Abstract and Keywords
This chapter examines how the congressional budget process influences health policy debates. It begins with an overview of the federal budgeting process and the role of health programs in the growth of federal spending over time. It considers three parts of the federal budget: discretionary spending, mandatory spending, and tax spending. It then describes the baseline used as a model to project the required spending of the federal government. It also discusses procedural and statutory limits to Congress’s ability to increase spending or cut taxes, including the “Pay-as-You-Go” (PAYGO) requirement and the use of scorekeeping to estimate the costs of new legislative proposals to make PAYGO limits workable. The chapter concludes with examples illustrating how the budget process influences legislative results, including the tobacco bill, the Sustainable Growth Rate in Medicare, and the Patient Protection and Affordable Care Act’s federal matching rates for its Medicaid expansion.
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