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The Congressional Budget Office review of the federal budget impact of ACA looking out 10 years, is missing over a billion dollars in cost savings and revenue increases from the system change impacts it has.  I have a request into CBO for all the factors they used because it is hard to get to their data.  No, their technical info isn't it.  

I didn't seen any factors and/or categories that reflect some of the biggest impacts on the Federal budget and the economy.  These impacts could silence the negative debate and make us race to get ACA and more in place.  Probably a pipe dream thinking about Republican side because they don't deal with truths, but nonetheless I don't think huge positive impacts from ACA aren't included.  The CBO Budget Impact Assessment of ACA doesn't include the items below.  These things can be conservatively modeled.  I’m afraid we won’t hold the private insurance companies accountable for the windfall they’re going to have, if we don't consider these impacts.  In the third or fourth year and beyond with continued promotion of getting healthcare insurance through ACA Marketplaces:

Medicare Cost Reduction
-Significant reduction in Medicare costs and/or growth due to getting to millions of people with care and prevention a lot earlier than age 65.

Private Insurance Cost Reduction
-Significant reduction in healthcare costs to insurance companies and Medicare starting in 4th year and going forward for helping to keep more people healthy, enabling people to get to healthcare before they are very ill, and for identifying health problems earlier.

More Paying Income Tax and Less Unemployment Costs
-Significant job growth and economic stimulation across the country resulting in more income taxes and less unemployment costs.

More Private Insurance Cost Reduction and Disposable Income for Economic Stimulus
-Significant reduction in private insurance rates due to a lot more people supported by Medicaid (this really should be a factor after the first year)
-After first year, when insurance companies can see the impact, significant reduction in private insurance rates due to more younger and healthier people buying insurance.
-Significant decrease in hospital retail pricing and co-insurance costs to patients, since they will have a large reduction in the uninsured they have to support.

There are so many changes in the ACA bill that have the leverage our healthcare system to operate more the way we desire.  

Someone must have done analysis on the system change impacts.  Have to keep searching.

Several Key Facts that Underlie ACA Systems Dynamics Impacts
The Problem with Escalating Systems
-In an escalating system, like our healthcare systems cost and the out of control heart disease, diabetes, cancer, etc., families bankrupt and the government bankrupts unless we change the game in very significant ways.  Escalating systems behavior is science and evidence based, but not well understood across the country.  In an escalating system to win you have to change the game or someone has to bankrupt.  The Cold War is a good example.  We kept spending and so did the USSR.  USSR bankrupted first.  The shame of it is that Reagan and the Russians actually helped the world closer to bankruptcy because they used so much world resource and added so much carbon to the environment.  Prohibition is another great example of changing the game in an escalating system.  

A LOT MORE Expensive To Get Someone Well
-It is orders of magnitude more expensive to get someone healthy versus keeping them healthy.

70% of us are Overweight or Obese and it is Getting Worse.
-No one bill or reform package can fix the lack of health in so many Americans.
-No one yet knows the answer for how to help major numbers of people exercise, lose weight and keep it off.  It is complex and requires a lot of customization.  
-The country has not yet faced it's lack of wellness and will have to invest a lot more in getting 'we, the people' healthier or we'll bankrupt more families and within about 10 years bankrupt Medicare and the US.  We can’t give up because we don’t know how or because people seem unwilling.
-For some people, once the weight is gained, from a science and evidence basis, they physically can't lose the weight because their body structure and composition has changed.  By some estimates, only 5% of obese people can return to and maintain a healthy weight.
-Our insurance and health system drives use of meds and specialists.  Most GPs or Internists can't make enough money to stay in business.  In the Southwest area of Orlando, called Dr. Phillips, there is only one GP left.  GPs, Internists, Nurse Practitioners, Physician's Assistants is where wellness improvement happens.
-Most GPs, Internists, Nurse Practioners, etc. don’t know how to help people change to a healthier lifestyle and require training to have an impact on their patients.

Stranding Pre-existing Condition People
-For so many of us we are a job away from no coverage due to a pre-existing condition.  Leaving people with pre-existing conditions stranded without insurance is good for the insurance companies but NOT the country.  It incents insurance companies incorrectly.  They have no reason to pay for wellness support, if they don't have to deal with pre-existing conditions.  Now, they have to deal with pre-existing conditions!

Terrible Formula for Insurance
Medicare is insurance we pay throughout our careers in every job.  Imagine the insurance cost if most people didn't have Medicare.  No insurance company would offer insurance to all Americans over 65 because the price would be astronomical.  The most cost in healthcare is 65 and older and end of life.  Allowing people who have low risk of a health problem opt out of health insurance hurts everyone with insurance.  They're payments don't get factored into all of our insurance rates.

Except for Medicaid, Private Insurance Covers the Uninsured, Not the Government
-Private Insurance absorbs (pays) for the majority of uninsured because these people are cared for by local hospitals who can't, and shouldn't, turn them away.  Hospitals load in the cost to support the uninsured into the rates they negotiate with each insurer.  Government doesn't subsidize the cost of uninsured for hospitals.
-Medicare reimburses hospitals and doctors at less than actual cost in the majority of cases.  If a hospital or Doctor were only to support Medicare, they would immediately bankrupt.

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