This statement at the end of the report actually is more revealing: “Those calculations incorporate an assumption that the provisions of current law would otherwise remain unchanged throughout the next two decades. However, current law includes a number of policies that might be difficult
to sustain over a long period of time. For example, the ACA reduced payments to many Medicare providers relative to what the government would have paid under prior law. On the basis of those cuts in payment rates and the existing “sustainable growth rate” mechanism that governs Medicare’s payments to physicians, CBO projects that Medicare spending (per beneficiary, adjusted for overall inflation) will increase significantly more slowly during the next two decades than it has increased during the past two decades. If those provisions would subsequently be modified or implemented incompletely even in the absence of H.R. 6079, then the
budgetary effects of H.R. 6079 could be quite different—but CBO cannot forecast future changes in law or assume such changes in its estimates.”
The Medicare actuary now issues 2 sets of projections: “current law” projections (equivalent to CBO’s in terms of assuming that Obamacare is implemented exactly as specified in the law) and an “alternative fiscal scenario” that makes much more realistic assumptions about which components of Obamacare are likely NOT to be implemented because they are unrealistically draconian (e.g., paying doctors under Medicare 70% less than what they’d be paid by private health insurers). Needless to say, Medicare spending is far higher under the second set of assumptions than the first, which is to say that Obamacare actually will contribute to rising rather than shrinking deficits.
Using more realistic assumptions about Obamacare’s impact, the former director of CBO estimates Obamacare will add $2 trillion to deficits over the next 2 decades. http://americanactionforum.org/sites/default/files/health_reform_to_increase_deficit.pdf
This estimate was made in 2010, but there’s no way the Supreme Court decision would appreciably alter the net impact of the law on the deficit, i.e., changing a $2T deficit increase into a decrease etc.