For the first decade, the CBO is projecting a $143 billion reduction in deficits. But in the bill, the Democrats failed to include a more than 20% increase in physician payments called the "Doc Fix," moving it to a separate measure instead. In a letter to Congressman Paul Ryan (R-Wis.), the CBO said that including the over $200 billion Doc Fix, a big phantom funds item, would erase the fiction of deficit reduction, and create shortfall of $54 billion.
If the number of subsidized customers doubled to 50 million, the bill's costs would increase by about $580 billion. Adding the $53 billion shortfall from the Doc Fix, the $520 billion in lockbox items, and the $580 billion from raising the number of exchange participants to a 50 million -- replacing lowballing with a more realistic forecast -- and new borrowing required in the first ten years rises to around $1.2 trillion.