The Congressional Budget Office web site has a section entitled “Frequently Requested” (sites) and this Health site is one of them. The caption at the top of the main page states that “[r]ising health care costs and their consequences for federal health insurance programs constitute the nation’s central fiscal challenge.“ The purpose of this paper is to outline the types of documents that can be found at this site. The goal is to get beneath the surface of the home page and discover the gems that lie buried below.
At the top of the homepage are links entitled Home, Publications, Cost Estimates, About CBO, Employment, Contact Us, and RSS. All of these links are to the main CBO web site and take the user away from the Health page. All of the health-related material is organized below these links on the main part of the homepage itself. First, there is a brief message from CBO Director, Peter Orszag, giving CBO’s rationale for “substantially augmenting its capabilities and work on health care issues….” Second, there is a section entitled Presentations, although there are only six listed at this time. One is entitled “Challenges of Health Care Costs” which is a Power Point presentation of 10 slides presented by Director Orszag and dated June, 2007.
The first slide is entitled “Total Federal Spending for Medicare and Medicaid Under Assumptions About the Health Cost Growth Differential.” There are also slides that compare private and public health care spending, the percentage of GDP spent on health in various countries from 1980 to 2004, and demographic effects on health care spending in selected countries from 2005 to 2050, to mention only a few.
The homepage also has an Inside CBO section that links to one-page explanations of the role of various CBO divisions that do agency health analysis. There is a link that lists CBO’s Panel of Health Advisers. There is a Health Policy Internship link which discusses the role of graduate student interns in CBO’s work. The most significant sections of the web site are entitled Publications, Cost Estimates, and Supplemental Info. Each of these areas have a lot of material within them and are considered separately.
The three most recent CBO publications on health are listed on the homepage with a link to a pdf file. Each publication entry gives the title, date, the links, and a brief description. For example, Estimate of Section 904 (Comparative Effectiveness Research) of H.R. 3162, the Children’s Health and Medicare Protection Act of 2007 is dated September 5, 2007, and is described as “Letter to the Honorable Pete Stark.” Perhaps the most important word in this section of the web site is the word “more” which is below the three publications and encircled. Click on this link and the main list of CBO health publications opens.
The health publications page is organized by date with the current year’s publications at the top. 2007 comes first and the three most recent publications that are listed on the homepage are the first three on this page as well. Scroll down the page and there are over 200 publications dated from 2007 to 1978. Each publication has the elements of title, date, and link (sometimes html but all have pdf), and some have an additional description. There are a few publications that also have a link to a Summary. For example, one October 2002 publication is entitled “Issues in Designing a Prescription Drug Benefit for Medicare.” It has html, pdf, and Summary links. The Summary link connects to a brief Executive Summary. From the Executive Summary there is a View Document link at the bottom that goes to the html format for the document. Each html publication has a Table of Contents and is navigated by “Previous Page” or “Next Page” links at the bottom of each section. The pdf files are searchable within the pdf format. The html files have a Search box at the top of the page. They also have a link to the pdf file if the user accesses the html file and then prefers the pdf version, although the pdf link is always to the first page of the pdf file.
A cursory glance at the list of publications shows that most of them are either testimony before a committee or subcommittee or a letter to a congressperson. Sixteen of the twenty-seven 2007 publications have Medicare in the title. There are publications that address veteran’s affairs, medical malpractice, prescription drugs, Medicaid, long-term care, limiting tort liability, and many other health-related subjects. There are older publications that have value as current issues are debated. For example, there is a June 1981 publication entitled “Medicaid: Choices for 1982 and Beyond.” “Scaling Medicare Benefits to Income is the title of a May 1983 publication. There is “Testimony on Comprehensive Health Care Reform” from May 6, 1992. One theme that runs throughout the publications is, of course, budget and financial matters relating to the health industry.
This section of the web site is similar in looks to the Publications section. It includes cost estimates for particular bills or amendments. The two most recent cost estimates are presented on the home page. Included are the title, date, pdf link, and description. For example, the most recent update is entitled “H.R. 1424, Paul Wellstone Mental Health and Addiction Equity Act of 2007.” It is dated September 7, 2007, has a pdf file link, and is described as “Cost estimate for the bill as ordered reported to the House Committee on Education and Labor on July 18, 2007.” This section also has a link to “more” that takes the user to the Cost Estimates page.
Unlike the Publications page that has documents dated from 1978-2007, this page is limited. Its title is “Health Cost Estimates for the 110th Congress.” There are cost estimate documents on bills to change names of institutes, to amend the U.S. Code, on Indian Health Care amendments, Medicare prescription drugs, breast and cervical cancer, veterans suicide, and the Genetic Information Nondiscrimination Act of 2007, to mention only a few.
An illustration of what is included in each cost estimate comes from the document entitled “H.R. 2199, Traumatic Brain Injury Health Enhancement and Long-Term Support Act of 2007.” First is a summary that sets forth the purpose of H.R. 2199 and the cost to the Department of Veteran Affairs in 2008 and then from 2008-2012. Following the summary are sections on the estimated cost to the federal government, the basis of the estimate, traumatic brain injury centers, long-term care for traumatic brain injury, mobile health centers for rural veterans, other provisions, and then concludes with statements on the intergovernmental and private-sector impact of the bill, along with who prepared the estimate and who approved it.
This section of the web site has six links. They are Medicare, Medicare: President’s Proposals, Medicaid, State Children’s Health Insurance Program, Medicaid and State Children’s Health Insurance Program: President’s Proposals, and National Institutes of Health. Each link is a spreadsheet of the topic. For example, the Medicare document is entitled “Fact Sheet for CBO’s March 2007 Baseline: Medicare.”
It is organized by fiscal year and presents figures from 2006 to 2017. It includes information on Medicare Totals (in billions of dollars), components of mandatory outlays (broken down by Medicare parts A, B, and D), components of benefits payments, annual growth rates for components of benefits payments, a comparison of Medicare spending and dedicated funding, the status of the Hospital Insurance Trust fund, offsetting receipts, components of hospital inpatient payments, payment updates and changes in price indexes, beneficiary cost sharing, and enrollment.
Without any fanfare, the Congressional Budget Office has produced a web site that has a wealth of government documents related to health. The site is simple, easy to navigate, and linked to the main web site of the CBO. Potential users of this site must dig for the information they want. They should dig knowing that they will not come up empty. There is gold “in them thar (cyber) hills.”