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Scoring Health Legislation

The National Institute for Health Care Management Foundation has released a new edition of Expert Voices, Scoring Health Legislation by Paul N. Van de Water, PhD, Senior Fellow, Center on Budget and Policy Priorities.  The fate of legislative proposals in the U.S. Congress often hinges on how much they are estimated to increase or decrease the federal budget deficit.  Currently, the Congressional Budget Office is responsible for developing these estimates – or “scores” – for all pending legislation, following rules and procedures established by Congress and the Administration.  Yet these rules and their impact on the resulting budget estimates are often poorly understood.  In this essay, Van de Water describes the basic elements of budget scoring, provides some cautionary comments on how the estimates should be used, and looks at the scoring issues likely to arise as health reform legislation is advanced and debated.