Obamacare Great -- Rebuttal

Obamacare Great -- Rebuttal

Claim

Facts

VO: News reports say 300,000 health plans cancelled.

SUPER: 300,000 Health Plans in Florida Canceled Some Floridians losing health insurance plans.

The St. Augustine Record, October 23, 2013

Sen. Rubio Made Similar Claim, PolitiFact Called Mostly False

In October 2013, PolitiFact rated a similar claim by Senator Marco Rubio, that 300,000 people would lose their health coverage, as mostly false. [PolitiFact, 10/25/13]

See Appendix A

AP: Ad Relies on Information that Is Not Accurate

On the morning the ad was released, Florida Associated Press reporter Gary Fineout tweeted the following:

@fineout: The campaign of @FLGovScott launches new $2mil ad going after @CharlieCrist over Obamacare http://bit.ly/1lgAO4H [twitter.com, 3/24/14]

@fineout: But new Lets Get to Work TV ad from @FLGovScott relies on information regarding cancellation of health plans that is not accurate [twitter.com, 3/24/14]

See Appendix E

AP: Most Customers have Kept Their Plans

On the morning the ad was released, Florida Associated Press reporter Gary Fineout tweeted the following:

@fineout: Fla. Blue spokesman this month told @kkennedyAP that most of those initially notified about losing their plan have kept their plans [twitter.com, 3/24/14]

See Appendix B

FL Blue Senior VP: We are not Terminating Anyones Coverage.

In October 2013, Jon Urbanek, a senior vice president at Florida Blue told the Florida Times Union, This is more of a transitionWe are not terminating anyones coverage. [Florida Times Union, 10/23/13]

See Appendix B

The Phrase Some Floridians losing health insurance plans Never Appears in Article

The ad included the line Some Floridians losing health insurance plans under the St. Augustine Records masthead implying it is a quotation from the article. However, this phrase never appeared in the article. [St. Augustine Record, 10/23/13]

See Appendix C

From the ad:

VO: Obama says patients may lose their doctors.

SUPER: Theyre going to have to make some choices, and they might end up having to switch doctors

-President Obama (March 14, 2014)

Obama Said Patients Might Switch Doctors in Order to Save Money

In March 2014, President Obama said, For the average person, many folks who dont have health insurance initially, theyre going to have to make some choices. And they might end up having to switch doctors, in part because theyre saving money.

The Presidents quotation makes clear that patients could still see whatever doctor they chose but may decide to change in order to receive a reduced cost. [youtube.com @1:00, 3/14/14]

See Appendix D

VO: The federal government says less work hours for American jobs.

SUPER: Obamacare will drive 2.5 Million Americans out of the workforce.

-CBO, February 4, 2014

PolitiFact Ranked Similar Claim Mostly False

In February 2014, PolitiFact called an ad mostly false that was sponsored by the National Republican Congressional Committee arguing Obamacare will cost our economy up to 2.5 million jobs.

According to PolitiFact, the CBO report says that with Obamacare in place providing greater access to insurance on the individual market and subsidies to help pay for it, some Americans will decide on their own to work less. [PolitiFact, 2/14/14]

See Appendix E

Headline: CBO: Guys, We Didnt Say Obamacare Would Cost 2.5 Million Jobs

In February 2014, the Congressional Budget Office issued an official rebuttal to the Republican talking point that Obamacare would cost 2.5 million American jobs. In an FAQ explanation of their report, CBO director Doug Elmendorf was asked if 2.5 million people will lose their jobs by 2024 because of the health care reform law. He replied, No, we would not describe our estimates in that way. [talkingpointsmemo.com, 2/10/14]

See Appendix F

Decline in Work Hours Due to People Choosing to Work Less

In February 2014, Reuters reported that Jason Furman, Chair of the White House Council of Economic Advisers, said Its not that the businesses are cutting those jobs. The CBO report showed an impact on labor supply rather than demand for workers from employers. [Reuters, 2/04/14]

See Appendix G

The Washington Post made a similar point writing, More than 2 million Americans who would otherwise rely on a job for health insurance will quit working, reduce their hours or stop looking for employment because of new health benefits available under the Affordable Care Act... [Washington Post, 2/04/14]

See Appendix H

Quoting Phrase that Does Not Exist in CBO Report

The ad supposedly quotes a CBO report claiming Obamacare will drive 2.5 million Americans out of the workforce. This phrase never appeared in the CBO report. [CBO, 2/04/14]

See Appendix I

From the ad:

Obamacare Great -- Rebuttal Backup

Appendix A: PolitiFact, 10/25/13

In Florida, 300,000 people are going to lose their individual coverage because of Obamacare. Now those people next year, they dont have health insurance.

Published: Friday, October 25th, 2013 at 2:10 p.m.

Written by: Amy Sherman

Researched by: Amy Sherman

Edited by: Angie Drobnic Holan

http://www.politifact.com/florida/statements/2013/oct/25/marco-rubio/marco-rubio-said-florida-300000-people-are-going-l/

Marco Rubio on Tuesday, October 22nd, 2013 in an interview on The OReilly Factor.

Rubio says 300,000 will lose their individual health insurance coverage under Obamacare and wont be able to enroll in new plans

Mostly False

Recent letters to 300,000 Floridians from Florida Blue, a division of Blue Cross Blue Shield, have injected new vigor into claims that the health care law means consumers will lose their insurance.

The issue of Obamacare is about a much broader agenda to inject more government control over our lives and over our economy, said Sen. Marco Rubio, R-Fla., on Foxs The OReilly Factor. On this very day in Florida, it was announced that 300,000 people are going to lose their individual coverage because of Obamacare. Now those people next year, they dont have health insurance. They are going to owe the IRS money in the form of a fine. Where are they supposed to go now and buy that health insurance if the website isnt working, if Consumer Reports is telling people to avoid the website?

Rubios concerns about the website referred to healthcare.gov, the federal governments online marketplace for health insurance. The website has been plagued with problems and hasnt been functioning properly since its debut on Oct. 1.

Rubio made his claim during a week when the announcement by Florida Blue affecting 300,000 policy holders received much attention. (U.S. Rep. Tom Rooney, R-Fla., and former House Speaker Newt Gingrich made similar statements related to Florida Blue.)

We asked Rubios office for evidence to support his claim. This is pretty simple, said Rubios spokesman Alex Conant in an email to PolitiFact Florida. Question: can any one of the 300,000 people keep their current health plan? Answer: No.

We decided to check Rubios claim: Are 300,000 people going to lose their individual coverage because of Obamacare? And will they face the consequences Rubio suggests?

Florida Blues letters

On Oct. 21, Kaiser Health News reported that health plans were sending hundreds of thousands of cancellation letters to people who buy their own coverage.

We found the news repeated by several news outlets and blogs, with headlines such as this one in the Miami Heralds Naked Politics blog: Whos to blame for the 300,000 policy purge? Florida Blue or Obamacare or both?

In response to the news coverage, Florida Blue issued a statement:

The Affordable Care Act mandates that all health insurance coverage packages provide 10 categories of essential health benefits. Because some plans offered by all insurers did not include all of these new services, they will no longer be available. Approximately 300,000 current Florida Blue members are enrolled in plans that will not meet these new benefit requirements.

Florida Blue is proactively communicating to these members to help them understand how this transition affects them. Prior to their 2014 renewal date, each member will receive a letter that instructs them to contact Florida Blue to review their migration options. These new plans will offer members access to more comprehensive benefits in 2014.

It is important to note that a persons individual situation will be the key driver of what they will pay for coverage under the ACA. Subsidies will be available in the marketplace to lower the cost of coverage for eligible individuals, and the amount an individual will pay could vary significantly once his or her specific age, area in which they live, smoking status, family size, and income are factored in.

The Miami Heralds Public Insight Network obtained copies of letters received by Florida Blue consumers. The letters stated that due to the Affordable Care Act, the consumers particular plan will be closed and recommended another Florida Blue plan.

To help ensure that you have continuous health care coverage, youll be enrolled in this health plan effective Jan. 1, 2014, unless we hear from you by Nov. 1, 2013.

The letters stated that consumers could choose a different Florida Blue plan.

Well help you find a plan thats right for you, the letter stated.

A spokesman for Florida Blue, Mark Wright, told PolitiFact Florida that when it comes to getting new plans, nobody is throwing anybody off a cliff.

Not everyones policies expires on Jan. 1, those expirations will happen throughout the year. Consumers have to be notified that they have to choose a new plan 90 days before their plan expires.

Jon Urbanek, a senior vice president at Florida Blue, told us the company intends to offer people with expiring policies a range of options. Depending on where they live and other factors, most people will have a choice of somewhere around 40 plans to choose from, Urbanek said.

Health care experts

We sent Rubios statement to a few health care experts to see if they thought it was accurate. What we generally heard was that while policy holders are losing that particular insurance plan, they do have other options.

There is some truth to saying that they are losing their coverage plans they are now in -- they are no longer available, said Timothy Jost, a law professor at William and Lee and co-author of the casebook Health Law. Presumably those are plans with very high deductibles, high out-of-pocket costs.

However, it is also inaccurate saying people are losing coverage.

Christopher J. Conover, a health research scholar at Duke University and adjunct scholar at the conservative American Enterprise Institute, told PolitiFact Florida that these consumers are losing their current health plan.

Most of your readers might interpret losing coverage as meaning these individuals will become uninsured. Some in fact will be, but not the majority...., he said.

Conover said that the same situation is happening to millions of consumers nationwide.

This eventually will touch millions of Americans, he told PolitiFact Florida.

Our ruling

Rubio said, 300,000 people are going to lose their individual coverage because of Obamacare. Now those people next year, they dont have health insurance.

Rubio was referring to letters Florida Blue started sending to consumers in the individual market in August. The letters do tell consumers that their particular plan will end due to the Affordable Care Act. Thats because the plans typically dont offer the comprehensive coverage that is required under the new law.

However, the letters also state that consumers will have continuous health care coverage and assigned them a particular plan, or gave them the option to contact Florida Blue and choose another plan. So their coverage is not dependent on being able to buy insurance through healthcare.gov, the governments online marketplace.

We rate this claim Mostly False.

Appendix B: Twitter.com, 3/24/14

@fineout: The campaign of @FLGovScott launches new $2mil ad going after @CharlieCrist over Obamacare http://bit.ly/1lgAO4H [twitter.com, 3/24/14]

@fineout: But new Lets Get to Work TV ad from @FLGovScott relies on information regarding cancellation of health plans that is not accurate [twitter.com, 3/24/14]

@fineout: Fla. Blue spokesman this month told @kkennedyAP that most of those initially notified about losing their plan have kept their plans [twitter.com, 3/24/14]

Appendix C: St. Augustine Record, 10/23/13

Florida Blue to cancel 300,000 policies over Obamacare

Posted: October 23, 2013 - 6:53am

By Matt Dixon

Morris News Service

http://staugustine.com/news/florida-news/2013-10-23/florida-blue-cancel-300000-policies-over-obamacare#.UzBRQIUXHpc

Tallahassee - Citing costs associated with the federal Affordable Care Act, Jacksonville-based Florida Blue is canceling 300,000 individual policies.

Florida Blue, the states largest health insurer, says the move is to offset the new health care laws requirement that things like maternity and newborn care, mental health, substance abuse services, and emergency services be covered by individual and small market plans.

Kaiser Health News reported that many canceled plans from Florida Blue, and other insurers across the country, fall short of the requirements laid out in the Affordable Care Act, commonly referred to as ObamaCare. The organization says many were purchased after the law was passed in 2010, so insurance companies knew they would be temporary policies.

Impacted Florida Blue customers will be notified by mail.

We will provide our members recommendations for new plan options, and encourage them to contact us so we could help determine their best course of action, Mark Wright, a Florida Blue Spokesman, said in a statement.

Wright said officials who could answer specific follow-up questions were not in the office.

As a result, information related to the amount the cancellations will save the company, how many people have enrolled in company plans through the Affordable Care Act, and updated numbers on how much the company thinks the new law will cost was not available Tuesday.

During springs legislative session, Florida Blue lobbyists told lawmakers they thought the Affordable Care Act would cost the company $110 million.

In September, the Office of Insurance Regulation estimated that ObamaCare would boost Florida Blue premiums by 31 percent under Obamacare, or $118-per-month. Thats slightly less than the 35 percent overall increase the office estimated would occur under the new health care law.

Those state numbers did not include income-based federal subsidies offered through the plan. Its estimated that 3.2 million of Floridas 3.5 million uninsured will be eligible for the subsidies.

During the legislative session, Florida Blue lobbyists used the uncertainty under ObamaCare as a key message when lobbying on key issues.

That led to the defeat of a proposal to ax an insurance industry tax. Florida Blue estimated that plan would have cost it $32.5 million. ObamaCare was also the stated reason Florida Blue used when pushing language that allowed it a new type of expansion, company officials said. That restructure would allow the company to own other not-for-profit insurers and corporations in Florida.

Figures filed with the Office of Insurance Regulation show that Florida Blue claimed $3.7 billion in gross annual direct premiums in 2012. That accounts for 29 percent of the states health care market.

Since opening Oct. 1, the online marketplaces created under ObamaCare have been wrought with problems. Many consumers have said they have not been able to access the site, while others report long wait times. People must enroll in an insurance plan by Feb. 15, or face a penalty.

Appendix D: youtube.com @1:00, 3/14/14

https://www.youtube.com/watch?v=dHSrOangKZA#t=65

WebMD

Published on Mar 14, 2014

Note: An mp4 version of this video is available upon request. It is 5.7 mb in size.

Appendix E: PolitiFact, 2/14/14

Nonpartisan government analysts say Obamacare will cost our economy up to 2.5 million jobs.

http://www.politifact.com/truth-o-meter/statements/2014/feb/14/national-republican-congressional-committee/nrcc-says-congressional-budget-office-predicts-oba/

Published: Friday, February 14th, 2014 at 12:04 p.m.

Written by: Steve Contorno, Louis Jacobson

Researched by: Steve Contorno, Louis Jacobson

Edited by: Angie Drobnic Holan

National Republican Congressional Committee on Wednesday, February 12th, 2014 in a television ad

NRCC says Congressional Budget Office predicts Obamacare will cost economy 2.5 million jobs

Heres a claim we expect to hear often from Republicans in the 2014 midterm races: Obamacare is a jobs killer.

The National Republican Congressional Committee gave us a sneak peek at how the attack will be framed with a new ad critical of Alex Sink, the Democrat vying for the former seat of U.S. Rep. C.W. Bill Young, R-Fla., in a special election.

Nonpartisan government analysts say Obamacare will cost our economy up to 2.5 million jobs, the ad says. Yet Alex Sink still supports it.

Its amazing how quickly an economic report can turn into an attack ad. The claims stems from new numbers from the Congressional Budget Office, a nonpartisan fiscal scorekeeper, that came out just last week.

Weve already rated similar statements a couple of times already. We said theyre Mostly False.

Heres the problem with the ads claim:

The CBO estimated that by 2017, there would be the equivalent of about 2 million fewer workers than there would be in the absence of the law. The CBO said that number would grow to about 2.5 million by 2024.

The ad misinterprets the difference between workers and jobs. And the word costs makes it seem like these are positions that employers are eliminating as a result of the Affordable Care Act.

Instead, the CBO report says that with Obamacare in place providing greater access to insurance on the individual market and subsidies to help pay for it, some Americans will decide on their own to work less.

The CBO estimated that Obamacare would 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. This would equal 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, the report continued.

By providing subsidies that decline with rising income and by making some people financially better off, the ACA will create an incentive for some people to work less, the report said.

An important distinction in the report is that labor force will reduce by the equivalent of 2.5 million full-time workers over the next decade. That doesnt mean 2.5 million people will leave their jobs. Some people will only cut back a few hours or leave a second part-time job while others may stop working entirely.

This would not increase unemployment. Instead, it may actually create new opportunities for those who have been looking for work. It could also invite people who have given up on looking for work (who arent counted in unemployment statistics) back into the labor market, the report said.

That doesnt mean the outlook is entirely rosy.

As more people choose to work less, the labor force participation rate should decline, putting a larger burden for supporting the social safety net on those who remain working. Any change in labor force participation comes on top of an already major shift toward retirement driven by the aging of the baby boom.

Also, some commentators have expressed concern about having people work less because taxpayer-subsidized insurance is available. Ultimately, it boils down to a tradeoff, said Tara Sinclair, a George Washington University economist.

Admittedly there are some touchy issues with the government potentially paying or subsidizing the health care costs for people who could work but choose not to, Sinclair told PolitiFact last week.

In a macroeconomic sense, this still means fewer people working, even if that is their choice, she said. It also probably means relatively higher wages and better bargaining power for those who are looking for a job. This is very different than the short-run effects of employers cutting positions, where we would see unemployment rates go up, less bargaining power for workers, and potentially relatively lower wages. So, the description of the source of the cut -- whether its from supply or demand -- does matter, but not for the count of jobs.

In an email to PolitiFact, the NRCC pointed to stories about the new CBO numbers on Obamacare. But those stories distinguished that this was a decrease in workers, not jobs cut by employers, and thats important.

Our ruling

The NRCC said nonpartisan government analysts say Obamacare will cost our economy up to 2.5 million jobs. Its misleading to suggeset the report indicated cuts in jobs. Instead, workers who can now receive subsidized insurance will cut back on hours equivalent to about 2.5 million workers by 2024. The distinction is critical to understanding the laws impact on the labor market.

We rate this statement Mostly False.

Correction: Though our ruling statement accurately quoted the ad as saying, Nonpartisan government analysts say Obamacare will cost our economy up to 2.5 million jobs, a later line in our story inaccurately quoted the ad as saying cuts instead of costs. That line has since been corrected. The ruling remains the same.

Appendix F: talkingpointsmemo.com, 2/10/14

CBO: Guys, We Didnt Say Obamacare Would Cost 2.5 Million Jobs

http://talkingpointsmemo.com/dc/cbo-obamacare-jobs-clarification

Dylan Scott February 10, 2014, 3:27 PM EST24802

The Congressional Budget Office issued its official rebuttal Monday to the Republican talking point that Obamacare would cost 2.5 million American jobs.

In a new FAQ explainer of last weeks budget report, CBO director Doug Elmendorf, answering if 2.5 million people will lose their jobs by 2024 because of the health care reform law, said: No, we would not describe our estimates in that way.

In the immediate aftermath of the CBO report, some Republicans characterized the reports findings as: The law would cost the U.S. economy up to 2.5 million jobs. The phrase quickly found its way into a Senate GOP web advertisement.

But what the CBO actually said was much different, as TPM reported. The agency said that some Americans would choose to stop working or work less because of the law. They could change their work habits for various reasons, such as starting a new business or choosing to spend time at home. The voluntary cutback in hours would be equal to 2.5 million full-time jobs.

Because the longer-term reduction in work is expected to come almost entirely from a decline in the amount of labor that workers choose to supply in response to the changes in their incentives, we do not think it is accurate to say that the reduction stems from people losing their jobs, Elmendorf wrote.

But in the broader debate about whether Obamacares effect on the American work ethic is a good or bad thing, as TPM discussed, the CBO decided to leave that to the politicians.

Whether voluntary reductions in hours worked owing to the ACA are good or bad for the country as a whole is a matter of judgment, Elmendorf said.

Appendix G: Reuters, 2/04/14

Obamacare to cut work hours by equivalent of 2 million jobs: CBO

By David Morgan and David Lawder

Tue Feb 4, 2014 3:08pm EST

http://www.reuters.com/article/2014/02/04/us-usa-fiscal-obamacare-idUSBREA131B120140204

(Reuters) - President Barack Obamas healthcare law will reduce American workforce participation by the equivalent of 2 million full-time jobs in 2017, the Congressional Budget Office said on Tuesday, prompting Republicans to paint the law as bad medicine for the U.S. economy.

In its latest U.S. fiscal outlook, the nonpartisan CBO said the health law would lead some workers, particularly those with lower incomes, to limit their hours to avoid losing federal subsidies that Obamacare provides to help pay for health insurance and other healthcare costs.

The biggest impact would begin in 2017, CBO said, because major provisions of the law will be well under way by then. The CBO said there would be smaller declines in work hours that would occur before then.

Work hours would be reduced by the equivalent of 2.5 million jobs in 2024, said the agency, which earlier predicted 800,000 fewer fulltime jobs by 2021. The bottom line would be a slower rate of growth for employment and compensation in the coming decade, according to the report.

The link that the CBO drew between the health law and slower employment growth is likely to become fodder for partisan attacks in this years congressional election battle, which will determine who controls Congress in the final years of the Obama presidency. Obamacare is unpopular with many voters and its botched October rollout was accompanied by a public outcry by millions of people who saw their health plans cancelled as a result of its implementation.

Republicans, who have already made Obamas Patient Protection and Affordable Care Act (ACA) a top campaign issue for November, seized on the CBO report to press their argument that Obamacare is putting a damper on jobs growth and the economy.

The presidents healthcare law creates uncertainty for small businesses, hurts take-home pay, and makes it harder to invest in new workers. The middle class is getting squeezed in this economy, and this CBO report confirms that Obamacare is making it worse, House of Representatives Speaker John Boehner said in a statement.

But the White House pushed back on the argument that Obamas signature domestic policy achievement would mean an actual reduction in jobs.

Its not that the businesses are cutting those jobs, said Jason Furman, who chairs the White House Council of Economic Advisers. He said the CBO report showed an impact on labor supply rather than demand for workers from employers.

The CBO report offered some bright spots on the broader fiscal front, saying the U.S. budget deficit would be a smaller than expected $514 billion in the fiscal 2014 year ended September 30. That is down from a previous estimate of $560 billion and a fiscal 2013 deficit of $680 billion.

But it said sluggish economic growth and stubbornly high unemployment would cause the improvement to be short-lived.

The CBO also said Obamacare would enroll 1 million fewer uninsured Americans than initially expected as a result of technical glitches that largely paralyzed the federal website HealthCare.gov in the first two months of open enrollment.

In a fresh forecast for 2014, the CBO estimated that 6 million people would sign up for private coverage through new health insurance marketplaces, down from an earlier forecast of 7 million. But the report predicted that the program would eventually overcome the deficit, signing up 24 million people by 2017.

The Obama administration says the health insurance marketplaces now operating in all 50 states and the District of Columbia have enrolled about 3 million people in private coverage so far, with volumes increasing following major fixes to HealthCare.gov.

Despite claims from Obamacare critics about the laws potential effects on hiring, CBO said the expected drop in work hours between 2017 and 2024 would result largely from worker decisions not to participate in the labor force, rather than from higher unemployment or the inability of part-time workers to find full-time hours.

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, CBO said.

According to the report, federal subsidies can be substantial, particularly for lower-wage workers who receive more under the laws sliding income scale. But that also means the benefits can be phased out as a workers income rises.

The phaseout effectively raises peoples marginal tax rates (the tax rates applying to their last dollar of income), thus discouraging work, CBO said.

(Additional reporting by Roberta Rampton in Washington; editing by Caren Bohan and Matthew Lewis)

Appendix H: Washington Post, 2/04/14

Health-care law will prompt over 2 million to quit jobs or cut hours, a CBO report says

By Zachary A. Goldfarb and Amy Goldstein, Published: February 4

http://www.washingtonpost.com/business/economy/cbo-botched-health-care-law-rollout-will-reduce-signups-by-1-million-people/2014/02/04/c78577d0-8dac-11e3-98ab-fe5228217bd1_story.html

More than 2 million Americans who would otherwise rely on a job for health insurance will quit working, reduce their hours or stop looking for employment because of new health benefits available under the Affordable Care Act, congressional budget analysts said Tuesday.

The findings from the nonpartisan Congressional Budget Office revived a fierce debate about the impact President Obamas signature health-care program will have on the U.S. economy.

The White House scrambled to defend the law, which has bedeviled Obama since its 2010 passage, arguing that the report shows it will work as planned, freeing people to care for their children, retire early or start their own businesses without worrying about health coverage.

The Affordable Care Act today, right now, is helping labor markets, is helping businesses and is helping jobs, said Jason Furman, the presidents chief economist.

But Republicans hailed the report as fresh evidence that the law will decimate the American workforce, encouraging people to forgo private employment in favor of taxpayer handouts.

Todays CBO report gives a sobering outlook on our economy, Sen. Bob Corker (R-Tenn.) said in a statement. It confirms what weve known all along: The health care law is having a tremendously negative impact on economic growth.

The report raises new questions about the health-care law just as some Republicans are again looking for concessions related to the Affordable Care Act in exchange for an agreement to raise the federal debt limit. Treasury Secretary Jack Lew has urged quick action on the debt limit with no concessions or negotiations saying he could run out of cash to pay the nations bills by the end of this month.

Meanwhile, the health-care law promises to be a major issue in midterm congressional elections this fall, with Republicans looking to bludgeon Democrats over the programs botched launch and Democrats hoping to highlight the millions of Americans who have gained coverage.

On Tuesday, few Democrats publicly defended the law, a sign that lawmakers recognize its vulnerability. In its report, the CBO said severe technical problems during the October rollout of the HealthCare.gov Web site will sharply curtail enrollment this year.

In its assessment of the laws impact on the job market, the agency had bad news for both political parties. In an implicit rebuke of GOP talking points, the CBO said that there was little evidence the health-care law is affecting employment and that businesses are not expected to significantly reduce head count or hours as a result of the law.

But the report also contained a setback for the White House. The CBO predicts that the economy will have the equivalent of 2.3 million fewer full-time workers by 2021 as a result of the law nearly three times previous estimates.

After obtaining coverage under the health-care law, some workers will choose to forgo employment, the report said, while others will voluntarily reduce their hours. That is because insurance subsidies under the law become less generous as income rises, so workers will have less incentive to work more or at all.

The design of the subsidies like many programs in the social safety net represents an implicit tax on additional work, CBO Director Douglas Elmendorf said.

The CBO attributed the decline in workforce participation primarily to this effect. But there were other, less important causes, too, including the likelihood that some employers will cut peoples hours, hire fewer workers or offer lower wages to new workers to avoid or compensate for a new fine on employers that do not offer insurance to employees who work more than 30 hours a week.

While the CBOs assessment of the laws impact on the labor market generated the most political heat, budget analysts also provided significant updates on the Affordable Care Acts effects on health coverage.

The agency predicted that 6 million Americans will have bought private health plans through the new insurance exchanges by the March 31 deadline for obtaining coverage this year, while 8 million low-income people will have enrolled in Medicaid. Both figures are off by 1 million people compared with previous CBO forecasts.

But enrollment will pick up within a few years, the CBO said, forecasting that enrollment in the marketplaces health plans will eventually hover between 24 million and 25 million, while 12 million to 13 million people will be covered through Medicaid and CHIP, the Childrens Health Insurance Program.

Despite the glitches, the CBO said, 86 percent of American citizens and legal residents younger than 65 will have health insurance this year, up from 82 percent in 2013. And that figure is expected to continue rising, topping out at 92 percent in 2017.

The Obama administration has not produced its own enrollment forecasts for coverage under the law, one of the presidents main domestic achievements. But internally and in public forums, the administrations top health officials have for months been using the 7 million estimate that the CBO issued in May.

Asked Tuesday whether it was a problem that fewer people are now expected to have insurance this year, White House press secretary Jay Carney did not answer directly but said, Were confident were going to have a substantial number of Americans covered both through the exchanges and through expansion of Medicaid.

Given the hardware and software defects in HealthCare.gov that thwarted many consumers who tried to sign up this fall, Carney said, the impact on enrollment is certainly not as severe as a lot of our critics hoped and expected.

On Jan. 24, Health and Human Services Secretary Kathleen Sebelius announced that about 3 million people had signed up for private health plans through the federal and state exchanges. The number who have enrolled is not the same as the number who have become insured; people are covered once they pay their first months premium, and administration officials have declined to say how many have paid.

Appendix I: CBO, 2/04/14

The CBO report titled The Budget and Economic Outlook: 2014 to 2024 is available for download at http://www.cbo.gov/sites/default/files/cbofiles/attachments/45010-Outlook2014_Feb.pdf

Note: A PDF version is available via email upon request. It is 1.7 mb in size.