Count Medicare net of premiums in CBO household income

changelog.d/cbo-medicare-net-of-premiums.fixed.md

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+The default CBO household income now counts Medicare as CBO does, at the average cost per enrollee net of premiums and excluding the Part D low-income subsidy, through a new `cbo_medicare_benefit` variable instead of gross Medicare spending.

policyengine_us/parameters/calibration/gov/hhs/medicare/part_d_low_income_subsidy_per_enrollee.yaml

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+description: The Medicare Trustees report and project these Part D low-income subsidy payments per Medicare enrollee.
+metadata:
+  unit: currency-USD
+  period: year
+  label: Medicare Part D low-income subsidy per enrollee
+  # From 2036, each value is the 2035 value times the growth in Medicare
+  # spending per enrollee, so the subsidy keeps its 2035 share of spending.
+  uprating: calibration.gov.hhs.medicare.per_capita_cost
+  reference:
+  # From 2015, each value is Table IV.B10's "Low-income subsidy" payments ($
+  # billions, incurred basis) over Table V.B3's total enrollment (file page
+  # 196, thousands), people with Part A and/or Part B coverage, so it is per
+  # Medicare enrollee, not per subsidy recipient. 2016 to 2035 come from the
+  # 2026 report's Table IV.B10 (file page 159); 2015, which that table no
+  # longer shows, from the 2025 report's (file page 159). The two reports
+  # agree on 2016 to 2023. 2026 Medicare Trustees Report, transmitted
+  # 2026-06-09, retrieved 2026-10-11, sha256
+  # ffa56b9137006872300b0346149eae1613d09a172b6ba118aad48e66dfc48fa8; 2025
+  # report sha256
+  # 1b3de7a4faeee5ad42059e10740603182b716a5fa7b53b30d360b45b9e474d95.
+  - title: "2026 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Tables IV.B9, IV.B10 and V.B3 #page 119,158-159,196"
+    href: https://www.cms.gov/oact/tr/2026#page=119
+  - title: "2025 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Table IV.B10"
+    href: https://www.cms.gov/oact/tr/2025#page=159
+  # 2013 and 2014: the 2023 report's Table IV.B10 (file page 159),
+  # "Low-income subsidy", $ billions, incurred basis, over the 2021
+  # report's Table V.B3 total enrollment (file page 199, thousands). Both
+  # retrieved 2026-11-04; 2023 report sha256
+  # 89daaf2909ae18648783f652c05114d007c5f902cc5fa5fad0f76d43f6ccfa67,
+  # 2021 report sha256
+  # ef3d1fa77e99362c460f45b3d0ff0734181340e617675e21fde99276a520fc8e.
+  - title: "2023 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Table IV.B10"
+    href: https://www.cms.gov/oact/tr/2023#page=159
+  - title: "2021 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Table V.B3"
+    href: https://www.cms.gov/files/document/2021-medicare-trustees-report.pdf#page=199
+values:
+  # Historical.
+  2013-01-01: 441.87
+  2014-01-01: 449.04
+  2015-01-01: 460.52
+  2016-01-01: 462.57
+  2017-01-01: 465.21
+  2018-01-01: 474.84
+  2019-01-01: 482.65
+  2020-01-01: 524.75
+  2021-01-01: 547.05
+  2022-01-01: 604.61
+  2023-01-01: 663.6
+  2024-01-01: 605.29
+  # 2025 is the first year of the full Inflation Reduction Act benefit
+  # redesign (file page 119). The subsidy per low-income enrollee fell from
+  # $2,833 to $1,226 while the direct subsidy per enrollee rose from $383 to
+  # $1,869 (Table IV.B9, file page 158).
+  2025-01-01: 251.12
+  # Trustees' intermediate estimates.
+  2026-01-01: 255.86
+  2027-01-01: 283.45
+  2028-01-01: 298.54
+  2029-01-01: 324.78
+  2030-01-01: 377.29
+  2031-01-01: 396.02
+  2032-01-01: 404.71
+  2033-01-01: 409.83
+  2034-01-01: 417.15
+  2035-01-01: 431.59

policyengine_us/parameters/calibration/gov/hhs/medicare/premium_income_per_enrollee/part_a.yaml

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+description: The Medicare Trustees report and project this Part A premium income per Medicare enrollee, which counts premiums paid by or on behalf of people without premium-free Part A who enroll voluntarily.
+metadata:
+  unit: currency-USD
+  period: year
+  label: Medicare Part A premium income per enrollee
+  # From 2036, each value is the 2035 value times the growth in Medicare
+  # spending per enrollee, so premiums keep their 2035 share of spending.
+  uprating: calibration.gov.hhs.medicare.per_capita_cost
+  reference:
+  # From 2015, each value is Table III.B4's "Premiums from voluntary
+  # enrollees" (file page 64, $ billions, cash basis) over Table V.B3's
+  # total enrollment (file page 196, thousands), which footnote 2 defines as
+  # the "Number of beneficiaries with HI and/or SMI coverage". The Part A
+  # premium is paid "by or on behalf of" these enrollees (glossary, file
+  # page 257), so state Medicaid buy-in payments are included. 2026 Medicare
+  # Trustees Report, transmitted 2026-06-09, retrieved 2026-10-11, sha256
+  # ffa56b9137006872300b0346149eae1613d09a172b6ba118aad48e66dfc48fa8.
+  - title: "2026 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Tables III.B4 and V.B3 and glossary #page 64,196,257"
+    href: https://www.cms.gov/oact/tr/2026#page=64
+  # 2013 and 2014: the 2021 report's Table III.B4 (file page 62),
+  # "Premiums from voluntary enrollees", $ billions, cash basis, over its
+  # Table V.B3 total enrollment (file page 199, thousands). 2021 report
+  # retrieved 2026-11-04, sha256
+  # ef3d1fa77e99362c460f45b3d0ff0734181340e617675e21fde99276a520fc8e.
+  - title: "2021 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Tables III.B4 and V.B3 #page 62,199"
+    href: https://www.cms.gov/files/document/2021-medicare-trustees-report.pdf#page=62
+values:
+  # Historical.
+  2013-01-01: 64.76
+  2014-01-01: 60.98
+  2015-01-01: 57.57
+  2016-01-01: 57.82
+  2017-01-01: 59.64
+  2018-01-01: 59.98
+  2019-01-01: 63.38
+  2020-01-01: 63.61
+  2021-01-01: 65.65
+  2022-01-01: 69.05
+  2023-01-01: 70.56
+  2024-01-01: 70.52
+  2025-01-01: 82.26
+  # Trustees' intermediate estimates.
+  2026-01-01: 97.54
+  2027-01-01: 102.32
+  2028-01-01: 106.72
+  2029-01-01: 112.68
+  2030-01-01: 117.5
+  2031-01-01: 125.13
+  2032-01-01: 131.5
+  2033-01-01: 140.4
+  2034-01-01: 149.07
+  2035-01-01: 156.27

policyengine_us/parameters/calibration/gov/hhs/medicare/premium_income_per_enrollee/part_b.yaml

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+description: The Medicare Trustees report and project this Part B premium income per Medicare enrollee, which counts premiums paid by or on behalf of enrollees, including income-related premiums and premiums that state Medicaid programs pay.
+metadata:
+  unit: currency-USD
+  period: year
+  label: Medicare Part B premium income per enrollee
+  # From 2036, each value is the 2035 value times the growth in Medicare
+  # spending per enrollee, so premiums keep their 2035 share of spending.
+  uprating: calibration.gov.hhs.medicare.per_capita_cost
+  reference:
+  # From 2015, each value is premium income over Table V.B3's total
+  # enrollment (file page 196, thousands), people with Part A and/or Part B
+  # coverage.
+  # - 2015 to 2026: Table III.C7 (file page 102), "Premium income", $
+  #   millions, incurred basis.
+  # - 2027 to 2035: Table III.C4 (file page 96), "Premium income", $
+  #   billions, cash basis. Footnote 7 credits premiums withheld from the
+  #   benefits due January 3, 2027 on December 31, 2026; their amount is
+  #   III.C4's 2026 cash value less III.C7's 2026 incurred value (174.8 -
+  #   173.228 = 1.572), which is added back to 2027. Cash and incurred
+  #   premium income agree in every year from 2017 to 2025 except 2020 and
+  #   2021, the other footnote 7 years.
+  # Premium income is "premium payments by (or on behalf of) enrollees"
+  # (file page 88). It includes income-related premiums: in 2019 the
+  # standard premium, $135.50 a month (Table III.C2, file page 89), times
+  # 56.019 million Part B enrollees plus Table V.E3's $8.4 billion of
+  # income-related premiums (file page 215) is $99.5 billion, against $99.4
+  # billion of premium income.
+  # 2026 Medicare Trustees Report, transmitted 2026-06-09, retrieved
+  # 2026-10-11, sha256
+  # ffa56b9137006872300b0346149eae1613d09a172b6ba118aad48e66dfc48fa8.
+  - title: "2026 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Tables III.C2, III.C4, III.C7, V.B3 and V.E3 #page 88-89,96,102,196,215"
+    href: https://www.cms.gov/oact/tr/2026#page=88
+  # 2013 and 2014: the 2021 report's Table III.C7 (file page 104),
+  # "Premium income", $ millions, incurred basis, over its Table V.B3
+  # total enrollment (file page 199, thousands). Incurred premium income
+  # needs no cash timing adjustment. 2021 report retrieved 2026-11-04,
+  # sha256 ef3d1fa77e99362c460f45b3d0ff0734181340e617675e21fde99276a520fc8e.
+  - title: "2021 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Tables III.C7 and V.B3 #page 104,199"
+    href: https://www.cms.gov/files/document/2021-medicare-trustees-report.pdf#page=104
+values:
+  # Historical.
+  2013-01-01: 1_201.53
+  2014-01-01: 1_213.05
+  2015-01-01: 1_214.54
+  2016-01-01: 1_296.34
+  2017-01-01: 1_389.19
+  2018-01-01: 1_554.68
+  2019-01-01: 1_615.55
+  2020-01-01: 1_729.23
+  2021-01-01: 1_772.6
+  2022-01-01: 2_009.35
+  2023-01-01: 1_969.28
+  2024-01-01: 2_054.43
+  2025-01-01: 2_169.44
+  # Trustees' intermediate estimates.
+  2026-01-01: 2_448.69
+  2027-01-01: 2_549.32
+  2028-01-01: 2_755.79
+  2029-01-01: 2_946.87
+  2030-01-01: 3_178.93
+  2031-01-01: 3_409.4
+  2032-01-01: 3_662.85
+  2033-01-01: 3_985.68
+  2034-01-01: 4_334.37
+  2035-01-01: 4_652

policyengine_us/parameters/calibration/gov/hhs/medicare/premium_income_per_enrollee/part_d.yaml

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+description: The Medicare Trustees report and project this Part D premium income per Medicare enrollee, which counts premiums withheld from benefits, paid to the federal government or paid directly to plans, including income-related premiums.
+metadata:
+  unit: currency-USD
+  period: year
+  label: Medicare Part D premium income per enrollee
+  # From 2036, each value is the 2035 value times the growth in Medicare
+  # spending per enrollee, so premiums keep their 2035 share of spending.
+  uprating: calibration.gov.hhs.medicare.per_capita_cost
+  reference:
+  # From 2015, each value is Table III.D3's "Premium income" (file page 116,
+  # $ billions, cash basis) over Table V.B3's total enrollment (file page
+  # 196, thousands), people with Part A and/or Part B coverage. Footnote 1:
+  # "Premiums include both amounts withheld from Social Security benefits or
+  # other Federal payments, direct payments to the Federal government, and
+  # those paid directly to Part D plans." Footnote 6 (file page 117) credits
+  # one January's withheld premiums on December 31 of the year before: about
+  # $0.2 billion in 2015, $0.1 billion in 2020 and an estimated $0.2 billion
+  # in 2026, which are moved to 2016, 2021 and 2027. Premium income includes
+  # income-related premiums, which are deposited into the Part D account
+  # (footnote 73, file page 151). So each value equals the Part D enrollment
+  # share times calibration.gov.hhs.medicare.part_d.premiums_per_enrollee,
+  # plus Table V.E4's aggregate income-related premiums (file page 218) per
+  # Medicare enrollee. 2026 Medicare Trustees Report, transmitted
+  # 2026-06-09, retrieved 2026-10-11, sha256
+  # ffa56b9137006872300b0346149eae1613d09a172b6ba118aad48e66dfc48fa8.
+  - title: "2026 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Tables III.D3, V.B3 and V.E4 #page 109,116-117,151,154,196,218"
+    href: https://www.cms.gov/oact/tr/2026#page=109
+  # 2013 and 2014: the 2026 report's Table III.D3 (file page 116),
+  # "Premium income", $ billions, cash basis, over the 2021 report's
+  # Table V.B3 total enrollment (file page 199, thousands). Footnote 6
+  # (2026 report, file page 117) lists no December 31 credit in 2013 or
+  # 2014, so neither year moves. 2021 report retrieved 2026-11-04, sha256
+  # ef3d1fa77e99362c460f45b3d0ff0734181340e617675e21fde99276a520fc8e.
+  - title: "2021 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Table V.B3"
+    href: https://www.cms.gov/files/document/2021-medicare-trustees-report.pdf#page=199
+values:
+  # Historical.
+  2013-01-01: 188.56
+  2014-01-01: 210.66
+  2015-01-01: 224.86
+  2016-01-01: 245.3
+  2017-01-01: 264.13
+  2018-01-01: 264.91
+  2019-01-01: 255.14
+  2020-01-01: 249.65
+  2021-01-01: 267.27
+  2022-01-01: 270.08
+  2023-01-01: 274.75
+  2024-01-01: 282.08
+  # 2025 premiums fell with the voluntary Part D premium demonstration for
+  # stand-alone prescription drug plans (file page 109).
+  2025-01-01: 215.04
+  # Trustees' intermediate estimates. The 2030 jump is the Inflation
+  # Reduction Act's reset of the base beneficiary premium percentage
+  # (file page 154).
+  2026-01-01: 281.3
+  2027-01-01: 356.74
+  2028-01-01: 389.05
+  2029-01-01: 404.32
+  2030-01-01: 674.95
+  2031-01-01: 708.2
+  2032-01-01: 720.06
+  2033-01-01: 752.61
+  2034-01-01: 776.68
+  2035-01-01: 809.85

policyengine_us/parameters/gov/household/cbo_social_insurance_benefits.yaml

@@ -2,11 +2,30 @@ description: Social insurance benefits included in CBO household income.
 values:
   0000-01-01:
     - social_security
-    - medicare_gross_cost
+    - cbo_medicare_benefit
     - total_unemployment_compensation
     - workers_compensation
 
 metadata:
   unit: list
   period: year
   label: CBO social insurance benefits
+  reference:
+    # "Social insurance benefits consist of benefits provided through Social
+    # Security (Old Age, Survivors, and Disability Insurance); Medicare
+    # (measured as the average cost to the government of providing those
+    # benefits, net of offsetting receipts); regular unemployment insurance
+    # ...; and workers' compensation." (Appendix A, note 3, PDF page 27.)
+    # Appendix D (PDF page 39) defines Medicare as "measured by the average
+    # cost to the government of providing those benefits", with no netting
+    # clause.
+    - title: "Congressional Budget Office, The Distribution of Household Income in 2021, Appendixes A and D #page 27,39"
+      href: https://www.cbo.gov/system/files/2024-09/60341-income.pdf#page=27
+    # "The measure of Medicare benefits in The Distribution of Household
+    # Income includes the federal government's average cost per enrollee of
+    # providing Medicare, net of premiums paid by enrollees." (Report PDF,
+    # 61910-DOHI-health.pdf, page 27; the same report lists "Medicare (net
+    # of premiums paid by enrollees)" on PDF pages 5 and 37.) CBO calls that
+    # measure plus enrollee premiums "gross Medicare spending".
+    - title: Congressional Budget Office, Sensitivity of the Distribution of Household Income to the Treatment of Health Insurance From 1979 to 2021
+      href: https://www.cbo.gov/publication/61910