and, perhaps most important, the time and costs of changing
work processes to accommodate a larger number of employees
working shorter and different schedules. The extent to which
people would be willing to work at more than one part-time
job instead of a single full-time job is unclear as well;
although hourly wages for full-time jobs might be lower than
those for part-time jobs (once wages adjust to the penalty),
workers also would incur additional costs associated with
holding more than one job at a time.
In CBO's judgment, there is no compelling evidence that
part-time employment has increased as a result of the ACA. On
the one hand, there have been anecdotal reports of firms
responding to the employer penalty by limiting workers'
hours, and the share of workers in part-time jobs has
declined relatively slowly since the end of the recent
recession. On the other hand, the share of workers in part-
time jobs generally declines slowly after recessions, so
whether that share would have declined more quickly during
the past few years in the absence of the ACA is difficult to
determine. In any event, because the employer penalty will
not take effect until 2015, the current lack of direct
evidence may not be very informative about the ultimate
effects of the ACA.
More generally, some employers have expressed doubts about
whether and how the provisions of the ACA will unfold.
Uncertainty in several areas--including the timing and
sequence of policy changes and implementation procedures and
their effects on health insurance premiums and workers'
demand for health insurance--probably has encouraged some
employers to delay hiring. However, those effects are
difficult to quantify separately from other developments in
the labor market, and possible effects on the demand for
labor through such channels have not been incorporated into
CBO's estimates of the ACA's impact.
Effects of Changes in the Demand for Goods and Services on the Demand
for Labor
CBO estimates that, over the next few years, the various
provisions of the ACA that affect federal revenues and
outlays will increase demand for goods and services, on net.
Most important, the expansion of Medicaid coverage and the
provision of exchange subsidies (and the resulting rise in
health insurance coverage) will not only stimulate greater
demand for health care services but also allow lower-income
households that gain subsidized coverage to increase their
spending on other goods and services--thereby raising overall
demand in the economy. A partial offset will come from the
increased taxes and reductions in Medicare's payments to
health care providers that are included in the ACA to offset
the costs of the coverage expansion.
On balance, CBO estimates that the ACA will boost overall
demand for goods and services over the next few years because
the people who will benefit from the expansion of Medicaid
and from access to the exchange subsidies are predominantly
in lower-income households and thus are likely to spend a
considerable fraction of their additional resources on goods
and services--whereas people who will pay the higher taxes
are predominantly in higher-income households and are likely
to change their spending to a lesser degree. Similarly,
reduced payments under Medicare to hospitals and other
providers will lessen their income or profits, but those
changes are likely to decrease demand by a relatively small
amount.
The net increase in demand for goods and services will in
turn boost demand for labor over the next few years, CBO
estimates. Those effects on labor demand tend to be
especially strong under conditions such as those now
prevailing in the United States, where output is so far below
its maximum sustainable level that the Federal Reserve has
kept short-term interest rates near zero for several years
and probably would not adjust those rates to offset the
effects of changes in federal spending and taxes. Over
time, however, those effects are expected to dissipate as
overall economic output moves back toward its maximum
sustainable level.
Why Short-Term Effects Will Be Smaller Than Longer-Term Effects
CBO estimates that the reduction in the use of labor that
is attributable to the ACA will be smaller between 2014 and
2016 than it will be between 2017 and 2024. That difference
is a result of three factors in particular--two that reflect
smaller negative effects on the supply of labor and one that
reflects a more positive effect on the demand for labor:
The number of people who will receive exchange subsidies--
and who thus will face an implicit tax from the phaseout of
those subsidies that discourages them from working--will be
smaller initially than it will be in later years. The number
of enrollees (workers and their dependents) purchasing their
own coverage through the exchanges is projected to rise from
about 6 million in 2014 to
about 25 million in 2017 and later years, and most of those
enrollees will receive subsidies. Although the number of
people who will be eligible for exchange subsidies is similar
from year to year, workers who are eligible but do not enroll
may either be unaware of their eligibility or be unaffected
by it and thus are unlikely to change their supply of labor
in response to the availability of those subsidies.
CBO anticipates that the unemployment rate will remain high
for the next few years. If changes in incentives lead some
workers to reduce the amount of hours they want to work or to
leave the labor force altogether, many unemployed workers
will be available to take those jobs--so the effect on
overall employment of reductions in labor supply will be
greatly dampened.
The expanded federal subsidies for health insurance will
stimulate demand for goods and services, and that effect will
mostly occur over the next few years. That increase in demand
will induce some employers to hire more workers or to
increase their employees' hours during that period.
CBO anticipates that output will return nearly to its
maximum sustainable level in 2017 (see Chapter 2). Once that
occurs, the net decline in the amount of labor that workers
choose to supply because of the ACA will be fully reflected
in a decline in total employment and hours worked relative to
what would otherwise occur.
Differences From CBO's Previous Estimates of the ACA's Effects on Labor
Markets
CBO's estimate that the ACA will reduce aggregate labor
compensation in the economy by about 1 percent over the 2017-
2024 period--compared with what would have occurred in the
absence of the act--is substantially larger than the estimate
the agency issued in August 2010. At that time, CBO estimated
that, once it was fully implemented, the ACA would reduce the
use of labor by about one-half of a percent. That measure of
labor use was calculated in dollar terms, representing the
change in aggregate labor compensation that would result.
Thus it can be compared with the reduction in aggregate
compensation that CBO now estimates to result from the act
(rather than with the projected decline in the number of
hours worked).
The increase in that estimate primarily reflects three
factors:
The revised estimate is based on a more detailed analysis
of the ACA that incorporates additional channels through
which that law will affect labor supply. In particular, CBO's
2010 estimate did not include an effect on labor supply from
the employer penalty and the resulting reduction in wages (as
the costs of that penalty are passed on to workers), and it
did not include an effect from encouraging part-year workers
to delay returning to work in order to retain their insurance
subsidies.
CBO has analyzed the findings of several studies published
since 2010 concerning the impact of provisions of the ACA (or
similar policy initiatives) on labor markets. In particular,
studies of past expansions or contractions in Medicaid
eligibility for childless adults have pointed to a larger
effect on labor supply than CBO had estimated previously.