THE_AT ECONOMIC_JJ CASE_NN1 FOR_IF HEALTH_NN1 CARE_NN1 REFORM_NN1 :_: UPDATE_VV0 DECEMBER_NPM1 Over_II the_AT past_JJ several_DA2 months_NNT2 ,_, the_AT Council_NN1 of_IO Economic_JJ Advisers_NN2 (_( CEA_NP1 )_) has_VHZ released_VVN a_AT1 series_NN of_IO reports_NN2 analyzing_VVG the_AT impact_NN1 of_IO reform-induced_JJ expansions_NN2 in_II health_NN1 insurance_NN1 coverage_NN1 and_CC reductions_NN2 in_II the_AT growth_NN1 of_IO health_NN1 care_NN1 spending_NN1 ._. 
In_II this_DD1 update_NN1 to_II our_APPGE June_NPM1 report_NN1 on_II the_AT Economic_JJ Case_NN1 for_IF Health_NN1 Care_NN1 Reform_NN1 ,_, the_AT CEA_NN1 reviews_VVZ the_AT case_NN1 for_IF reform_NN1 that_CST genuinely_RR reduces_VVZ the_AT growth_NN1 rate_NN1 of_IO health_NN1 care_NN1 costs_NN2 ,_, and_CC presents_VVZ new_JJ findings_NN2 on_II the_AT economic_JJ impact_NN1 of_IO recent_JJ Congressional_JJ proposals_NN2 ._. 
The_AT necessity_NN1 of_IO slowing_VVG the_AT growth_NN1 rate_NN1 of_IO health_NN1 care_NN1 costs_NN2 is_VBZ uncontroversial_JJ ,_, as_CSA families_NN2 ,_, businesses_NN2 ,_, and_CC governments_NN2 at_II every_AT1 level_NN1 are_VBR struggling_VVG to_TO cope_VVI with_IW rapidly_RR increasing_JJ health_NN1 care_NN1 costs_NN2 ._. 
Each_DD1 year_NNT1 ,_, a_AT1 larger_JJR share_NN1 of_IO workers_NN2 '_GE total_JJ compensation_NN1 and_CC of_IO Medicare_NP1 recipients_NN2 '_GE Social_JJ Security_NN1 benefits_NN2 is_VBZ eaten_VVN up_RP by_II insurance_NN1 premiums_NN2 ._. 
Each_DD1 year_NNT1 ,_, fewer_DAR businesses_NN2 ,_, and_CC especially_RR small_JJ businesses_NN2 ,_, can_VM afford_VVI to_TO offer_VVI health_NN1 insurance_NN1 to_II their_APPGE workers_NN2 ._. 
And_CC each_DD1 year_NNT1 ,_, a_AT1 larger_JJR share_NN1 of_IO spending_VVG at_II all_DB levels_NN2 of_IO government_NN1 goes_VVZ to_II health_NN1 care_NN1 ,_, which_DDQ has_VHZ led_VVN to_TO tax_VVI increases_NN2 ,_, cuts_VVZ in_II other_JJ programs_NN2 ,_, and_CC higher_JJR budget_NN1 deficits_NN2 ._. 
Since_CS the_AT release_NN1 of_IO the_AT three_MC CEA_NP1 reports_VVZ earlier_RRR this_DD1 year_NNT1 ,_, both_DB2 the_AT House_NN1 and_CC the_AT Senate_NN1 have_VH0 made_VVN substantial_JJ progress_NN1 toward_II passing_VVG comprehensive_JJ health_NN1 reform_NN1 legislation_NN1 ._. 
Last_MD month_NNT1 ,_, the_AT House_NN1 passed_VVD the_AT Affordable_JJ Health_NN1 Care_NN1 for_IF America_NP1 Act_NN1 of_IO 2009_MC ,_, and_CC the_AT Senate_NN1 is_VBZ currently_RR debating_VVG the_AT Patient_JJ Protection_NN1 and_CC Affordable_JJ Care_NN1 Act_NN1 ._. 
According_II21 to_II22 projections_NN2 by_II the_AT non-partisan_JJ Congressional_JJ Budget_NN1 Office_NN1 (_( CBO_NP1 )_) ,_, both_DB2 bills_NN2 would_VM provide_VVI a_AT1 new_JJ measure_NN1 of_IO security_NN1 and_CC stability_NN1 to_II those_DD2 with_IW insurance_NN1 and_CC extend_VV0 health_NN1 insurance_NN1 coverage_NN1 to_II more_DAR than_CSN thirty_MC million_NNO individuals_NN2 who_PNQS would_VM otherwise_RR be_VBI uninsured_JJ ._. 
The_AT bills_NN2 would_VM also_RR significantly_RR lower_VVI the_AT Federal_JJ budget_NN1 deficit_NN1 in_II the_AT upcoming_JJ decade_NNT1 ,_, and_CC extend_VV0 the_AT solvency_NN1 of_IO the_AT Medicare_NP1 Trust_NN1 Fund_NN1 by_II five_MC years_NNT2 ._. 
This_DD1 report_NN1 presents_VVZ new_JJ estimates_NN2 that_CST the_AT Congressional_JJ proposals_NN2 will_VM reduce_VVI the_AT growth_NN1 of_IO health_NN1 care_NN1 costs_VVZ for_IF individuals_NN2 ,_, businesses_NN2 ,_, and_CC the_AT government_NN1 ,_, and_CC reviews_VVZ the_AT economic_JJ case_NN1 for_IF health_NN1 care_NN1 reform_NN1 ._. 
Some_DD of_IO the_AT many_DA2 benefits_NN2 discussed_VVN below_RL include_VV0 higher_JJR standards_NN2 of_IO living_VVG for_IF workers_NN2 ,_, more_RGR private_JJ sector_NN1 job_NN1 creation_NN1 ,_, and_CC lower_JJR government_NN1 budget_NN1 deficits_NN2 ._. 
I._NP1 HEALTH_NN1 INSURANCE_NN1 REFORM:WILL_FO IT_NN1 CONTROL_VV0 FEDERAL_JJ HEALTH_NN1 CARE_NN1 SPENDING_NN1 ?_? 
The_AT President_NN1 has_VHZ made_VVN clear_JJ his_APPGE support_NN1 for_IF health_NN1 reform_NN1 legislation_NN1 that_CST genuinely_RR slows_VVZ the_AT growth_NN1 rate_NN1 of_IO costs_NN2 ._. 
As_II the_AT Senate_NN1 continues_VVZ debate_NN1 on_II its_APPGE own_DA version_NN1 of_IO health_NN1 insurance_NN1 reform_NN1 legislation_NN1 ,_, the_AT CEA_NN1 has_VHZ been_VBN investigating_VVG whether_CSW and_CC to_II what_DDQ extent_NN1 that_CST bill_NN1 reduces_VVZ the_AT growth_NN1 rate_NN1 of_IO health_NN1 care_NN1 spending_VVG in_II government_NN1 programs_NN2 and_CC in_II the_AT economy_NN1 as_II a_AT1 whole_NN1 ._. 
To_TO do_VDI this_DD1 ,_, we_PPIS2 have_VH0 analyzed_VVN data_NN on_II projected_JJ Federal_JJ spending_NN1 on_II Medicare_NP1 and_CC Medicaid_VVN from_II the_AT CBO_NN1 in_II each_DD1 year_NNT1 through_II 2019_MC ,_, and_CC combined_VVD it_PPH1 with_IW data_NN from_II the_AT CBO_NP1 's_GE most_RGT recent_JJ estimates_NN2 of_IO the_AT impact_NN1 of_IO the_AT Senate_NN1 bill_NN1 ._. 
Our_APPGE findings_NN2 for_IF Medicare_NP1 and_CC Medicaid_NP1 indicate_VV0 that_CST ,_, while_CS combined_JJ Federal_JJ spending_NN1 on_II these_DD2 two_MC programs_NN2 will_VM initially_RR increase_VVI (_( as_CSA eligibility_NN1 for_IF the_AT Medicaid_JJ program_NN1 expands_VVZ )_) ,_, the_AT Senate_NN1 's_GE bill_NN1 will_VM lead_VVI to_II a_AT1 substantial_JJ reduction_NN1 in_II the_AT growth_NN1 rate_NN1 of_IO this_DD1 spending_NN1 over_II time_NNT1 ._. 
These_DD2 findings_NN2 are_VBR consistent_JJ with_IW the_AT CBO_NN1 score_NN1 of_IO the_AT Senate_NN1 legislation_NN1 ,_, which_DDQ finds_VVZ that_CST --_JJ Medicare_NP1 spending_NN1 under_II the_AT bill_NN1 would_VM increase_VVI at_II an_AT1 average_JJ annual_JJ rate_NN1 of_IO around_RG 6_MC percent_NNU during_II the_AT next_MD two_MC decades_NNT2 --_JJ well_RR below_II the_AT roughly_RR 8_MC percent_NNU annual_JJ growth_NN1 rate_NN1 of_IO the_AT past_JJ two_MC decades_NNT2 ._. 
More_RGR specifically_RR ,_, we_PPIS2 find_VV0 that_CST :_: By_II 2019_MC ,_, total_JJ Federal_JJ spending_NN1 on_II the_AT Medicare_NP1 and_CC Medicaid_NP1 programs_NN2 will_VM be_VBI lower_JJR than_CSN it_PPH1 would_VM have_VHI been_VBN absent_JJ reform_NN1 ._. 
These_DD2 long-run_JJ savings_NN2 are_VBR achieved_VVN through_II a_AT1 reduction_NN1 in_II wasteful_JJ spending_NN1 ,_, fraud_NN1 ,_, inefficiencies_NN2 and_CC abuse_NN1 in_II both_DB2 programs_NN2 ,_, along_II21 with_II22 a_AT1 combination_NN1 of_IO delivery_NN1 system_NN1 reforms_VVZ that_CST gives_VVZ providers_NN2 an_AT1 incentive_NN1 to_TO deliver_VVI high_JJ quality_NN1 and_CC efficient_JJ medical_JJ care_NN1 rather_II21 than_II22 costly_JJ ,_, inefficient_JJ care_NN1 with_IW little_JJ or_CC no_AT impact_NN1 on_II quality_NN1 or_CC health_NN1 ._. 
From_II 2016_MC to_II 2019_MC ,_, the_AT annual_JJ growth_NN1 rate_NN1 of_IO Federal_JJ spending_NN1 on_II these_DD2 two_MC programs_NN2 will_VM be_VBI at_RR21 least_RR22 0.7_MC percentage_NN1 point_NN1 lower_JJR than_CSN it_PPH1 otherwise_RR would_VM have_VHI been_VBN ._. 
CBO_NP1 estimates_NN2 suggest_VV0 that_CST the_AT magnitude_NN1 of_IO these_DD2 growth_NN1 rate_NN1 reductions_NN2 will_VM increase_VVI in_II the_AT subsequent_JJ decade_NNT1 ,_, which_DDQ will_VM substantially_RR improve_VVI the_AT long-term_JJ Federal_JJ budget_NN1 outlook_NN1 ._. 
These_DD2 reductions_NN2 will_VM also_RR help_VVI lower_JJR the_AT growth_NN1 rate_NN1 of_IO Medicare_NP1 recipients_NN2 '_GE Part_NN1 B_ZZ1 premiums_NN2 ,_, which_DDQ more_DAR than_CSN doubled_VVN from_II 2000_MC to_II 2008_MC and_CC grew_VVN three_MC times_NNT2 faster_RRR than_CSN did_VDD average_VVI Social_JJ Security_NN1 benefits_NN2 during_II the_AT same_DA period_NN1 ._. 
When_CS combined_VVN with_IW the_AT other_JJ provisions_NN2 that_CST are_VBR in_II the_AT Senate_NN1 bill_NN1 ,_, CBO_NP1 estimates_NN2 suggest_VV0 that_CST the_AT Federal_JJ budget_NN1 deficit_NN1 will_VM be_VBI lower_JJR by_II 0.25_MC percent_NNU of_IO GDP_NN1 in_II the_AT decade_NNT1 following_RA 2019_MC than_CSN it_PPH1 otherwise_RR would_VM have_VHI been_VBN ,_, with_IW the_AT effects_NN2 growing_VVG over_II the_AT decade_NNT1 ._. 
It_PPH1 is_VBZ worth_II noting_VVG that_DD1 CBO_NN1 projections_NN2 in_II the_AT past_NN1 have_VH0 sometimes_RT understated_VVN the_AT savings_NN2 from_II delivery_NN1 system_NN1 reforms_NN2 and_CC revised_JJ payment_NN1 policies_NN2 such_II21 as_II22 those_DD2 included_VVN in_II the_AT Senate_NN1 bill_NN1 ._. 
For_REX21 instance_REX22 ,_, actual_JJ savings_NN2 following_VVG the_AT Balanced_JJ Budget_NN1 Act_NN1 (_( BBA_NP1 )_) of_IO 1997_MC ,_, which_DDQ changed_VVD the_AT way_NN1 skilled_JJ nursing_JJ facilities_NN2 and_CC home_NN1 health_NN1 services_NN2 were_VBDR reimbursed_VVN under_II Medicare_NP1 ,_, were_VBDR 50_MC percent_NNU greater_JJR in_II 1998_MC and_CC 113_MC percent_NNU greater_JJR in_II 1999_MC than_CSN CBO_NP1 originally_RR forecast_VV0 ._. 
Similarly_RR ,_, spending_VVG on_II the_AT Medicare_NP1 Part_NN1 D_ZZ1 prescription_NN1 drug_NN1 benefit_NN1 following_VVG the_AT Medicare_NP1 Modernization_NN1 Act_NN1 of_IO 2003_MC was_VBDZ about_RG 40_MC percent_NNU less_DAR than_CSN CBO_NP1 forecast_NN1 ._. 
CBO_NP1 's_GE analysis_NN1 is_VBZ generally_RR limited_VVN to_II the_AT Federal_JJ budget_NN1 ,_, and_CC does_VDZ not_XX attempt_VVI to_TO account_VVI for_IF savings_NN2 in_II the_AT health_NN1 care_NN1 system_NN1 more_RGR broadly_RR from_II policies_NN2 implemented_VVN through_II reform_NN1 ._. 
For_REX21 example_REX22 ,_, the_AT CBO_NP1 's_GE --_JJ Budget_NN1 Options_NN2 ,_, Volume_NN1 1_MC1 :_: Health_NN1 Care_NN1 document_NN1 found_VVD only_RR $19_NNU billion_NNO in_II Federal_JJ government_NN1 savings_NN2 from_II transitioning_VVG toward_II post-acute_JJ bundled_JJ payments_NN2 in_II Medicare_NP1 ._. 
However_RR ,_, recent_JJ research_NN1 published_VVN in_II the_AT New_NP1 England_NP1 Journal_NN1 of_IO Medicine_NN1 suggests_VVZ that_CST bundled_JJ payments_NN2 for_IF chronic_JJ diseases_NN2 and_CC elective_JJ surgeries_NN2 could_VM reduce_VVI health_NN1 care_NN1 spending_VVG by_II as_RG much_DA1 as_CSA 5.4_MC percent_NNU from_II 2010_MC to_II 2019_MC ._. 
Even_CS21 if_CS22 such_DA savings_NN2 applied_VVN to_II only_JJ half_NN1 of_IO spending_VVG in_II the_AT health_NN1 care_NN1 sector_NN1 ,_, the_AT result_NN1 would_VM be_VBI more_DAR than_CSN $900_NNU billion_NNO of_IO savings_NN2 over_II the_AT decade_NNT1 ,_, according_II21 to_II22 CEA_NP1 estimates_VVZ ._. 
If_CS bundled_JJ payments_NN2 were_VBDR expanded_VVN beyond_II post-acute_JJ care_NN1 and_CC even_RR half_DB of_IO the_AT potential_JJ savings_NN2 from_II bundled_JJ payments_NN2 were_VBDR realized_VVN in_II the_AT Medicare_NP1 program_NN1 during_II the_AT upcoming_JJ decade_NNT1 ,_, these_DD2 savings_NN2 would_VM translate_VVI to_II an_AT1 additional_JJ 0.2_MC percent_NNU per_II year_NNT1 reduction_NN1 in_II program_NN1 expenditures_NN2 ,_, or_CC more_DAR than_CSN $190_NNU billion_NNO between_II 2010_MC and_CC 2019_MC ._. 
Similarly_RR large_JJ reductions_NN2 in_II Federal_JJ health_NN1 care_NN1 expenditures_NN2 are_VBR plausible_JJ from_II the_AT combination_NN1 of_IO other_JJ delivery_NN1 system_NN1 reforms_NN2 ,_, including_II accountable_JJ care_NN1 organizations_NN2 (_( a_AT1 group_NN1 of_IO primary_JJ care_NN1 physicians_NN2 ,_, specialists_NN2 ,_, and_CC one_MC1 or_CC more_DAR hospitals_NN2 that_CST coordinate_VV0 the_AT care_NN1 of_IO and_CC accept_VV0 joint_JJ responsibility_NN1 for_IF the_AT quality_NN1 and_CC cost_NN1 of_IO care_NN1 of_IO their_APPGE group_NN1 of_IO patients_NN2 )_) and_CC incentives_NN2 to_TO reduce_VVI hospital-acquired_JJ infections_NN2 ._. 
The_AT CBO_NN1 estimates_NN2 of_IO the_AT savings_NN2 from_II these_DD2 provisions_NN2 are_VBR relatively_RR small_JJ ,_, which_DDQ may_VM simply_RR reflect_VVI the_AT paucity_NN1 of_IO evidence_NN1 of_IO the_AT real-world_JJ impact_NN1 of_IO such_DA policies_NN2 ,_, especially_RR when_CS done_VDN in_II concert_NN1 and_CC on_II a_AT1 national_JJ scale_NN1 ._. 
When_CS there_EX are_VBR not_XX historical_JJ examples_NN2 for_IF the_AT effect_NN1 of_IO a_AT1 possible_JJ reform_NN1 ,_, the_AT CBO_NN1 estimate_NN1 is_VBZ often_RR very_RG close_JJ to_II zero_MC ,_, despite_II the_AT potential_NN1 for_IF significant_JJ expenditure_NN1 reductions_NN2 from_II reforms_NN2 ._. 
Savings_NN2 are_VBR also_RR plausible_JJ from_II certain_JJ features_NN2 that_CST could_VM spur_VVI innovation_NN1 in_II cost-saving_NN1 and_CC quality-improvements_NN2 ,_, thereby_RR accelerating_VVG the_AT cost_NN1 savings_NN2 still_RR further_RRR ._. 
For_REX21 instance_REX22 ,_, health_NN1 information_NN1 technology_NN1 adoption_NN1 could_VM facilitate_VVI cost-saving_JJ advances_NN2 in_II payment_NN1 methods_NN2 ._. 
Additionally_RR ,_, provisions_NN2 for_IF administrative_JJ simplification_NN1 in_II reform_NN1 legislation_NN1 --_NN1 which_DDQ require_VV0 the_AT standardization_NN1 and_CC streamlining_NN1 of_IO paperwork_NN1 and_CC create_VV0 standards_NN2 for_IF electronic_JJ transaction_NN1 --_NN1 will_VM help_VVI cut_VVN down_RP on_II the_AT $23-$31_NNU billion_NNO time_NNT1 cost_NN1 to_II medical_JJ practices_NN2 of_IO interacting_VVG with_IW health_NN1 plans_NN2 and_CC their_APPGE administrators_NN2 ._. 
Another_DD1 potentially_RR significant_JJ cost_NN1 saver_NN1 within_II the_AT Senate_NN1 bill_NN1 is_VBZ the_AT Independent_NP1 Medicare_NP1 Advisory_JJ Board_NN1 (_( IMAB_NP1 )_) ._. 
The_AT IMAB_NN1 would_VM recommend_VVI changes_NN2 to_II the_AT Medicare_NP1 program_NN1 that_CST would_VM both_RR improve_VVI the_AT quality_NN1 of_IO care_NN1 and_CC also_RR reduce_VV0 the_AT growth_NN1 rate_NN1 of_IO program_NN1 spending_NN1 ._. 
Absent_JJ Congressional_JJ action_NN1 ,_, these_DD2 recommendations_NN2 would_VM be_VBI automatically_RR implemented_VVN ,_, which_DDQ would_VM give_VVI it_PPH1 much_RR greater_JJR authority_NN1 than_CSN the_AT current_JJ Medicare_NP1 Payment_NN1 Advisory_JJ Commission_NN1 (_( MedPAC_NP1 )_) ._. 
The_AT CBO_NN1 score_NN1 of_IO the_AT Senate_NN1 bill_NN1 estimates_VVZ that_CST the_AT IMAB_NN1 would_VM reduce_VVI Medicare_NP1 spending_NN1 by_II $23_NNU billion_NNO from_II 2015_MC to_II 2019_MC ,_, with_IW the_AT savings_NN2 likely_JJ to_TO continue_VVI in_II the_AT subsequent_JJ decade_NNT1 ._. 
An_AT1 additional_JJ benefit_NN1 of_IO the_AT IMAB_NN1 is_VBZ that_CST it_PPH1 has_VHZ the_AT potential_JJ to_TO increase_VVI the_AT savings_NN2 from_II many_DA2 of_IO the_AT delivery_NN1 system_NN1 reforms_NN2 described_VVN above_RL ,_, which_DDQ may_VM not_XX be_VBI fully_RR captured_VVN by_II the_AT CBO_NN1 estimates_VVZ for_IF the_AT reasons_NN2 previously_RR mentioned_VVN ._. 
Taken_VVN together_RL ,_, the_AT combination_NN1 of_IO Medicare-_NN1 and_CC Medicaid-related_JJ provisions_NN2 in_II the_AT Senate_NN1 's_GE Patient_JJ Protection_NN1 and_CC Affordable_JJ Care_NN1 Act_NN1 are_VBR estimated_VVN to_TO reduce_VVI the_AT annual_JJ growth_NN1 rate_NN1 of_IO Federal_JJ spending_NN1 on_II both_DB2 programs_NN2 by_II 1.0_MC percentage_NN1 point_NN1 in_II the_AT upcoming_JJ decade_NNT1 and_CC by_II an_AT1 even_RR greater_JJR amount_NN1 in_II the_AT subsequent_JJ decade_NNT1 ._. 
II_MC ._. 
HEALTH_NN1 INSURANCE_NN1 REFORM:WILL_FO IT_NN1 CONTROL_VV0 PRIVATE_JJ HEALTH_NN1 CARE_NN1 SPENDING_NN1 ?_? 
The_AT CBO_NN1 score_NN1 makes_VVZ clear_JJ that_CST the_AT Senate_NN1 's_GE Patient_JJ Protection_NN1 and_CC Affordable_JJ Care_NN1 Act_NN1 will_VM relieve_VVI significant_JJ pressure_NN1 on_II the_AT Federal_JJ budget_NN1 in_II the_AT years_NNT2 ahead_RL ._. 
But_CCB will_VM it_PPH1 also_RR reduce_VVI the_AT growth_NN1 rate_NN1 of_IO costs_NN2 in_II the_AT private_JJ sector_NN1 ?_? 
An_AT1 examination_NN1 of_IO the_AT projected_JJ revenues_NN2 from_II just_RR one_MC1 provision_NN1 in_II the_AT bill_NN1 --_NN1 the_AT excise_NN1 tax_NN1 on_II high-cost_JJ insurance_NN1 plans_VVZ --_JJ strongly_RR suggests_VVZ that_CST the_AT answer_NN1 is_VBZ yes_UH ._. 
This_DD1 tax_NN1 will_VM be_VBI levied_VVN only_RR on_II the_AT most_RGT expensive_JJ private_JJ sector_NN1 plans_NN2 ._. 
It_PPH1 will_VM ,_, however_RR ,_, provide_VVI health_NN1 insurers_NN2 with_IW a_AT1 powerful_JJ incentive_NN1 to_TO reduce_VVI their_APPGE premiums_NN2 and_CC provide_VVI a_AT1 high-value_JJ package_NN1 of_IO benefits_NN2 ._. 
According_II21 to_II22 estimates_NN2 from_II CBO_NP1 and_CC from_II the_AT Joint_JJ Committee_NN1 on_II Taxation_NN1 (_( JCT_NP1 )_) ,_, the_AT resulting_JJ reduction_NN1 in_II premiums_NN2 will_VM lead_VVI employers_NN2 to_TO pay_VVI substantially_RR higher_JJR wages_NN2 to_II affected_JJ employees_NN2 ,_, with_IW this_DD1 effect_NN1 growing_VVG over_II time_NNT1 ._. 
Using_VVG data_NN from_II CBO_NP1 and_CC JCT_NP1 ,_, CEA_NP1 estimates_VVZ that_CST the_AT excise_NN1 tax_NN1 on_II high-cost_JJ insurance_NN1 plans_NN2 will_VM reduce_VVI the_AT growth_NN1 rate_NN1 of_IO annual_JJ health_NN1 care_NN1 costs_VVZ in_II the_AT private_JJ sector_NN1 by_II 0.5_MC percentage_NN1 point_NN1 per_II year_NNT1 from_II 2012_MC to_II 2018.11_MC To_II the_AT extent_NN1 that_CST insurers_NN2 in_II the_AT private_JJ sector_NN1 mimic_VV0 the_AT delivery_NN1 system_NN1 reforms_VVZ that_CST are_VBR included_VVN in_II the_AT Senate_NN1 bill_NN1 ,_, the_AT reduction_NN1 in_II the_AT growth_NN1 rate_NN1 of_IO costs_NN2 is_VBZ likely_JJ to_TO be_VBI even_RR greater_JJR ._. 
This_DD1 is_VBZ especially_RR true_JJ for_IF bundled_JJ payments_NN2 ,_, as_CSA the_AT potential_JJ savings_NN2 to_II Medicare_NP1 from_II this_DD1 provision_NN1 are_VBR smaller_JJR than_CSN in_II the_AT private_JJ sector_NN1 because_CS inpatient_NN1 care_NN1 is_VBZ already_RR largely_RR bundled_VVN in_II Medicare_NP1 ._. 
And_CC it_PPH1 is_VBZ worth_II noting_VVG that_CST the_AT transition_NN1 to_II bundled_JJ ,_, inpatient_NN1 care_NN1 generated_VVD considerable_JJ savings_NN2 to_II the_AT program_NN1 ._. 
There_EX are_VBR several_DA2 additional_JJ sources_NN2 of_IO savings_NN2 that_CST would_VM accrue_VVI to_II the_AT private_JJ sector_NN1 as_II a_AT1 result_NN1 of_IO the_AT provisions_NN2 included_VVN in_II the_AT House_NN1 and_CC Senate_NN1 bills_NN2 ._. 
For_REX21 example_REX22 ,_, the_AT legislation_NN1 passed_VVN by_II the_AT House_NN1 of_IO Representatives_NN2 ,_, the_AT Affordable_JJ Health_NN1 Care_NN1 for_IF America_NP1 Act_NN1 ,_, would_VM allow_VVI individuals_NN2 without_IW access_NN1 to_II affordable_JJ coverage_NN1 and_CC firms_NN2 with_IW 25_MC or_CC fewer_DAR employees_NN2 to_TO purchase_VVI coverage_NN1 through_II a_AT1 competitive_JJ ,_, well-regulated_JJ marketplace_NN1 ,_, or_CC exchange_NN1 ,_, starting_VVG in_II 2013_MC ._. 
By_II 2015_MC ,_, firms_NN2 with_IW up_RG21 to_RG22 100_MC workers_NN2 could_VM cover_VVI their_APPGE employees_NN2 through_II the_AT exchange_NN1 ,_, with_IW even_RR larger_JJR firms_NN2 admitted_VVN in_II subsequent_JJ years_NNT2 ._. 
Recent_JJ estimates_NN2 by_II MIT_NP1 economist_NN1 Jonathan_NP1 Gruber_NP1 and_CC by_II the_AT CBO_NN1 suggest_VV0 that_CST this_DD1 health_NN1 insurance_NN1 exchange_NN1 would_VM lead_VVI to_II health_NN1 insurance_NN1 coverage_NN1 that_CST is_VBZ both_RR more_RGR secure_JJ and_CC comprehensive_JJ ,_, and_CC has_VHZ lower_JJR administrative_JJ costs_NN2 and_CC premiums_NN2 than_CSN comparable_JJ coverage_NN1 under_II current_JJ law_NN1 ._. 
Additionally_RR ,_, the_AT CBO_NN1 estimates_VVZ that_CST premiums_NN2 would_VM fall_VVI by_II as_RG much_DA1 as_CSA 3_MC percent_NNU for_IF large_JJ firms_NN2 and_CC as_RG much_DA1 as_CSA 2_MC percent_NNU for_IF small_JJ firms_NN2 ,_, even_RR before_II accounting_VVG for_IF incentives_NN2 to_TO curb_VVI high-cost_JJ policies_NN2 as_II a_AT1 result_NN1 of_IO the_AT excise_NN1 tax_NN1 ._. 
Moreover_RR ,_, the_AT CEA_NN1 's_GE earlier_JJR report_NN1 described_VVD waste_NN1 and_CC inefficiency_NN1 throughout_II the_AT health_NN1 care_NN1 system_NN1 which_DDQ could_VM be_VBI eliminated_VVN without_IW adverse_JJ health_NN1 consequences_NN2 ._. 
Health_NN1 insurance_NN1 reform_NN1 legislation_NN1 is_VBZ likely_JJ to_TO diffuse_VVI care_NN1 delivery_NN1 reforms_NN2 throughout_II the_AT health_NN1 care_NN1 system_NN1 ._. 
Public_JJ investments_NN2 in_II patient-centered_JJ health_NN1 research_NN1 on_II quality-improving_JJ treatments_NN2 ,_, and_CC in_II best_JJT practices_NN2 such_II21 as_II22 bundling_VVG payments_NN2 and_CC accountable_JJ care_NN1 organizations_NN2 ,_, will_VM likely_RR reduce_VVI cost_NN1 growth_NN1 in_II the_AT private_JJ sector_NN1 ._. 
Because_CS hospitals_NN2 ,_, doctors_NN2 ,_, and_CC other_JJ providers_NN2 serve_VV0 publicly_RR and_CC privately_RR financed_VVN patients_NN2 alike_RR ,_, the_AT diffusion_NN1 of_IO efficient_JJ ,_, quality-improving_JJ practices_NN2 will_VM lead_VVI to_II private_JJ sector_NN1 savings_NN2 on_II health_NN1 care_NN1 spending_VVG as_RR21 well_RR22 ,_, amplifying_VVG the_AT effectiveness_NN1 of_IO each_DD1 individual_JJ component_NN1 of_IO reform_NN1 ._. 
