Reducing the Deficit: Spending and Revenue Options
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CONGRESS OF THE UNITED STATES CONGRESSIONAL BUDGET OFFICE CBO Reducing the Deficit: Spending and Revenue Options MARCH 2011 © Shutterstock, LLC Pub. No. 4212 CBO Reducing the Deficit: Spending and Revenue Options March 2011 The Congress of the United States O Congressional Budget Office Notes Unless otherwise indicated, all years referred to in this report are federal fiscal years, which run from October 1 to September 30. The numbers in the text and tables are in nominal (current year) dollars. Those numbers may not add up to totals because of rounding. The baseline budget projections discussed in this report are those published in Congressional Budget Office,The Budget and Economic Outlook: Fiscal Years 2011 to 2021 (January 2011). The estimates for the various options shown in this volume may differ from any subsequent cost estimates for legislative proposals that resemble the options presented here. On the cover: A U.S. Navy F/A-18F Super Hornet aircraft near Joint Base Pearl Harbor– Hickam, Hawaii, July 2010, photo by Technical Sergeant Jacob N. Bailey, U.S. Air Force; other photos, copyright as indicated on the cover. CBO Preface The Congressional Budget Office (CBO) regularly issues a compendium of budget options to help inform federal lawmakers about the implications of possible policy choices. This volume—one of several reports that CBO produces regularly for the House and Senate Committees on the Budget—presents more than 100 options for altering federal spending and revenues. Nearly all of the options would reduce federal budget deficits. From 1983 to 1997, the reports in this series were titled Reducing the Deficit: Spending and Revenue Options. In 2000, at a time of budget surpluses, the title was changed to Budget Options. This volume returns to the earlier title because the budgetary context has shifted dramatically since 2000. The report begins with an introductory chapter that describes the current budgetary picture and the uses and limitations of this volume. Chapters 2 and 3 present options that would reduce mandatory and discretionary spending, respectively. Chapter 4 contains options that would increase revenues from various kinds of taxes and fees. The options discussed in this report stem from a variety of sources, including legislative proposals, various Administrations’ budget proposals, Congressional staff, other government entities, and private groups. The options are intended to reflect a range of possibilities rather than to provide a ranking of priorities or a comprehensive list. The inclusion or exclusion of a particular policy change does not represent an endorsement or rejection by CBO. In keeping with CBO’s mandate to provide objective, impartial analysis, this report makes no recommendations. Some previous reports in this series grouped spending options according to budget function (the 20 programmatic categories into which the government’s activities are frequently divided). This volume, however, groups spending options according to whether the funds are generally controlled through authorizing legislation (mandatory spending) or through the annual appropriation process (discretionary spending). An index listing the options by budget function appears in Appendix C. This volume is the result of work by more than 130 people at CBO; those contributors are listed in Appendix E. The staff of the Joint Committee on Taxation prepared most of the revenue estimates. The report is available on CBO’s Web site (www.cbo.gov). Douglas W. Elmendorf Director March 2011 CBO Contents Introduction 1 1 The Current Context for Making Decisions About the Budget 1 The Options in This Report 8 Caveats About This Report 9 Mandatory Spending Options 11 2 Trends in Mandatory Spending 11 Assumptions Underlying Projections of Mandatory Spending 12 Sources of Growth in Mandatory Programs 14 Approaches to Reducing Mandatory Spending 17 Mandatory Spending Options in This Chapter 17 Discretionary Spending Options 69 3 Trends in Discretionary Spending 71 Approaches to Reducing Discretionary Spending 72 Discretionary Spending Options in This Chapter 73 Revenue Options 129 4 Trends in Revenues 129 Considerations in Setting Tax Policy 130 Approaches to Increasing Revenues 135 Revenue Options in This Chapter 136 CBO VI REDUCING THE DEFICIT: SPENDING AND REVENUE OPTIONS A Options That Would Increase the Deficit 207 B Deficit Reduction Options with Smaller Budgetary Effects 219 C Options by Budget Function 223 D Options by Major Program or Category 229 E Contributors to This Volume 237 CBO CONTENTS REDUCING THE DEFICIT: SPENDING AND REVENUE OPTIONS VII Tables 1-1. CBO’s Baseline Budget Projections 4 2-1. CBO’s Baseline Projections of Mandatory Outlays 16 3-1. Discretionary Spending in 2010 69 4-1. CBO’s Baseline Projections of Revenues 132 Figures 1-1. Federal Debt Held by the Public Under CBO’s Baseline or with a Continuation of Certain Policies, Compared with Past Debt 2 1-2. Total Revenues and Outlays, 1971 to 2021 3 1-3. Federal Revenues and Spending in 2021 Under CBO’s Baseline or with a Continuation of Certain Policies 5 1-4. Breakdown of Federal Spending in 2010 9 2-1. Breakdown of Mandatory Spending in 2010 12 2-2. Mandatory Spending, 1971 to 2021 13 3-1. Breakdown of Defense and Nondefense Discretionary Spending in 2010 70 3-2. Discretionary Spending, 1971 to 2021 71 4-1. Breakdown of Revenues in 2010 130 4-2. Total Revenues, 1971 to 2021 131 4-3. Cumulative Budgetary Effect of Major Income Tax Expenditures, 2010 to 2014 133 4-4. Average Federal Tax Rates, by Income Quintile and Tax Source, 2007 135 CBO VIII REDUCING THE DEFICIT: SPENDING AND REVENUE OPTIONS Mandatory Spending Defense Option 1 Introduce Minimum Out-of-Pocket Requirements Under TRICARE For Life 19 Energy Option 2 Transfer the Tennessee Valley Authority’s Electric Utility Functions and Associated Assets and Liabilities 20 Option 3 Reduce the Size of the Strategic Petroleum Reserve 22 Natural Resources and Environment Option 4 Prohibit New Enrollment in the Conservation Stewardship Program 24 Option 5 Limit Enrollment in the Conservation Reserve Program 25 Agriculture Option 6 Reduce the Premium Subsidy in the Crop Insurance Program 26 Option 7 Reduce by 20 Percentage Points the Share of a Farmer’s Base Acreage Eligible for USDA Payments 27 Housing Credit Option 8 Lower the Loan Limits on Mortgages Guaranteed by Fannie Mae and Freddie Mac 28 Option 9 Increase Guarantee Fees Charged by Fannie Mae and Freddie Mac 30 Education Option 10 Eliminate Subsidized Loans to Graduate Students 31 Option 11 Change the Interest Rate Structure for Student Loans 32 Health Option 12 Add a “Public Plan” to the Health Insurance Exchanges 33 Option 13 Limit Medical Malpractice Torts 35 Option 14 Adopt a Voucher Plan and Slow the Growth of Federal Contributions for the Federal Employees Health Benefits Program 37 Option 15 Convert the Federal Share of Medicaid’s Payments for Long-Term Care Services into a Block Grant 39 CBO CONTENTS REDUCING THE DEFICIT: SPENDING AND REVENUE OPTIONS IX Mandatory Spending (Continued) Option 16 Reduce the Floor on Federal Matching Rates for Medicaid Services 41 Option 17 Consolidate and Reduce Federal Payments for Graduate Medical Education Costs at Teaching Hospitals 43 Option 18 Raise the Age of Eligibility for Medicare to 67 45 Option 19 Impose Cost Sharing for the First 20 Days of a Stay in a Skilled Nursing Facility Under Medicare 47 Option 20 Require a Copayment for Home Health Episodes Covered by Medicare 48 Option 21 Reduce Medicare Costs by Changing the Cost-Sharing Structures for Medicare and Medigap Insurance 49 Option 22 Increase the Basic Premium for Medicare Part B to 35 Percent of the Program’s Costs 51 Option 23 Reduce Medicare’s Payment Rates Across the Board in High-Spending Areas 52 Option 24 Eliminate the Critical Access Hospital, Medicare-Dependent Hospital, and Sole Community Hospital Programs in Medicare 53 Option 25 Require Manufacturers to Pay a Minimum Rebate on Drugs Covered Under Medicare Part D for Low-Income Beneficiaries 54 Retirement and Social Security Option 26 Base Cost-of-Living Adjustments for Federal Civilian and Military Pensions and Veterans’ Benefits on an Alternative Measure of Inflation 56 Option 27 Base Social Security Cost-of-Living Adjustments on an Alternative Measure of Inflation 58 Option 28 Link Initial Social Security Benefits to Average Prices Instead of Average Earnings 60 Option 29 Raise the Earliest Eligibility Age for Social Security 62 Option 30 Raise the Full Retirement Age in Social Security 63 Option 31 Lengthen by Three Years the Computation Period for Social Security Benefits 65 Option 32 Apply the Social Security Benefit Formula to Individual Years of Earnings 66 Options That Would Increase the Deficit Option A-1 Extend the Requirement for States to Provide Transitional Medical Assistance 208 Option A-2 Permanently Extend Cost-Sharing Assistance for Qualifying Individuals Under Medicaid 209 Option A-3 Increase Social Security Benefits for Workers Who Have Low Earnings Over a Long Working Lifetime 210 CBO X REDUCING THE DEFICIT: SPENDING AND REVENUE OPTIONS Discretionary Spending Defense Option 1 Reduce the Growth in Appropriations for the Department of Defense 74 Option 2 Cap Increases in Military Basic Pay 76 Option 3 Increase Medical Cost Sharing for Military Retirees Who Are Not Yet Eligible for Medicare 78 Option 4 Limit the TRICARE Benefit for Military Retirees and Their Dependents 80 Option 5 Increase Cost Sharing for Pharmaceuticals Under TRICARE 82 Option 6 Consolidate