James S. Brady Press Briefing Room
1:46 P.M. EST
MR. CARNEY: Good afternoon, ladies and gentlemen. I hope you all are well. Thanks for your patience.
As you can see, I have with me today Jason Furman, Chairman of the President’s Council of Economic Advisers. Because I know there is interest in today’s CBO report, I asked Jason to join me. He will say a few words at the top, then take questions from you on that subject and others related to his expertise. Like Tom Sawyer, I enjoy having other people paint fences for me, so it’s good to have Jason here to do this work. And I will stand by for questions on other subjects. So if you take all your questions related to matters Jason handles at the top, I’ll be here for when he goes.
Thanks.
MR. FURMAN: Thank you very much, Jay. I wanted to start with the main thing that the CBO report is about, which is about the federal budget. And it confirms the very substantial near-term improvements that the United States has made in its deficit. In particular, it finds that the deficit last year was 4.1 percent of GDP. That’s cutting the deficit the President inherited in half, and the fastest pace of deficit reduction since the demobilization from World War II.
The CBO report also finds that the deficit will continue to decline in the near term, falling by another $200 billion in the next two years, falling to 2.6 percent of GDP. That number is important, because from the very beginning the President’s economic team and the President thought that the most important goal in fiscal policy was to ensure that your debt was falling as a share of the economy. And having deficits below 3 percent of GDP are consistent with that goal.
CBO does also find and confirm that there is over the medium and long term still a substantial deficit challenge, and that’s why you’re going to see the President’s budget once again, as it has in previous years, continue to propose deficit reduction over the medium and long run as it makes investments in jobs and priorities as well.
Turning now to Appendix C of the report, since that seems to have attracted some interest from some people, I can give you a little bit of context for the impact the Affordable Care Act has had on labor markets and will have on labor markets and the economy going forward.
First, since the Affordable Care Act has passed, the private sector has added 8.1 million jobs. That’s the fastest pace of private sector job growth since the late 1990s. And I think that fully puts to rest a lot of the more overwrought predictions about how the sky would fall and the economy would be deeply damaged by the Affordable Care Act.
Turning now to this report, CBO itself says that in very important ways the Affordable Care Act today, right now, is helping labor markets, is helping businesses, and is helping jobs.
And in particular, what CBO finds is that the tax credits for health coverage, Medicaid will help put more money in people’s pockets, help them be able to spend more, and that will provide a boost to the economy. To give you the full quote, “The expanded federal subsidies for health insurance will stimulate demand for goods and services, and that effect will mostly occur over the next few years. That increase in demand will induce some employers to hire more workers or to increase their employees’ hours during that period.”
Very importantly, we have seen many claims that the Affordable Care Act is impacting the job market today -- for example, numerous allegations that it’s increased part-time employment. CBO refutes that, saying, “In CBO’s judgment, there is no compelling evidence that part-time employment has increased as a result of the ACA.” That is what the ACA is doing to labor markets in the near term, right now, the economy today.
Finally, the report talks about what happens to labor markets over time, which the report defines as 2017 through 2024. That, too, refutes one of the main attacks and criticisms against the Affordable Care Act, which is that it would lead employers to shed jobs; that it would lead employers to dramatically cut back on hours, and increase the unemployment rate. In fact, what CBO found -- and this is their summary quote near the top of Appendix C, again -- “The estimated reduction” -- this is the reduction in the total quantity of labor that all of you have seen and talked about -- “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.”
What’s relevant about that is their word itself is “choose.” This is a choice on the part of workers. And I have no doubt that if, for example, we got rid of Social Security and Medicare, there are many 95-year-olds that would choose to work more to avoid potentially starving or to give themselves an opportunity to get health care. I don’t think anyone would say that was a compelling argument to eliminate Social Security and Medicare. Similarly here, CBO’s analysis itself is about the choices that workers are making in the face of new options afforded to them by the Affordable Care Act, not something about firms destroying jobs.
The final thing I’d like to say is that CBO themselves stress that their analysis is not complete -- it doesn’t reflect the full set of factors -- and that there’s substantial uncertainty around their analysis. In particular, I think there’s three very important ways that the Affordable Care Act is and will continue to improve labor markets that weren’t reflected here.
The first is an increase in the productivity of workers because of fewer sick days, less disability, and generally improved productivity as a result. The second is something the Council of Economic Advisers has done a report on, which is contributing to the slowest pace of per capita health spending growth in the last 50 years. That slowest pace in the last 50 years is a fact. We documented the ways in which the Affordable Care Act is one of the important factors that has contributed to that slowdown. What that does is it helps employers in the short and medium run. It lowers some of their compensation costs, help them hire more workers. And then finally, by giving people more security in terms of their health care, it reduces what economists call “job lock,” or more colloquially, it gives more opportunities for entrepreneurism and moving from job to job.
In addition to that, as I said, there’s a lot of uncertainty. I think economists would debate some of the assumptions here and I’d expect there to be a robust debate around things like how much workers respond to a set of phase-outs that in other parts of social programs you generally haven’t seen people respond to in some of the degrees assumed here. But regardless of that, as I said, this report confirms the ACA is making positive impacts today in very important ways. It refutes some of the arguments about how it has hurt the labor market today or will hurt it in the future. And it confirms what we’ve all known, which is when you do something like that it gives people new choices and new options, and people will sometimes make different choices in the face of new choices and new options.
Q I get that you think that this report refutes the idea that it’s going to be businesses that are cutting back on jobs, but even if some of these nearly 2.5 million people who are going to leave full-time jobs are doing it because they’re choosing to, doesn’t just the sheer idea of losing 2.5 million jobs over 10 years have a negative economic impact?
MR. FURMAN: First of all, two things. One is, I every month go out on TV to talk about the jobs numbers. Every month, pretty much every one of you that does television in here asks me the question, “If something bad happened last month wasn’t that because of the Affordable Care Act?” Or “there’s been an increase in part-time employment lately” -- which was true in the spring, it actually hasn’t been true in the last couple months – “isn’t that because of the Affordable Care Act?” So over and over again, there has been the claim that the Affordable Care Act has impacted the labor market today. This refutes that.
In the long run, first of all, as I said, getting rid of Social Security and Medicare would cause more 95-year-olds to work; we don’t think that would be an effective economic strategy for boosting the economy or particularly wise policy. So you can ask that question in the context here. Second of all, the numbers themselves don’t incorporate some of the important ways in which this does help labor markets by improving productivity, reducing the growth of health care, reducing job lock and thus increasing entrepreneurialism. So I think when you look at the Affordable Care Act as a whole, it’s good for the economy and gives more choices to people.
Q But isn’t the report basically saying that the Affordable Care Act will have the impact on the labor market of reducing full-time employment by 2.5 million jobs over the next 10 years?
MR. FURMAN: The report finds that there will be less -- that workers will choose to supply less labor, correct. It describes it as a choice. Again, it’s not that the businesses are cutting those jobs.
Q I guess what I don’t understand, if you’re losing that many jobs -- and I’m really just trying to understand this here. If you’re losing that many jobs, regardless of why you’re losing them, doesn’t that have some kind of negative impact on the economy?
MR. FURMAN: Two things. One, just a small, picky thing. It doesn’t say “losing jobs.” It says FTEs. So to some degree, this might be somebody who used to work 60 hours because they needed health insurance and that was the only job that offered it, and now they can get a different job at 35 hours that doesn’t offer health insurance, but they’re getting it through this and they’re switching from one to the other. And that’s a better choice for that person, and this is giving them that option that they didn’t used to have.
As I said, you wouldn’t judge whether Social Security or Medicare are good or bad based on what they do to labor supply. I’m not contesting that fewer 95-year-olds work because of those programs. So I don’t think that’s the total way in which anyone would look at anything that we choose to legislate and judge it.
But, finally, I’m not necessarily saying that the 2.5 million number gives a complete picture of all of the myriad effects of the Affordable Care Act. CBO says, for example, the ACA could also alter labor productivity, the amount of output generated per hour, which in turn would influence employment. And then it says that the report isn’t taking into account factors like that because they’re harder to quantify and be sure about. That’s not the same as saying it doesn’t matter.
Q Jason, do you refute any of the data that the report is using?
MR. FURMAN: CBO does excellent work. We cite CBO all the time. I wouldn’t say anything other than that about them. I would say no matter how excellent any organization’s work is, number one, it’s subject to be misinterpreted. And a lot of what I’ve been talking about here is the way that this has been interpreted.
But, number two, an analysis can only take into account so many things. This analysis, by design, looked at a set of labor market effects. It didn’t look at another set of labor market effects. And I talked about what those three effects were. I think in particular that slowdown in health costs is something that, put in the language of CBO, would increase labor demand and be quite an important factor. So that’s the second point.
And then the third point I’d make is that CBO themselves says that there’s a tremendous amount of uncertainty. A lot of the report stems from -- as tax credits phase out, what does that do to people’s incentives. There’s a literature on the earned income tax credit that has generally found that the phase-out of the earned income tax credit doesn’t affect labor supply. CBO is assuming that in this context people will have a much better understanding of these phase-outs and alter their behavior in response to it to a much greater degree than we’ve seen in the context of the earned income tax credit. I suspect CBO itself would say that there’s uncertainty around that, and I suspect that’s one of the many assumptions that one could debate in this report.
Q But you don’t dispute -- or do you dispute -- the conclusion -- one of the main conclusions that we’ve talked about already, that some people would choose to go part time so as not to lose the subsidies that are part of the design of the ACA.
MR. FURMAN: I think there is no dispute that the Affordable Care Act provides people with new options, and that people who today are doing a set of things because they don’t have options and choices will be able to do new things that they would not have otherwise chosen to do -- in many cases, not have been able to do. There are puts and takes -- and this is describing the net effect of that put and take -- in terms of whether this number is the most accurate net effect. Again, I think there’s a number of other effects you’d want to factor in. There’s a lot of uncertainty you’d want to think about in that regard, and that ultimately you’re not going to look at something and judge it entirely by the impact on labor supply, first of all. And second of all, if you want to judge it entirely by the impact on labor supply, you’re going to want to take into account a fuller analysis than just what was seen here and reflect also the uncertainty around that analysis.
Q The CBO is a non-partisan agency. Do you see this report as partisan in any way?
MR. FURMAN: I think CBO consistently does outstanding work. And I think this report is mainstream economics, but I think, like mainstream economics, it doesn’t take into account -- it’s subject to misinterpretation, doesn’t take into account every factor, and there’s uncertainty and debate around it. And I think one of those key debates is the responsiveness that labor supply would actually have in this context to phase-out rates.
MR. CARNEY: Brianna.
Q Thank you. You talk about choice -- you’re using that word -- and when you’re talking about a choice it makes me think of a calculation that some families make where the mom or the dad decides they’re not going to go back to work because they look at childcare costs and it becomes so expensive it doesn’t really make sense financially for them to go to work. Is it a choice or is it a calculation that some people are making, where some people may actually want to work but the benefit they’re receiving may discourage them from doing that?
MR. FURMAN: First of all, the word “choice” is -- I have been using that word a lot. A lot of my use of that word has also been in the quotes. So when you read Appendix C, you’ll see throughout it talks a lot about the labor that workers choose to supply. And it actually says there’s no increase in unemployment.
Q Before you said the choice is calculation, right? Some kind of a math.
MR. FURMAN: Well, let’s give you an example from Medicaid. For example, there’s some evidence that if you have just a single person, Medicaid is not going to impact their choice about working. And that’s because if you are the only breadwinner in your family because you are the only person in your family, you are going to need to have a job, you’re going to need to work.
There have been studies that have found that if two people are married and they get Medicaid, that that might lead a spouse who otherwise would have gotten a job and worked really hard to buy health care for the whole family might not need to get a full-time job, might get a part-time job and have more time to spend with their children as a result of the new option they have for health care. That is one of the types of choices that people would have now that they wouldn’t necessarily have had before, and that’s one of the choices in the types of studies that CBO is relying on in making this finding.
Q Jason, on your example when you were talking about somebody making –- working 60 or 65 hours a week, and they might now be able to work, I can’t remember if you used 30 or 35 hours a week, and they’d have health insurance. Just an example. So it’s a good thing that they now have health care, maybe they didn’t before, but isn’t that man or woman going from 60 or 65 hours to 30, they’re making less money, right?
MR. FURMAN: I’m saying if they –- yes, if -- the main thing going on here was a change in labor demand. And labor demand, just to be clear, that is the decision that employers are making. So employers are cutting jobs because of the Affordable Care Act, that would be a bad thing because that means somebody who really wanted a job wouldn’t be able to get one. You might see the unemployment rate go up as a result of that, for example.
CBO explicitly says that you’re not going to see an increase in the unemployment rate, that when you see changes it will be that person who maybe didn’t want to work those hours, they still have the option to, they still can, but in that case maybe they’ll decide they don’t need to anymore. And that, in their case, might be a better choice and a better option than what they had before.
Q Sure. Then they make that choice, and they go from 60 to 30-35 hours, presumably that family is going to have a lot less take-home pay and they’re going to have less money to put back into the economy.
MR. FURMAN: But we just described that example -– first of all, it’s a hypothetical example.
Q Well, it was your hypothetical.
MR. FURMAN: Right, it is my hypothetical. That is completely fair. Again, it’s a choice they’re making.
This doesn’t –- they had something before, which was a 65-hour job and maybe no health care and no great health care options. You now give them a new option they didn’t have, a brand new thing -- it’s option to buy in the marketplace; it is subsidies through that; maybe it’s Medicaid if their income is low enough. They still have everything they had before. Labor demand hasn’t changed. They still have that job. They can still go to that job. They can still do that. But you give them this extra new thing -- you can’t have made that person worse off. If they make a new choice, it’s because they’re –- in economics language, they’re optimizing subject to a new constraint and making themselves better off.
Q Right, but it wouldn’t be better for their family -- like, work hours-wise, it might be better for the family to have health insurance, but a lot less take-home pay when you go from 60 to 30 hours.
MR. FURMAN: But they –- in my example, the person -–
Q Are you going to make more money if you go from 60 to 30? I’m just trying to follow the math.
MR. FURMAN: Some people may choose to. I’m not going to sit here and go give a list of 140 million Americans and tell you how many hours each of them should work.
Q Oh, come on.
MR. FURMAN: And that’s not what the Affordable Care Act –- except maybe you, Karl -- Jonathan. That’s not what the Affordable Care Act does. The Affordable Care Act says you can do just what you did before in this regard, with some puts and takes, but sort of in aggregate you can basically do the same thing you did before. But now you have this new thing you didn’t used to have. If because of this new thing you make a different choice than you used to, you are by definition not worse off. There’s no way you have a set of stuff, you can make exactly the same choice you made before, and now I give you something else that you could be –- that you’re worse off as a result of that.
Q Doesn’t, Jason, that incentivize, though, some people to do less? All of a sudden there’s an incentive to do less because if your salary is less, you’re still getting government subsidies that then benefit you.
MR. FURMAN: First of all, for many people there’s potentially an incentive to do more. There’s an incentive for more entrepreneurship because you’re not locked into a job. There’s an incentive for employers to be able to hire more people because the cost of health care is lower. There is an incentive to hire workers who are going to be absentee less. So I think there is a whole bunch of puts and takes here that we need to take into account.
Q But there’s also sort of the opposite of that job lock, isn’t there? There’s that as a result of the job lock is that you’re stuck in a job so you’re afraid to pursue other things, entrepreneurial opportunities and other jobs because you need the job for workman’s comp.
MR. FURMAN: That’s the situation before the Affordable Care Act.
Q Right. And so now before that -–
MR. FURMAN: Now that situation has been -- the Affordable Care Act effectively solves that and creates a situation where you can be more dynamic and can be more and more mobile.
Q Or be less dynamic, right? Because if you do less, and you potentially have a lower salary, and you get more government subsidies that help provide for you in that, then --
MR. FURMAN: Right. The basic premise here is that people have more choices in the same way that Social Security and Medicare give retirees more choices than they’d have today. And on net, as I said, there is a whole lot of puts and takes, but this is an extra choice people have. And that’s not making somebody worse off to give them an option they didn’t have before.
Q Jason, I just want to be clear with your Social Security and Medicare example. So you’re saying it may be a good thing if there are 2 million fewer workers?
MR. FURMAN: I’m not saying that I accepted that number. I think there is a whole range of factors that go into estimating that number, some of which were captured here, some of which weren’t; some of which are subject to uncertainty, first of all. Second of all, I think it is -- just step back here. How many articles have we read, how many people have gone out and said the Affordable Care Act is causing businesses to cut back on jobs?
Q But the employer mandate hasn’t gone into effect yet. You guys delayed that. So that’s not a good analogy.
MR. FURMAN: No, but not just the part-time. The number of times a Republican has said ‘they are strangling the economy, and regulation from the Affordable Care Act and employers can’t create jobs, and it’s killing jobs, and employers can’t add jobs,’ -- this directly goes against all of that. And it raises a different set of issues around when you give people options what choices they make with those options.
Q But to go back to this thing, whether it’s 2 million -- you don’t dispute there will be fewer people working full-time jobs as a result of the Affordable Care Act, do you?
MR. FURMAN: I have done --
Q Do you find anything to dispute in the numbers that are presented here?
MR. FURMAN: Yes, I have gone through that several times. CBO itself says that they take into account some set of factors and analyze those. There’s another set of factors they don’t take into account, all of which go the other direction, and there’s uncertainty around in particular the key question of the degree to which people will understand and respond to a set of phase-outs in a way that we haven’t seen elsewhere. So, no, I’m not accepting the numerical premise here.
Q But you don’t dispute the idea there will be fewer full-time workers though? Some people will choose -- this was your whole point of your Medicare and Social Security example, right? That some people will choose not to work so they no longer are locked into a job to get health coverage. I thought that was part of your argument here.
MR. FURMAN: Part of it is even if the net result of this is a reduction in labor supply, to the degree that reduction and labor supply is voluntary and reflects the choices people are making, you’re going to think about that very differently than if it was businesses cutting back on jobs. This is not businesses cutting back on jobs. This is people having new choices they didn’t used to have. Those are two completely different things in terms of the impact it has on people, first of all.
Second of all, if you ask the net effect on this on overall labor in the economy, you would want to take into account that other set of factors, quantify them, put them into that analysis. CBO hasn’t done that, but economist David Cutler and Sood -- and he’s one of the leading health economists in the country -- when he did that, for example, he said that lower health costs would add 250,000 to 400,000 jobs per year towards the middle to end of this decade, and that’s based on just the slowdown in health costs and what it would do to jobs. This is by way of saying there are a number of different things that you want to factor in here that we haven’t seen factored in, in Appendix C.
Q But just one more. So you’re saying that one of those choices is the choice not to be employed or the choice to be unemployed?
MR. FURMAN: Somebody who used to be in a job they didn’t want to be in just because that was the only way of getting health insurance for their family may be able to be in a better job for them. Maybe a spouse who wanted to be part-time so they could spend more time with their family, now is able to do that. Somebody else who wanted to start a business and become an entrepreneur, and was terrified of doing it because they’d lose their health insurance, is now able to do that too, and switch and take a chance on creating jobs and growing the overall economy. So there’s a lot of new choices that this will facilitate.
Q Jason, are you going to do that more complete analysis that you say is missing from the CBO report, taking in the entrepreneurship and the other benefits that you’re referencing?
MR. FURMAN: I don’t have a particular plan on that at this point.
Q I wanted to ask about the subsidies here. You said that the subsidies were one of the main things that are causing workers to make these decisions; for example, the 60-hour worker going down to 40 -- now they can do that. But you’ve mentioned other factors, too. What would be some of those other factors causing people to make these decisions?
MR. FURMAN: The CBO does a set of -- incorporates a set of classical labor market factors in terms of looking at phase-out rates of credit schedules and pass-throughs and things of the like. And those are classic, standard things to analyze. I’ve been a little bit repetitive about the things that they didn’t include, but I think the three that I think are most important are that slowdown in health costs, which in the long run it’s passed on to workers in the form of higher wages. There is substantial research that shows in the short and medium run, a slowdown in health costs will also reduce compensation for employers that will increase the demand for labor by employers, or more colloquial, that will create jobs. And that’s the 250,000 to 400,000 that Cutler and Sood found. That’s number one.
Number two, reduced absenteeism and increased and reduced disability. And you’ve seen some cross-national studies that have looked at these types of factors. And you had something like the Oregon Health Experiment, for example, which found reductions in depression associated with people getting Medicaid. If that’s going to be the case, those people are probably going to show up at work and be more productive on the job, and that will help the economy.
And then, the final factor is this job lock or entrepreneurialism -- that you don’t need to get stuck in a job just to have health insurance. And that’s really important, because what matters for the economy is people who are going to the job that’s best for them that they’re most productive in, and that may be also choosing to be an entrepreneur. And the Affordable Care Act facilitates that.
Q And at the top, you said that the President’s budget, coming out March 4, would continue to propose deficit cuts. Are you talking about net deficit cuts, or are you talking about cutting some here, but raising it here?
MR. FURMAN: I don’t want to lift the curtain on the budget the President is going to put out. But every budget he has put out to date has on net, over the medium and long term, reduced the deficits from what would otherwise have happened if you continued along current policy.
Q And we should expect that that will continue?
MR. FURMAN: I don’t want to lift the curtain on any specific. And in the State of the Union, in fact, he said something to the effect of we need to do more deficit reduction and do it in a balanced manner while making investments.
MR. CARNEY: Alexis. I’m sorry, I did say Bill, and then Alexis.
Q Taking over where Roger was -- you said we are now at 4.1 percent of GDP with the deficit, and heading toward 2.6 percent. What is the ideal considered among economists as a percent?
MR. FURMAN: The most important thing is that you’re getting your debt down as a share of the economy, and that -- that it’s on a downward path says that you’re fiscally sustainable. And deficits under about 3 percent of GDP are generally consistent with getting your debt down.
And I want to be completely clear: CBO finds that the debt as a share of the economy, after about 2017 or 2018 –- I don’t remember the exact year -- does start to rise as a share of the economy. So they are not saying we have solved our fiscal problems. They continue to confirm that we do have a medium- and long-run fiscal challenge. What they do find, though, is that deficit reduction in the last four years, and then again in the near term over the next couple of years, we’re going to continue on a strong downward path.
Q So I guess my question is, if you’re already at 4.1 and you’re heading to 2.6 and you’ve got 15 million Americans out of work, why the fixation on more deficit cutting? Why not an emphasis on more stimulus or more spending to boost the economy? It seems you can afford it. You’ve succeeded in getting the deficit down.
MR. FURMAN: Again, if you looked at the State of the Union, the President was talking about things like more investment in infrastructure, about other fiscal policies that would help growth and help job creation. And in the past, we’ve always shown how you can do that while also, over the medium and long run, dealing with your deficit.
MR. CARNEY: Alexis.
Q Jason, I have three quick questions. One, just to follow up, CEA and OMB do not have any plans to produce your own economic analysis of ACA related to the work that CBO has completed?
MR. FURMAN: There are no plans. We have done a very extensive analysis of the impact the Affordable Care Act has had on the growth of health costs, and that itself is an important economic input. But we don’t -- there’s no plan to do this analysis.
Q My second question is, am I understanding what you’re saying correctly that the change in incentives for people is not a net drag on economic growth? If 2.5 million people change their choice about working, that is not a net drag on economic growth?
MR. FURMAN: First of all, I haven’t accepted the number. There’s a lot of factors that go into that number, not all of them an uncertainty. And second of all, I’m saying that that whole analysis refutes the claim that this is about employers cutting back on jobs and increasing unemployment, and that has been a central argument against the Affordable Care Act.
Instead, this analysis itself -- which isn’t a complete analysis -- but this analysis itself is about the choices that people make and the new options that they have.
Q But you didn’t answer my question.
MR. FURMAN: I could repeat that again if that would help.
Q But you’re talking about something different. You’re talking about the choices that employers make, and CBO is talking about the choices that workers make. So I was asking you, if workers choose to take federal-supplied incentive and not work --
MR. FURMAN: I guess partly I don’t -- I think once you think about -- I think the question, again, to use my Social Security and Medicare example, I don’t think that the right question is would we increase people’s choices about working by repealing Social Security and Medicare. I don’t think that’s the right way to think about that. I think you want to think about that as what does that do for workers, what does that do for retirees, what does that do for people with disabilities, and what options does it give them.
Q Well, except that Medicare and Social Security are aimed at primarily people of a certain age -- seniors. So when you talk about older people, that’s a whole separate equation than the ACA. This is a group of human beings who are in a program that are of all ages.
MR. FURMAN: Right. First of all, this number itself is a small percentage of the overall economy. Second of all, this number itself purports -- I mean, not purports -- is about effectively choices of people. And third, it doesn’t reflect the full set of factors that go into it. So again, I mean, our economic -- if you look at what some of the challenges we have in our economy, one of the challenges has been the growth rate of health costs. Part of how you deal with the growth rate of health costs is dealing with some of the things that were causing that growth rate of health costs and some of that was the way in which our policies were constructed vis-à-vis employers and vis-à-vis the public provision of health insurance.
The Affordable Care Act makes really important changes in that regard, and in that regard is contributing to slower health cost growth. And I think, if anything, that’s probably the number-one thing I would look at in the Affordable Care Act to ask about the overall economic impact. Because if it is slowing the growth of health costs, then it gives you a set of better options than you had before all around. The federal government can save money, employers can save money, workers can save money, there can be more incentive to work, sort of net-net good. And so in thinking about is the Affordable Care Act helping the economy, I think that’s the important question, and in that regard I would answer the question, yes.
Q And one last follow-up. Puts and takes -- for those of us who are used to that in options trading, what the heck do you mean? (Laughter.)
MR. FURMAN: I’m saying there’s a lot of provisions in the Affordable Care Act. A lot of them will create different incentives here and there. I’m not saying that no one anywhere will have any -- no employer will have any new incentive to do anything. There will be some that will have an incentive to increase something here or to decrease something there, or to raise something, to lower something, to do something different. There will be different incentives. On net, though, that aggregates out to something that is -- “slightly affect” was CBO’s word -- labor demand or what employers are doing.
MR. CARNEY: Mara.
Q Just to follow up on this. If you can’t answer Alexis’s question by saying no, how do you answer Republicans who now have this big piece of evidence that they can wave to say, ah-ha, the ACA, bad for the economy. You can’t say that this isn’t -- 2.5 million fewer full-time workers isn’t a net drag. How do you counter what is a really convenient shorthand that they now can trumpet to say I told you so?
Q And they already are.
MR. CARNEY: Shocking.
MR. FURMAN: I just thought you all would be interested in Appendix C and wanted to bring it to your attention in case you hadn’t noticed it.
The Affordable Care Act had three primary goals. One was related to coverage, one was related to quality, and one was related to cost. Insofar as you are asking about the economic impact of the Affordable Care Act, what it does to job creation, what it does to income, what it does to the overall economy, I think overwhelmingly the most important factor there is what does it do to the cost of health care. And I think the evidence is very clear that it is slowing the growth of the cost of health care, and in that way is helping the overall economy and raising incomes.
That is the -- there’s a lot of things one could analyze, but in terms of the biggest and most important one, I think it’s that. So I don’t think there is any problem at all making -- and I just made a very clear argument that the Affordable Care Act is good for the economy.
Q So you think the settled matter that --
MR. FURMAN: It is good for wages and incomes and for the economy overall.
Q But you’re saying it’s a settled matter that the decrease that we’ve seen in health care costs is due to the ACA?
MR. FURMAN: I think it is -- there’s obviously debate around that proposition. To me, I think the evidence is very clear that that is the case. And I’ll do the two-second version, and we have a whole report on it, and we’re happy to follow up with people about that report -- it is indisputable that health costs are growing at the slowest pace they have in 50 years. That is measured in real per capita terms. I don’t think the recession -- many said that was the reason. I don’t think that is increasingly the main reason, and that’s because we’re now five years past the recession.
We are seeing a slowdown in Medicare, which is not very affected by the overall economy, and we’re seeing a big slowdown in health prices as measured by a couple different price indices, and those also aren’t affected by recessions as much as quantities are. That’s ruling out that explanation or that as a total explanation.
In terms of the Affordable Care Act, we have CBO just this year -- said that this year, it would reduce spending by .2 -- that’s the growth rate of the last couple of years -- which in health world is actually a decent amount. That’s just the direct effect of Medicare. If you take into account spillovers to the private sector and assume three-quarters of that spills over, then it is .6 off the growth rate of health care prices. And none of that takes into account things that are coming online, like the innovation center, like the benefits of reduced readmissions -- 130,000 readmissions averted -- and a whole range of things in the accountable care organizations that are designed to better integrate care -- all of these innovations and delivery system reforms that are coming online.
So you take all that into account, I think it’s slowing the growth of health costs. Slowing the growth of health costs, most important economic variable here.
MR. CARNEY: Just a couple more. Yes.
Q So the benefit that you just described of slowing the growth in health care costs is going to balance out whatever the number is -- CBO’s or yours or someone else’s -- of the lost number of people who will be earning money, contributing to the economy, helping their families, and paying taxes by virtue of less work, even if it’s by choice?
MR. FURMAN: First of all, if you look at the fiscal impact of the Affordable Care Act, that’s also positive. And we know that’s going to reduce the deficit by more than a trillion dollars. So you went to some fiscal things in that set of arguments. We reduced the growth of health costs, and, again, I think that matters. I think job lock matters. I think the productivity of workers matter. I think all of those factors matter. And I think regardless -- so first of all, I think all of those factors matter. And second of all, this, at its core, refutes the notion that businesses are not going to add jobs because of the Affordable Care Act.
Q But, Jason, you seem to be dismissing the effect of, even if it’s by choice, people not productively paying into the economy; paying, for example, Social Security tax, toward a system that’s increasingly based on fewer and fewer workers.
MR. FURMAN: Labor supply is important. You look at something like immigration reform. A real motivation for immigration reform is to have more talented people contributing to our economy, creating jobs, adding to the overall strength of our economy. So I think that certainly matters, but I think, again, you have to factor in the way in which people make different choices. They have different options. And when health costs are lower, we as a country have a better set of options than we would have otherwise had.
Q Jason, you said you disputed the total, so just from the individual perspective, when an individual works fewer hours every week in order to access a subsidy -- a subsidy that the government is paying them, a government that is now getting less taxes -- going to what Mark was just saying -- less taxes from Social Security, spending all those other things, why is that good economic policy when they are intentionally working fewer hours to access a government subsidy?
MR. FURMAN: First of all -- you’re asking the same question, so I’ll give mostly of the same answer, which is I think what’s good economic policy is slowing the growth of health costs. What’s good economic policy is encouraging entrepreneurship. What is good economic policy is having a workforce that is suffering less from depression, that is suffering less from physical ailments, and is able to more productively contribute to the economy. I think in all of those respects, the Affordable Care Act is good for the overall economy.
I think right now there are a lot of people who are making choices that may not be the -- not right now -- last year, the year before, before the Affordable Care Act there were people that were making choices that may not have been the best choices for them and for their families. This will give them new options, and will make them better off as a result and, when you take all of these different economics effects into account, is part of an overall economic strategy, including that deficit reduction that we briefly mentioned.
Q I know it’s not the first Friday of the month, but anticipating what we might --
MR. FURMAN: Almost is.
Q -- be talking about, about a lowered unemployment rate, will we see a duplication effect where people who are leaving the workforce, because of these disincentives through the ACA, are being replaced by people who are still looking for a job and trying to fill the worker hours that -- obviously there’s no -- you’re saying this doesn’t affect net demand, labor demand. Will we see an artificial dampening of the unemployment rate because of this effect?
MR. FURMAN: I think you’re missing what was one of the main things in the report that I tried to call attention to at the top, which is if you’re asking about the economy right now in 2014, the economy in 2015, the economy in 2016, a really important impact of the Affordable Care Act that CBO analyzed in their report was that the increase in demand will induce some employers to hire more workers or to increase their employees’ hours during that period. That is because you put more money in the pockets of families, you help them with Medicaid, and that’s going to help people be able to spend more. That’s going to help the overall economy.
And so not only do we have the 8 million jobs since the Affordable Care Act was signed into law, private sector jobs since it was signed into law, you also have that when you’re thinking about the economy right now, when we talk about the jobs number for any given month right now -- CBO is saying a very important effect of the Affordable Care Act or one of the essential effects that it will have right now is increasing demand for goods and services, leading more employers to hire more workers and increase their employees’ hours.
Again, every time there’s a jobs number that is below what people expected, a number of people go out and say that was because of the Affordable Care Act. Precisely this is saying that aspect of the Affordable Care Act goes in the opposite direction. It’s helping jobs right now in the economy today. That’s really important. And I think people have largely missed out on that in their reporting on Appendix C.
MR. CARNEY: Is that a wrap?
Q You wish.
Q You owe him a lot of paint money? (Laughter.)
MR. CARNEY: I do. I do, indeed. You want to start again?
Q Yes, if I could just ask about the President’s meeting on Afghanistan today? If you could just tell us what the purpose of that meeting is and who specifically from DOD leadership is he meeting with?
MR. CARNEY: Sure. Given that General Dunford is in town, this is an important opportunity for President Obama to hear directly in person from his commander on the ground and other senior defense officials. The President continues to weigh inputs from military officials, as well as the intelligence community, our diplomats and development experts, and has not yet made decisions regarding the post-2014 U.S. presence.
As you heard the President say in the State of the Union, when he took office, 180,000 Americans were serving in uniform in Iraq and Afghanistan. Today, all our troops are out of Iraq and more than 60,000 U.S. troops have come home from Afghanistan. With Afghan forces now in the lead for their own security, our troops have moved to a support role. Together with our allies, we will complete our mission there by the end of this year. And America’s longest war will finally be over.
Of course, decisions about what a 2014 presence might look like to achieve the two narrowly defined missions of counterterrorism and training Afghan forces is contingent upon the Afghan government signing the bilateral security agreement that we negotiated last year in good faith. And our issues with that -- the status of that BSA remain as they were.
In addition to General Dunford, we expect Secretary Hagel, Joint Chiefs Chairman Dempsey, Vice Chairman Winnefeld, General Austin and Admiral McRaven to join the meeting with the President, Vice President and other senior White House leadership.
Q Just to follow up on that, Jay, you’ve been saying for some time now that it’s a matter of weeks, not months before you need to have clarity on that agreement. But it’s been several weeks and do you have -- how important is it that you have clarity on this in time for the NATO defense meeting in March? And how frustrated is the President and is the White House in general with President Karzai?
MR. CARNEY: I don’t have a deadline for you. I can tell you that as each day passes and we move further into this calendar year it becomes more imperative that the Afghan government sign the agreement that was negotiated in good faith so that NATO and the United States can make plans for a post-2014 troop presence. Absent a signed BSA, there will be no, and can be no U.S. troops beyond 2014. And when you’re making plans for NATO, a dynamic organization with many members, around a situation like a military presence halfway around the world, you need time. You need time to prepare and you need time to plan.
So that is why it is so important in our view that the bilateral security agreement be signed. Otherwise, NATO and the United States will have to plan for a contingency that does not include U.S. troops and does not include a signed BSA, or in reverse order. So I think it’s abundantly clear that we believe it ought to be signed quickly, that it was negotiated in good faith, it was endorsed by the loya jirga. And we have been calling on the Afghan government to sign the agreement for some time now and making clear that there is no option that includes U.S. troops on the ground in Afghanistan beyond 2014 for this narrow mission, absent a signed BSA.
Q Can you just wait for the next president?
MR. CARNEY: I was asked this yesterday and I think that the answer is this is not about who is president; this is about planning for 2014. And we are already into February. This agreement was negotiated after a prolonged process, a good-faith process, and endorsed by the Afghan elders represented by the loya jirga, and it ought to be signed. We can’t wait months, as I’ve been saying, this has to be a matter of weeks.
Yes, Mike.
Q John McCain and Lindsay Graham came out of a closed briefing in the Senate today and said the administration is floating 2017 as a date, even if there is a BSA, by which all American troops, including residual force, would be removed from Afghanistan. And that is the incentive, they say, for Karzai to go now and have secret talks with the Taliban. Is such a plan being considered?
MR. CARNEY: Well, first of all, the President has made no decisions about troop numbers, as I just said, if there are to be troops beyond 2014 if there is a signed BSA. And when he makes that decision, contingent upon a BSA being signed, we’ll have more details for it on you. Now, just as a general principle, I don’t doubt that some senators envision a world in which U.S. troops remain in Afghanistan for decades. Some senators envisioned a world in which U.S. troops remained in Iraq for decades. That’s not the President’s vision.
Jon.
Q Jay, can I ask about Appendix B? (Laughter.)
MR. CARNEY: Yes, sure, whatever Appendix B is.
Q So the Congressional Budget Office also says there will be 2 million fewer people covered under the Affordable Care Act than had previously been estimated. How big a problem is that?
MR. CARNEY: You’re talking about the estimates for signups by the March 31st deadline. What I can tell you is the issues with the website have been well-documented and covered. And what is true today is that enrollment is ramping up and ramping up rapidly, as we saw in December and saw in January, at least up to the point where we had figures. And that demonstrates the fact that there are a lot of really dedicated people working hard to ensure that healthcare.gov is functioning effectively for all those Americans who want to use it to get quality, affordable health insurance.
And what I can tell you is, come March 31st, we are confident that we will have a substantial number of people having signed up and a good mix of people having signed up. The original estimate of 7 million was a CBO estimate. The new estimate of 6 million is a CBO estimate. What we know is that looking at what we’ve seen now that the website is functioning effectively, we’re going to have a significant number of Americans, because of the demand for quality, affordable health insurance, signed up for that quality and affordable health insurance. So that’s a good thing, that’s a plus.
CBO, I would note, in this report continues to project that the law will ultimately reduce the number of uninsured by 25 million so that bottom-line figure in terms of the ultimate impact on the number of uninsured in this country has not changed in their report and that reflects the fact that we are committed to covering as many Americans as possible. And we’re working to achieve that goal and we’ll continue to work to achieve that goal up until March 31st and beyond.
I would note -- and perhaps you were going to ask this but maybe not -- that the CBO in its report also, as regarding the ACA, did an analysis of the so-called risk corridors that Republicans have been attacking and found that that provision within the ACA would save $8 billion -- $8 billion.
I would also note that Medicare Part D -- which was a law championed by and signed into law by President George W. Bush, supported by many Republicans on Capitol Hill, many of the same Republicans who are trying to make an issue of this -- has a very similar provision in it. The only distinction is for the Affordable Care Act, it lasts three years; for Medicare Part D, it lasts forever. Thereby putting -- we think it’s a good program; we think it’s good for Medicare Part D, we think it’s good for the Affordable Care Act. The only distinction is, coming at it from the Republican critique, is that the one for Medicare Part D potentially puts Americans at risk every year in perpetuity as opposed to the Affordable Care Act, which, at least in theory, could put folks at risk for three years, but in fact, according to the CBO, is leading to $8 billion in savings.
Q Back to this notion of fewer --
MR. CARNEY: You might want to ask them about that proposal they have.
Q Okay. But back to this question of who will be covered, I know the 7 million was the CBO estimate, the 9 million they estimated that would be added to Medicaid. But they are estimating a combined 2 million fewer people will be covered than previously thought. Do you see --
MR. CARNEY: Sure, but what I’m saying is by March 31st, we know we’re going to have -- we’re confident we’re going to have a substantial number of Americans covered both through the exchanges and through expansion of Medicaid. Obviously the second number would be a lot larger if Republican governors around the country -- although there have been a number who have taken the step to expand Medicaid in their states, rejecting the ideological opposition that we’ve seen here -- a number of them continue to deny their own constituents the opportunity to have access to health care through Medicaid that the Affordable Care Act offers. So that number would be even bigger.
But what I’m saying is by March 31st, we’re going to have a substantial number. I daresay a much more substantial number than many in this room were predicting a month or two or three months ago. And again, looking at the CBO estimate, they are still saying that the end point, the number of uninsured Americans who will be insured because of the Affordable Care Act has not changed.
So regardless of the impact of the website’s trouble on those who sign up by March 31st -- and again, I would say that just looking at their analysis -- and it’s their analysis -- that that impact is not as severe as a lot of the folks in this room would have expected, certainly not as severe as a lot of our critics hoped and expected. The end point will still be 25 million Americans with insurance who didn’t have it before.
Q And just a political question. This report that combined conclusions -- 2 million fewer workers, 2 million fewer people covered -- how worried are you about the political impact of this report? Obviously, Republicans are already using it to hammer the health care law.
MR. CARNEY: They are. And what I can tell you is we’re out here with the President’s chief economist trying to explain that the facts of this and what CBO is saying and what they’re not saying, what factors they explicitly state did not go into that analysis, factors that Jason made clear he believes would be counterbalancing to the estimate in terms of fewer FTEs, full-time employees.
And I think that overall here we’re talking about an Affordable Care Act that’s providing affordable, quality health insurance to millions of Americans. We’re talking about an Affordable Care Act that’s reducing the deficit by a trillion dollars, as projected in the past and as projected today. We’re talking about an Affordable Care Act that is, as the CBO states, creating incentives for employers to hire more workers in real time. We’re talking about an Affordable Care Act, because of its dramatic effect on health care costs, is potentially anyway according to other economists’ analysis, going to create 250,000 to 450,000 more jobs annually. And that’s not taken into account by this CBO analysis.
And then, the broader point here that I think Jason made, but it’s important -- and I think a little clarity is required here in terms of Ed’s question -- when somebody decides for himself or herself not to work 64 hours, but to work instead for 35 hours, even though the option of working more hours and potentially having the extra money that that option provides is available to them, they’re making a choice about their overall quality of life, and perhaps pursuing something -- either an entrepreneurial opportunity or a new job -- in which they could be more productive, and they’re choosing to spend more time with their family.
I think the analysis to Social Security and Medicare is apt, because there’s no question that providing insurance for elderly Americans reduced the number of elderly Americans in the workforce. And that was a good thing for the overall health of the country and the overall economy of the country. What you had, as a result of Social Security, is a dramatic reduction in the number of seniors in poverty. So it would be weird if somebody were arguing that we should do away with not just the Affordable Care Act for this reason, but some of these other programs that provide substantial benefits that improve vastly the quality of life of millions of Americans.
Yes, Mark.
Q Afghanistan, if the President has not made his decisions already, is today’s meeting for General Dunford to make his recommendation to the President?
MR. CARNEY: Well, first of all, the President interacts with his commanders, including General Dunford, with some regularity.
Q But at some point he’ll have a formal presentation.
MR. CARNEY: General Dunford is in town, so he is having a face-to-face meeting instead of a SVTC meeting or a phone meeting -- SVTC meaning secure video teleconference, which is how the President communicates with the General when he is in theater.
Q At some point, typically in these things, they give a formal presentation --
MR. CARNEY: Sure. And the President will be, as he already has, weighing inputs from his military commanders and military officials at the Department of Defense, as well as the intelligence community, as he looks at his options and looks at a decision about what a post-2014 presence would look like. So that decision will not come today. And it is also obviously contingent upon the Afghan government signing the BSA.
Q But this is the opportunity for Dunford to make this formal presentation?
MR. CARNEY: I think you’re misunderstanding what I said. The President has been communicating with his General in Afghanistan for some time prior to this meeting. This is an opportunity for them to meet face to face because General Dunford happens to be in Washington. So I just didn’t want to create the impression that this is the only occasion that General Dunford will be able to present his view from the ground to the President, because the President has availed himself of that already.
Q Has anyone in the administration talked to Egyptian officials about their crackdown on the media, specifically the arrest of Al Jazeera’s journalists?
MR. CARNEY: Let me get to that. The matter that you raise is of deep concern to the administration. The restriction on freedom of expression in Egypt are a concern, and that includes the targeting of Egyptian and foreign journalists and academics simply for expressing their views.
These figures, regardless of affiliation, should be protected and permitted to do their jobs freely in Egypt. Egypt’s transition can only move forward if all Egyptians are free to express themselves peacefully, without fear of intimidation or violence. Egypt’s newly approved constitution upholds basic rights and freedoms. And Egypt’s interim government has a responsibility to ensure that they are protected.
Now, we have expressed these concerns directly to the government of Egypt -- in answer to your question -- and we have strongly urged the government to drop these charges and release those journalists and academics who have been detained.
Q Would you consider cutting aid if it continues?
MR. CARNEY: I think that we are expressing very directly the fact that we’re deeply concerned, that this contravenes the very constitution that it provides, the freedoms that we hold dear, and we believe the Egyptian people hold dear. And we’re making that clear to the Egyptian government.
Q -- working in the United States, people perhaps who might be making YouTube videos.
MR. CARNEY: I’m sorry, does what apply?
Q Does that defense of free speech apply to Egyptians who are working in the United States, including those who are making YouTube videos that annoy people?
MR. CARNEY: I’m not sure of your point, but our defense of free speech is very strong.
David
Q On another topic -- last week, Evan Medeiros of NSC was quoted in a Japanese publication saying that the U.S. is warning China specifically that if they create a new air defense zone in the South China Sea that would result in an increase in U.S. military presence and military posture in the region. That sounded like a bit stronger language than Vice President Biden used in his trip to China last December. Was that intended by the administration to sort of heighten --
MR. CARNEY: Well, we are very -- we have expressed very clearly, both Vice President Biden and others, our view that there needs to be a reduction in tensions around these issues. And we have made that clear in all of our communications, both private and public. So I don’t think what you’re citing is inconsistent with our position or where we’ve been.
Q -- the military posture, an increase in the military posture.
MR. CARNEY: I don’t have any more for you on that, David, except that our