The CBO is bound to look at the next ten years of effects. In order to make it look even remotely palatable, the bill collects four years of revenues before a significant amount of the benefits kick in. It is difficult to imagine a reason for this that doesn't involve gaming the CBO's estimates. (It's not as if our government is all like, "Oh, gosh, we really need to save up some money before we hand this entitlement out." It wouldn't matter anyhow because that wouldn't significantly affect the long term viability of this plan; what matters is steady-state income vs. spending.) Multiplying the estimated cost by 10/6 is a decent start to get a true view of the costs.
The CBO itself has also called attention to the fact that the scoring of this bill assumes that the so-called "doc fix", in which the payouts given to Medicare doctors will be cut in accordance with the law back to a certain rate unless a bill is passed to prevent this cut. This bill is passed every year, and there is no reason to believe this Congress will not pass that bill either (and quite substantial reason to believe it will). You can look around for how big that is, but it's pretty big.
This bill shifts yet more burden directly onto the States as unfunded mandates, which are not scored as Federal burden (for instance, "Find" the second instance of "mandate" in http://www.wdef.com/news/reaction_to_healthcare_reform_passa... ). Nevertheless, not only will we have to pay them, we will have to pay them in a context where we can't even borrow our way out of it as States ability to borrow is constrained compared to the Feds. I live in Michigan.... WTF is Michigan going to do with another few billion in mandates?
The CBO has its scope very tightly defined by law, and it's been getting increasingly gamed over the years. This completes the gaming. They might as well disband the office, IMHO, Congress has figured out how to bypass them.
Costs are shifted onto younger people by the mandate for people to purchase insurance or pay a penalty. Many of today's uninsured are young, healthy, and uninsured by choice. You may disagree with that choice, but that's beside the point. The point is that they are not paying into the system. Not all younger people are affected by this due to some other provisions (nothing says government at work like taxing with one hand and crediting with the other), but quite a few are. Coryrc linked this, I'm "borrowing" it: http://www.newsweek.com/id/224020
Incidentally, I give this provision a very high chance of being struck down on Constitutional grounds, but that of course leaves the entire rest of the bill in place. The CBO estimate can't assume that will happen, but if it does the already-screwy revenue numbers just get screwier.
Please carefully read the statements I am making here and note their factual content. I will not deny I think this bill is an enormous, enormous mistake, but it is not my opinion that taxes are collected for four years before benefits are paid out, it is not my opinion that the bill contains unfunded mandates on States, it is not my opinion that younger people will have to buy insurance or pay penalties (the reason why is arguably my opinion but extremely-well founded). It is my opinion the CBO might as well disband. It isn't my opinion that the insurance mandate is facing a constitutional challenge, though of course who will win that is currently a matter of opinion. To the best of my knowledge, these aren't "talking points", these are simply part of the bill as it stands.
