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A BUDGET FOR A  Better America PROMISES KEPT. TAXPAYERS FIRST.  Mid-Session Review FISCAL YEAR 2020 BUDGET OF THE U.S. GOVERNMENT  A BUDGET FOR A  Better America PROMISES KEPT. TAXPAYERS FIRST.  Mid-Session Review FISCAL YEAR 2020 BUDGET OF THE U.S. GOVERNMENT  EXECUTIVE OFFICE OF THE PRESIDENT OFFICE OF MANAGEMENT AND BUDGET WASHINGTON, D. C. 20503  July 12, 2019  The Honorable Nancy Pelosi Speaker of the House of Representatives U.S. House of Representatives  Washington, D.C. 20515  Dear Madam Speaker: Section 1106 of Title 31, United States Code, requests that the President send to the Congress a supplemental update of the Budget that was transmitted to the Congress earlier in the year. This enclosed supplemental update of the Budget, commonly known as the Mid-Session Review, contains revised estimates of receipts, outlays, budget authority, and the budget deficit  for fiscal years 2019 through 2029. Sincerely,  Russell T. Vought Acting Director  Enclosure  Identical Letter Sent to The Honorable Michael R. Pence  TABLE OF CONTENTS  Page List of Tables ��������������������������������������������������������������������������������������������������������������������������������������������vii Summary ����������������������������������������������������������������������������������������������������������������������������������������������������1 Economic Assumptions and Overview ������������������������������������������������������������������������������������������������������3 Receipts ������������������������������������������������������������������������������������������������������������������������������������������������������9 Expenditures ��������������������������������������������������������������������������������������������������������������������������������������������13 Summary Tables ��������������������������������������������������������������������������������������������������������������������������������������17  http://www.budget.gov  v  LIST OF TABLES  Table 1.  Page Changes in Deficits from the Budget ���������������������������������������������������������������������������������2  Table 2.  Economic Assumptions �������������������������������������������������������������������������������������������������������5  Table 3.  Comparison of Economic Assumptions ������������������������������������������������������������������������������7  Table 4.  Changes in Receipts ����������������������������������������������������������������������������������������������������������11  Table 5.  Changes in Outlays �����������������������������������������������������������������������������������������������������������15  Table S–1.  Budget Totals ���������������������������������������������������������������������������������������������������������������������19  Table S–2.  Effects of Budget Proposals on Projected Deficits �����������������������������������������������������������20  Table S–3.  Baseline by Category ���������������������������������������������������������������������������������������������������������21  Table S–4.  Proposed Budget by Category �������������������������������������������������������������������������������������������23  Table S–5.  Proposed Budget by Category as a Percent of GDP ��������������������������������������������������������25  Table S–6.  Mandatory and Receipt Proposals ������������������������������������������������������������������������������������27  Table S–7.  Proposed Discretionary Funding Levels in the 2020 Mid-Session Review ��������������������47  Table S–8.  2020 Discretionary Overview by Major Agency ���������������������������������������������������������������49  Table S–9.  Estimated Spending from 2020 Balances of Budget Authority: Discretionary Programs �������������������������������������������������������������������������������������������������52  Table S–10.	 Outlays for Mandatory Programs under Current Law ���������������������������������������������������53 Table S–11.	 Federal Government Financing and Debt ������������������������������������������������������������������������54  vii  SUMMARY The Mid-Session Review (MSR) updates the Administration’s estimates for outlays, receipts, and the deficit for economic, legislative, and other changes that have occurred since the President’s 2020 Budget was released in March. The 2019 deficit has been revised to a projected $1.0 trillion, $91 billion lower than the $1.1 trillion deficit projected in March. The improvement in the 2019 deficit is largely the result of technical revisions, including an increase in expected receipts based on new tax reporting data and collections to date, as well as a decrease in outlays, primarily in mandatory and net interest spending. Going forward, the MSR estimates that the deficit will decrease by $414 billion over the ten-year budget window relative to the Budget. This reduction is largely attributed to the changes in the Administration’s forecast of economic assumptions, the most notable of which is a reduction in the interest rate forecast. The 2020 Budget projected increases in near-term interest rates that have been slow to materialize, requiring an updated forecast of lower rates. These changes plus enacted legislation and policy changes lower the Government’s net interest payments by $711 billion over the 10-year window. Overall, tax receipts are still forecast  to increase both nominally and as a share of GDP each year throughout the budget window. The Administration still projects that the growth generated by its economic policies, including the Tax Cuts and Jobs Act’s reduction of the tax burden, will generate enough additional tax receipts to offset the tax cuts. These relatively small updates to the budget picture do not change the overall trajectory of Federal spending and deficits. Without reform, trillion dollar deficits will continue throughout the budget window, and will drive debt to more than $33 trillion by 2029. The trend of growing deficits can be reversed only through concerted efforts of spending restraint and restoring Government to the proper size. The 2020 Budget provides a clear roadmap for fiscal responsibility, proposing over $2.9 trillion in spending reductions—more proposed spending reductions than any previous administration in history—while still providing key funding increases for critical national priorities such as border security and national defense, veterans’ healthcare, childcare and rebuilding the Nation’s infrastructure. Under the President’s policies, deficits will fall from 4.7 percent of GDP in 2020 to 0.6 percent of GDP in 2029.  1  2  MID-SESSION REVIEW  Table 1.  CHANGES IN DEFICITS FROM THE BUDGET (In billions of dollars) 2019  2021  2022  1,101 4.9%  1,068 4.5%  1,049 4.2%  909 3.5%  700 2.6%  631 2.2%  577 1.9%  513 1.6%  508 1.5%  202 0.6%  8 11 1  2 1 1  2 * 1  1 * 1  2 ......... 1  –* ......... 1  –* ......... 2  –1 ......... 2  –1 ......... 2  –1 ......... 2  15 12 5  12 12 13  20  3  4  3  3  1  1  1  1  1  32  37  13  43  38  49  54  72  74  87  98  111  198  641  –12  –6  –2  5  *  1  1  2  –1  *  –*  –2  –*  –3 –2 –7 –1 –13 –2 –17 –44  –8 –2 –7 3 –6 –2 –1 –24  –13 –4 –6 2 1 –2 9 –13  –16 –9 –6 –3 7 –2 –* –30  –20 –9 –7 –4 12 –3 –4 –34  –22 –9 –6 –3 11 –3 –2 –33  –23 –8 –6 –4 11 –3 –2 –35  –24 –6 –6 –5 –* –3 –2 –46  –23 –7 –6 –9 1 –5 –2 –51  –22 –8 –6 –14 1 –5 –2 –56  –22 –5 –6 –7 2 –4 –3 –45  –80 –33 –32 –5 25 –12 2 –135  –194 –67 –62 –43 41 –32 –10 –367  –418 –724 –555 –1,092  2020 Budget deficit ������������������������� 1,092 Percent of GDP ���������������������������� 5.1% Enacted legislation and policy changes: Enacted legislation 1 ���������������� 8 Policy changes 2 ������������������������ 9 Debt service ����������������������������� * Subtotal, enacted legislation and policy changes ���������� 17 Economic and technical reestimates: Receipts ����������������������������������� –35 Outlays: Discretionary programs ������ Mandatory: Social Security ����������������� Foreign military sales ����� Child tax credit ��������������� Medicare �������������������������� Medicaid �������������������������� Earned income tax credit  Other �������������������������������� Total mandatory ����������  2023  2024  2025  2026  2027  2028  2029  2020– 2020– 2024 2029  2020  Net interest 3 ����������������������� Subtotal, outlays ������������� Subtotal, economic and technical reestimates �������������� Total, changes ����������������������������������  –17 –73  –58 –88  –84 –100  –98 –124  –94 –129  –83 –115  –73 –107  –67 –111  –60 –112  –55 –111  –52 –97  –108 –91  –75 –56  –56 –53  –86 –82  –79 –76  –61 –58  –34 –33  –37 –36  –25 –25  –12 –12  15 16  Mid-Session Review deficit ������������� Percent of GDP ����������������������������  1,001 4.7%  1,045 4.7%  1,016 4.3%  966 3.9%  832 3.2%  643 2.4%  598 2.1%  541 1.8%  489 1.6%  497 1.5%  218 0.6%  Note: Positive figures represent higher outlays or lower receipts. *$500 million or less. 1 Includes outlay and receipt effects. 2 2019 Humanitarian aid supplemental and trade mitigation assistance. 3 Includes debt service on all reestimates.  –357 –325  –452 –414  ECONOMIC ASSUMPTIONS AND OVERVIEW This Mid-Session Review (MSR) updates the economic forecast from the 2020 Budget, which was finalized in November 2018 and released in March 2019. In the November 2018 forecast for the 2020 Budget, the unemployment rate was expected to continue to decline in the near term and then to rise to 4.2 percent, the Administration’s estimate of the rate of employment consistent with stable inflation. Inflation measures were expected to rise in 2020 to levels consistent with Federal Reserve targets, and interest rates were expected to rise appreciably in the near term and then settle at a rate roughly consistent with the economy’s growth potential and inflation rates. The MSR forecast, completed at the end of May 2019, adjusts the near term forecast for recent data—most notably, lower interest rates—but otherwise largely matches the 2020 Budget forecast. The economic recovery following the 20082009 downturn was abnormally slow relative to other postwar recoveries. Economic growth was subdued, with real Q4/Q4 GDP growing at an average annual rate of 2.1 percent during the seven years from 2010 to 2016. Since the President was elected, growth has increased. In contrast to a performance of 1.9 percent growth over the four quarters of 2016, real GDP grew at 2.5 percent over the four quarters of 2017 and 3.0 percent over the four quarters of 2018. The current estimate of 2019:Q1 growth is 3.1 percent. Meanwhile, the labor market in 2017, 2018 and through June was remarkably strong, with payroll employment growing vigorously while unemployment rates fell to historic lows. In June 2019, the unemployment rate stood at 3.7 percent and the economy had added over 6 million nonfarm jobs since the 2016 election. The Administration’s efforts to support greater economic growth were spearheaded by the corporate aspects of the Tax Cuts and Jobs Act (TCJA), passed in December 2017, which has acted as a catalyst for sustained and ongoing positive effects on the American economy. As many of the policies in this law are still being finalized, it is expected that the TCJA will  continue to lead to more jobs and a greater investment in capital. In addition to changes to the tax code, this Administration has pursued a robust deregulatory agenda. Many cumbersome, duplicative and unnecessary regulations were removed, and the pace of added regulation was sharply curtailed, especially for small and medium enterprises. The Administration is also currently pursuing policies that would reform the immigration system, spur investments in infrastructure, pursue an “all of the above” energy policy, negotiate reciprocal trade agreements, encourage more participation in the labor market among marginalized populations, and most importantly, rein in Federal spending that contributes to large Federal budget deficits. The MSR economic forecast makes only limited revisions to the forecast in the 2020 Budget. MSR projections of economic growth and the unemployment rate are similar to the projections in the Budget. Real GDP powered through headwinds to increase by 3.1 percent on an annualized basis in the first quarter of 2019, overcoming not only a recently observed seasonal pattern of slower growth in the first quarter, but also international slowdowns and crises, as well as a Government shutdown of historic duration. The MSR forecasts a growth rate of 3.2 percent for the four quarters of 2019. Relative to the Budget forecast, the MSR forecast includes a substantial decrease in interest rates in the near term, and a slight decrease in the long run. This reflects the fact that interest rates have been lower than expected since the economic forecast for the Budget was finalized in November 2018. Inflation rates are forecast to be slightly lower in 2019, but thereafter are the same as those projected in the Budget. Although the U.S. economy is on track to hit this Administration’s estimates, several downside risks are being monitored. As mentioned in the “Economic Assumptions and Overview” chapter in the Analytical Perspectives volume of the 2020 Budget, debt burdens are of con3  4  MID-SESSION REVIEW  cern, with student loan debt, leveraged loans and the Federal deficit all expanding rapidly over the past decade. Recently, the 10-year 90day interest rate spread, a historic predictor of economic downturns, inverted for the first time since 2007. In addition, the Chicago Fed National Activity, the Institute for Supply Management Manufacturing, and the Morgan Stanley Business Conditions indexes have fallen throughout 2019. Despite this, there are signs of persistent strength in this economy. The labor force participation rate has remained stable, despite downward demographic pressure due to baby-boomers reaching retirement age, lifted by a 1.6 percent point increase in prime age participation since the 2016 election. The un-  employment rate has continued to fall. Real consumer spending remains strong. Upside potential for 2019 exists if Administration policies regarding infrastructure, immigration, and a responsible budget are enacted. These will have positive growth repercussions that will reverberate across productivity, participation, investment, and confidence. The overall international growth outlook poses a downside risk, but more agreements like the United States-Mexico-Canada Agreement that reduce uncompetitive actions and reach towards a trade barrier-free reciprocal world will increase standards of living in the United States and abroad. The Administration has set aspirational and achievable goals for the American economy, and it has succeeded in meeting them.  ECONOMIC PROJECTIONS The Administration’s forecast is based on information available at the end of May, and it retains the assumption that the President’s policy proposals in the 2020 Budget will be fully enacted. The projections for key variables can be found in Table 2. Real Gross Domestic Product (GDP): Real GDP growth in 2019 is expected to be 3.2 percent on a fourth quarter-over-fourth quarter (Q4/Q4) basis (as shown in Table 3), before edging down to a sustainable 2.8 percent in the long run. Unemployment Rate: The unemployment rate has remained consistent with the 2020 Budget projections, falling to 3.7 percent by June 2019. The unemployment rate is expected to average 3.7 percent in 2019 and 3.6 in 2020, and then slowly climb back towards 4.2 percent in 2025, which is the Administration’s estimate of the rate of unemployment consistent with stable inflation in the long run. Inflation: Post-financial crisis, the inflation rate has been low compared with the post-World War II average. The medium- and long-run inflation rate projections in the MSR  remain consistent with the 2020 Budget assumptions, with year-over-year long-run rates of 2.3 percent when measured by the Consumer Price Index for All Urban Consumers (CPI-U). Interest Rates: Interest rate forecasts comprise the most substantial change from the 2020 Budget to the MSR. Treasury rates have decreased notably since the Budget was finalized. The 2020 Budget forecast a 90-day rate of 2.7 percent and a 10-year rate of 3.4 percent in 2019. Reflecting recent data, these have been revised down to 2.4 percent and 2.6 percent, respectively. Incomes and Income Shares: Labor compensation and corporate profit trends remain roughly the same as in the 2020 Budget projections. As a share of GDP, wages and salaries are expected to increase, while corporate profits are expected to decline, with most of this evolution of income shares taking place during the middle and later years of the forecast. However, wages and salaries show small declines relative to the Budget estimates, due to revisions to estimates by the Bureau of Economic Analysis (BEA) in May 2019.  5  Economic Assumptions and Overview  Table 2.  ECONOMIC ASSUMPTIONS 1 (Calendar Years, Dollar Amounts in Billions) Actual 2017  Projections  2018  2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  Gross Domestic Product (GDP): Levels, Dollar Amounts in Billions: Current Dollars ��������������������������������� 19,485 20,494 21,460 22,591 23,746 24,956 26,225 27,561 28,946 30,372 31,856 33,412 35,044 Real, Chained (2012) Dollars ������������ 18,051 18,567 19,136 19,741 20,345 20,959 21,592 22,244 22,902 23,557 24,221 24,904 25,606 Chained Price Index (2012=100), Annual Average ����������������������������� 107.9 110.3 112.2 114.4 116.7 119.1 121.5 123.9 126.4 128.9 131.5 134.2 136.9 Percent Change, Fourth Quarter over Fourth Quarter: Current Dollars ��������������������������������� 4.5 5.2 4.8 5.2 5.1 5.1 5.1 5.1 5.0 4.9 4.9 4.9 4.9 Real, Chained (2012) Dollars ������������ 2.5 3.0 3.2 3.1 3.0 3.0 3.0 3.0 2.9 2.8 2.8 2.8 2.8 Chained Price Index (2012=100) ������ 2.0 2.1 1.7 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 Incomes, Billions of Current Dollars: Domestic Corporate Profits ������������������ 1,650 1,778 1,878 1,968 1,955 2,024 2,034 2,055 2,091 2,117 2,146 2,186 2,199 Employee Compensation ���������������������� 10,407 10,841 11,244 11,816 12,465 13,170 13,904 14,685 15,502 16,351 17,241 18,181 19,172 Wages and Salaries ������������������������������� 8,454 8,821 9,151 9,617 10,151 10,735 11,339 11,954 12,611 13,296 14,025 14,783 15,593 Nonwage Personal Income �������������������� 4,863 5,107 5,290 5,656 5,924 6,212 6,488 6,779 7,109 7,452 7,829 8,146 8,503 Consumer Price Index (All Urban) 2: Level (1982–1984 = 100), Annual Average ���������������������������������������������� Percent Change, Fourth Quarter over Fourth Quarter ����������������������������������  245.1 251.1 255.9 261.8 267.7 273.8 280.0 286.3 292.8 299.5 306.3 313.2 320.3 2.1  2.2  2.1  2.3  2.3  2.3  2.3  2.3  2.3  2.3  2.3  2.3  2.3  Unemployment Rate, Civilian, Percent: Annual Average �������������������������������������  4.4  3.9  3.7  3.6  3.7  3.9  4.0  4.1  4.2  4.2  4.2  4.2  4.2  Interest Rates, Percent: 91-Day Treasury Bills 3 ������������������������� 10-Year Treasury Notes ������������������������  0.9 2.3  1.9 2.9  2.4 2.6  2.4 2.8  2.5 3.1  2.6 3.4  2.7 3.6  2.8 3.6  2.8 3.6  2.8 3.6  2.9 3.6  2.9 3.6  2.9 3.6  Based on information available as of June 2019. Seasonally Adjusted. 3 Average rate, secondary market (bank discount basis). 1 2  FORECAST COMPARISONS Comparisons between the Administration’s topline MSR forecast and forecasts by the Congressional Budget Office (CBO), the Federal Reserve’s Federal Open Market Committee (FOMC), and the Blue Chip panel of private sector forecasters should be made with caution. The forecast of the Administration assumes that all of the President’s policy proposals will be enacted, including major changes to existing infrastructure, immigration, deregulation, labor market policies, and a reduction of budget deficits. The Administration’s relatively more optimistic forecast for real GDP growth can largely be accounted for by its expectation of higher productivity growth in the medium to long run, and by greater labor force participation rates due to those policies. By contrast,  CBO’s forecast assumes current law policies and a more pessimistic expectation for long-run productivity growth. The Blue Chip consensus reflects a combination of assumptions regarding the implementation of policy proposals among private sector forecasters. A comparison of forecasts for key economic variables is found in Table 3. Real Gross Domestic Product: The Administration’s forecast for real GDP growth differs from those published by CBO in January 2019, by the FOMC in June 2019, and by the Blue Chip consensus in June 2019 (short-run) and October 2018 (long-run). The Administration predicts higher GDP growth, peaking at 3.2 percent Q4/Q4 in 2019 and 3.1 percent  6 in 2020, while other estimates for 2020 range from 1.8 to 2.0 percent. The Administration also predicts long run growth at 2.8 percent, compared with other forecasts of between 1.8 to 2.0 percent. Unemployment: The Administration’s unemployment rate projections are generally similar to those of the other forecasters in the near term, but there is substantial disagreement about the long run rate of unemployment consistent with stable inflation. The Administration lowered its long run forecast for unemployment down to 4.2 percent last fall, and since then the Federal Reserve and Blue Chip have lowered their forecasts as well.  MID-SESSION REVIEW  However, CBO’s long run forecast for unemployment is 4.7 percent, a notable outlier. Inflation: Inflation expectations are relatively consistent across the different forecasts. CBO predicts higher inflation in 2020-2023, but has a similar outlook for the longer run as other forecasts. Interest Rates: The Administration’s interest rate forecast has been reduced in the MSR, to reflect recent changes in the data. This reduction has been matched by the Blue Chip consensus, which forecasts lower interest rates in 2020 than the Administration, while CBO is higher.  7  Economic Assumptions and Overview  Table 3.  COMPARISON OF ECONOMIC ASSUMPTIONS (Calendar Years) 2018  2019  Real GDP (Year-over-Year growth rates): 2020 MSR ���������������������������������� 2.9 2020 Budget ������������������������������� 2.9 CBO �������������������������������������������� 2.9 Blue Chip 1 ���������������������������������� 2.9  3.2 3.1 1.9 1.8  2021  3.1 3.0 1.6 1.8  2022  2023  2024  2025  2026  2027  2028  2029  3.0 3.0 1.6 1.9  3.0 3.0 1.7 2.1  3.0 3.0 1.8 2.1  3.0 2.9 1.8 2.0  2.9 2.8 1.7 2.0  2.8 2.8 1.8 2.0  2.8 2.8 1.8 2.0  2.8 2.8 1.8 2.0  Real GDP (Fourth-Quarter-over-Fourth-Quarter growth rates): 2020 MSR ���������������������������������� 3.0 3.2 3.1 3.0 2020 Budget ������������������������������� 3.1 3.2 3.1 3.0 CBO �������������������������������������������� 3.1 2.3 1.7 1.6 Federal Reserve (FOMC) 2 ��������� 3.0 2.1 2.0 1.8  3.0 3.0 1.6 1.9  3.0 3.0 1.7 1.9  3.0 3.0 1.9 1.9  2.9 2.9 1.8 1.9  2.8 2.8 1.7 1.9  2.8 2.8 1.9 1.9  2.8 2.8 1.8 1.9  2.8 2.8 1.8 1.9  Consumer Price Index (CPI-U Fourth quarter growth rates): 2020 MSR ���������������������������������� 2.2 2.1 2.3 2.3 2020 Budget ������������������������������� 2.5 2.1 2.3 2.3 CBO �������������������������������������������� 2.4 2.2 2.6 2.5 Blue Chip 1 ��������������������������������� 2.5 1.9 2.1 2.2 Federal Reserve (FOMC) 2, 3 ������ 1.9 1.8 1.9 2.0  2.3 2.3 2.5 2.2 2.0  2.3 2.3 2.5 2.3 2.0  2.3 2.3 2.4 2.2 2.0  2.3 2.3 2.3 2.2 2.0  2.3 2.3 2.3 2.2 2.0  2.3 2.3 2.3 2.2 2.0  2.3 2.3 2.3 2.2 2.0  2.3 2.3 2.4 2.2 2.0  Unemployment Rate (annual average): 2020 MSR ���������������������������������� 3.9 2020 Budget ������������������������������� 3.9 CBO �������������������������������������������� 3.9 Blue Chip 1 ��������������������������������� 3.9 Federal Reserve 2 ����������������������� 3.7 Interest Rates: 91-Day Treasury Bills (discount basis): 2020 MSR ������������������������������ 1.9 2020 Budget ��������������������������� 1.9 CBO ���������������������������������������� 1.9 Blue Chip 1 ����������������������������� 2.0 10-Year Treasury Notes: 2020 MSR ������������������������������ 2.9 2020 Budget ��������������������������� 2.9 CBO ���������������������������������������� 2.9 Blue Chip 1 ����������������������������� 2.9  3.1 3.2 2.7 2.5  2020  3.7 3.6 3.5 3.7 3.6  3.6 3.6 3.7 3.6 3.7  3.7 3.7 4.2 4.1 3.8  3.9 3.9 4.6 4.2 4.2  4.0 4.0 4.8 4.3 4.2  4.1 4.1 4.8 4.3 4.2  4.2 4.2 4.8 4.4 4.2  4.2 4.2 4.8 4.4 4.2  4.2 4.2 4.8 4.4 4.2  4.2 4.2 4.7 4.4 4.2  4.2 4.2 4.7 4.4 4.2  2.4 2.7 2.8 2.4  2.4 3.1 3.2 2.2  2.5 3.2 3.2 2.9  2.6 3.2 3.2 2.8  2.7 3.1 3.0 2.9  2.8 3.0 2.8 3.0  2.8 3.0 2.7 3.0  2.8 3.0 2.7 3.0  2.9 3.0 2.8 3.0  2.9 3.0 2.8 3.0  2.9 3.0 2.8 3.0  2.6 3.4 3.4 2.5  2.8 3.6 3.6 2.6  3.1 3.8 3.7 3.5  3.4 3.8 3.7 3.6  3.6 3.7 3.8 3.7  3.6 3.7 3.7 3.7  3.6 3.7 3.7 3.7  3.6 3.7 3.7 3.7  3.6 3.7 3.7 3.7  3.6 3.7 3.7 3.7  3.6 3.7 3.8 3.7  Sources: Administration; CBO, The Budget and Economic Outlook: 2019 to 2029, January 2019; June 2019 and October 2018 Blue Chip Economic Indicators, Aspen Publishers, Inc.; Federal Reserve Open Market Committee, June 19, 2019. 1 Blue Chip data: annual forecasts for 2025-2029 are extracted from their 5 year averages, the 2019 and 2020 forecasts are from the June 2019 issue, while 2021-2029 are from the October 2018 issue. 2 Median Projection. 3 PCE Inflation.  RECEIPTS Receipts for 2019 in MSR are estimated to be $3,472 billion, $35 billion above the 2020 Budget estimate. After 2019, receipts are estimated to be lower relative to the 2020 Budget in each year through 2029, for a net decrease in receipts of $640 billion over the 10-year budget horizon. Most of the net increase in 2019 receipts is attributable to technical revisions based on new tax reporting data, collections to date, and other information, which increase receipts by $54 billion. Revised economic assumptions lower 2019 receipts relative to the Budget estimate by $19 billion. The $640 billion decrease in receipts over the 10-year budget horizon is driven primarily by a $428 billion reduction in receipts attributable to revised economic assumptions, including a slight decline in the wages and salaries growth forecast, though growth has shown continued strength thus far in 2019. Wages and salaries growth rebounds over the  longer term and projections remain higher than absent the Administration’s policies. Technical reestimates drive an additional $212 billion reduction in receipts, largely due to lower-than-expected corporation income tax collections. Neither of these changes are large – roughly a 1-percent reduction in total receipts over 10 years – and, overall, receipts are projected to increase both nominally and as a share of GDP each year throughout the budget window. The Administration still projects that its economic policies, including the Tax Cuts and Jobs Act’s tax savings for Americans, will generate enough additional tax receipts to offset the tax cuts. Given the historic nature of the Tax Cuts and Jobs Act, there is a range of reasonable assumptions related to taxpayer behavior, wage and salary growth, and corporate profits. The Administration’s estimates will continue to be refined as the most comprehensive tax reform in a generation is implemented in full.  ECONOMIC CHANGES As noted above, revisions in the economic forecast decrease receipts by $19 billion in 2019, and decrease receipts by $428 billion over the 10 years from 2020 through 2029. In 2019, revisions to the economic forecast, specifically the forecast of wages and salaries, have the greatest effect on individual income taxes, decreasing receipts by $18 billion. Over the 10-year budget window, revisions in the economic forecast have the greatest effect on individual income taxes, decreasing collections by $368 billion relative to the Budget estimate, primarily attributable to the changes to the forecast of wages and  salaries. Decreases in certain types of income affect the taxes received from taxing that income. The change in the forecast of wages and salaries also accounts for most of the $47 billion decrease in social insurance and retirement receipts, primarily Social Security and Medicare payroll taxes. Decreases in the forecast of imports relative to the Budget drives a decrease of $107 billion in customs duties collections. Revisions in the forecast of GDP and depreciation increase collections of corporation income taxes by $99 billion. Revisions in the forecasts of GDP, interest rates, and other sources of income decrease all remaining sources of receipts by a net $5 billion.  TECHNICAL CHANGES Technical revisions increase receipts by $54 billion in 2019 and increase receipts by $19 billion in 2020. Technical revisions reduce receipts in each subsequent year, for a net decrease in receipts of $212 billion over the 10-  year budget window. The upward technical revisions in 2019 are primarily due to actual individual income tax collections data for tax year 2018 and 2019 and customs duties collections to date (increasing receipts by $39 bil9  10  MID-SESSION REVIEW  lion and $13 billion, respectively, relative to the Budget). Technical revisions reduced other sources of receipts by a net $2 billion. Over the 10-year budget window, technical revisions decrease collections of corporation income taxes by $139 billion and individual income taxes by $118 billion relative to the Budget. For corporation income taxes, these revisions reflect actual collections data since the Budget and modeling updates that reflect current law, including effects of the Tax Cuts  and Jobs Act. For individual income taxes, these revisions reflect actual collections data since the Budget, along with reestimates of the effects of extending expiring provisions of the Tax Cuts and Jobs Act reflected in the Administration’s adjusted baseline. Technical revisions of excise taxes and customs duties increase collections by $23 billion and $27 billion, respectively. Technical revisions in all other sources of receipts decrease receipts by $5 billion.  ENACTED LEGISLATION AND REVISIONS IN PROPOSALS The Consolidated Appropriations Act, 2018, is the only piece of legislation enacted since the Budget that had an effect on receipts, increasing 10-year collections by $1 billion. This increase in receipts is due to a provision in the Act that provided the Bureau of Engraving and Printing (BEP) authority to construct a re-  placement currency production facility, which reduces BEP’s operating costs and increases deposits of earnings by the Federal Reserve system. Changes in the estimates of receipt proposals net to zero over the 10-year window.  11  Receipts  Table 4.  CHANGES IN RECEIPTS (In billions of dollars) 2019 2020 Budget estimate ���������������������������� Changes in current law receipts due to revised economic assumptions: Individual income taxes ����������������� Corporation income taxes �������������� Social insurance and retirement ��� Other ����������������������������������������������� Total, changes due to revised economic assumptions �����������  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2020– 2024 2029  3,438 3,645 3,877 4,129 4,421 4,753 5,040 5,323 5,608 5,939 6,292  –18 1 –1 –1  –30 5 –6 –2  –34 10 –4 –3  –36 12 –4 –5  –35 13 –4 –9  –34 12 –4 –11  –35 10 –4 –12  –36 9 –4 –14  –38 8 –5 –17  –42 9 –5 –18  –46 11 –7 –21  –169 52 –21 –29  –368 99 –47 –112  –19  –33  –32  –33  –34  –37  –41  –46  –53  –58  –62  –168  –428  Changes in adjusted baseline receipts due to technical reestimates 1: Individual income taxes ����������������� Corporation income taxes �������������� Social insurance and retirement ��� Other ����������������������������������������������� Total, changes due to technical re-estimates ����������������������������  39 4 5 6  11 –7 * 15  1 –12 2 –1  5 –12 1 1  –2 –15 * 2  –* –21 –* 3  –9 –24 –1 3  –20 –10 –1 4  –25 –14 –2 6  –35 –12 –1 7  –43 –10 –1 7  14 –68 3 21  –118 –139 –3 48  54  19  –11  –5  –16  –18  –31  –27  –35  –42  –48  –31  –212  Changes in current law receipts due to enacted legislation �����������������������������  *  *  *  –*  *  *  –*  *  *  * .........  *  1  Changes in proposals due to enacted legislation and economic and technical revisions ������������������������������ Total, changes in proposals ��������  –* –*  * *  –1 –1  * *  * *  1 1  –* –*  –1 –1  * *  1 1  –1 –1  1 1  * *  35 –13 –43 –38 –49 –54 –72 –74 –86 –98 –111 3,472 3,632 3,833 4,091 4,372 4,698 4,968 5,248 5,522 5,841 6,181  –197  –640  Total change in receipts ��������� 2020 Mid-Session estimate ��������������������  * $500 million or less. 1 Includes economic and technical reestimates of receipt effects of extending expiring TCJA individual and estate provisions.  EXPENDITURES Outlays for 2019 in the Mid-Session Review (MSR) are estimated to be $4,473 billion, $56 billion lower than the 2020 Budget estimate. After 2019, outlays continue to be lower relative to the 2020 Budget in each year through 2029, for a total decrease of $1,054 billion over the 10-year budget horizon. The decrease in spending is largely due to technical reestimates of spending for mandatory programs and net interest programs. The downward technical revisions are partially offset by increases in projected spending due to enacted legislation and policy changes.  in 2019 and by $9 billion in 2020. The second is the requested supplemental appropriations for humanitarian aid and border security that would increase outlays by $1 billion in 2019, and by $3 billion in 2020 and 2021. At the time the MSR was prepared, H.R. 3401, the Emergency Supplemental Appropriations for Humanitarian Assistance and Security at the Southern Border Act, 2019, had not been enacted.1 As a result, the MSR includes an allowance to represent the Administration’s pending request that was transmitted to the Congress on May 1, 2019.  Enacted Legislation Changes  Estimating Changes  Relative to estimates in the Budget, legislation enacted since the Budget was completed increases outlays by $8 billion in 2019 and by $13 billion over the 10-year budget window. Two laws increase discretionary spending: Public Law 116-6, the Consolidated Appropriations Act, 2019 (Omnibus); and Public Law 116-20, the Additional Supplemental Appropriations for Disaster Relief Act, 2019 (Supplemental). These two laws increase discretionary outlays by $11 billion in 2019, and by an additional $19 billion from 2020 to 2029.  Estimating changes are changes due to factors other than enacted legislation or changes in policy. These include changes in economic assumptions, discussed earlier in this MSR, and changes in technical factors. Relative to the Budget estimates, economic and technical changes decrease estimated outlays for 2019 by $73 billion, and further decrease outlays by $1,092 billion over the 10-year window.  Six laws enacted since the Budget was completed affect mandatory spending: the Omnibus; the Supplemental; Public Law 1168 (the Pesticide Registration Improvement Extension Act of 2018); Public Law 11616 (the Medicaid Services Investment and Accountability Act of 2019); Public Law 116-23 (the Blue Water Navy Vietnam Veterans Act of 2019); and Public Law 116-24 (the Northern Mariana Islands Long-Term Legal Residents Relief Act). Together, these laws decrease net mandatory spending relative to Budget estimates by $3 billion in 2019 and by $6 billion over the next 10 years. Policy Changes There are two changes in policy since the Budget that increase spending. The first is the Trade Mitigation assistance payments to farmers, which increase outlays by $8 billion  Discretionary Programs. Relative to the Budget, outlays for discretionary programs decrease by $12 billion in 2019, but net to zero over the next 10 years. The changes in 2019 reflect higher outlays for defense ($5 billion), and lower outlays for non-defense ($17 billion), compared to the Budget. Outlays over the 10year period decrease by $9 billion for defense programs, but increase by $8 billion for nondefense base programs. Social Security. Estimating changes decrease outlays for Social Security by $3 billion in 2019 as compared with the Budget, and by an additional $194 billion over the next 10 years. The decreases are primarily due to revised assumptions for the ages at which retired workers start receiving benefits, based on actual benefit claiming behavior through 2018. The decreases are also partially due to 1  President Donald J. Trump signed into law H.R. 3401 on July 1, 2019.  13  14 the MSR’s lower forecast for the CPI in 2019, which results in a lower cost-of-living adjustment for 2020. Foreign Military Sales. Estimating changes decrease outlays by $2 billion in 2019, and further decrease outlays by $67 billion from 2020 to 2029 relative to the Budget. The decreases are due to revisions that reflect the latest military sales volumes and projections based on year-to-date actuals. Child Tax Credit (CTC). Technical changes decrease outlays for the CTC by $7 billion in 2019, and by $62 billion over the next 10 years. The decreases are due to the incorporation of year-to-date actuals, which were lower than expected after the first full year the Tax Cuts and Jobs Act expanded the CTC. Lower forecast wages (due to the technical revision in wages and salaries) also decreased outlays for the CTC over the window. The technical and economic changes to CTC outlays also decrease the cost of the Budget proposal to extend the CTC. Medicare. Economic and technical revisions result in a net decrease in outlays for Medicare by $1 billion in 2019 relative to Budget estimates, and an additional $43 billion from 2020 to 2029. The decrease is primarily due to technical factors that reduce projected Medicare Part A spending, such as a decline in estimated Medicare enrollment and a lower utilization rate (e.g., inpatient hospital, and skilled nursing facility services) compared to the Budget estimates. Changes in Part B estimates reflect updated actual spending, residual growth rates, and a correction in the sequestration calculation. Medicaid. Economic and technical revisions reduce projected Federal outlays for Medicaid by $13 billion in 2019 relative to the Budget estimates, and increase outlays by $41 billion on net from 2020 to 2029.  These changes are due to technical adjustments including slower Medicaid enrollment growth than previously projected and recent State Medicaid expansions, as well as adjustments to reflect changes to economic factors, including the CPI.  MID-SESSION REVIEW  Earned Income Tax Credit (EITC). Economic and technical changes decrease outlays for the EITC by $2 billion in 2019, and by $32 billion over the next 10 years. The revision to forecast wages in the MSR economic assumptions (due to the technical revision in wages and salaries) results in lower outlays for the EITC. The overall decrease is also due to technical revisions that incorporate year-todate actual data showing a reduction in the number of returns claiming the EITC and a stable average credit amount, resulting in lower outlays relative to the Budget. FHA Mutual Mortgage Insurance. Technical revisions to interest income estimates decrease outlays for the mutual mortgage insurance capital reserve by $1 billion in 2019, and by $23 billion over the 10-year window. Interest income from the first eight months of the fiscal year has already exceeded the Budget estimate (higher levels of interest income offset outlays, so net outlays are lower). Later years in the budget window are also adjusted to reflect projected interest earned based on current balances in the account and future deposits of negative subsidy and interest earned. Supplemental Nutrition Assistance Program (SNAP). Outlays for SNAP decrease by $6 billion in 2019, and by an additional $7 billion from 2020 to 2029, due to technical reestimates that incorporate lower-than-expected actual participation for SNAP benefits. In addition, decreases in unemployment and increases in anticipated earnings for program participants, partially offset by a small increase in the Thrifty Food Plan, also act to decrease spending for SNAP relative to the Budget. Net Interest. Excluding the debt service associated with enacted legislation and policy changes, outlays for net interest are projected to decrease by $17 billion in 2019 and by $724 billion over the next 10 years. The majority of the decrease is the result of revised economic assumptions, including projections for Treasury interest rates and lower growth in the CPI. Technical revisions are largely due to updating for year-to-date actuals.  15  Expenditures  Table 5.  CHANGES IN OUTLAYS (In billions of dollars) 2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2020– 2024 2029  2020 Budget estimate ��������������������� 4,529 4,746 4,945 5,177 5,330 5,453 5,671 5,899 6,122 6,447 6,495 Changes due to enacted legislation and policy changes: 2019 Discretionary appropriations ��������������������� 6 1 1 1 1 2 –* –* –* –* –* 6 5 Emergency supplemental 13 14 appropriations ��������������������� 5 6 3 2 1 1 1 * * * ......... Other enacted legislation �������� –3 1 –2 –1 –1 –1 –1 –1 –1 –1 –1 –3 –6 Additional supplemental appropriations 1 ������������������� 1 2 1 * * ......... ......... ......... ......... ......... ......... 3 3 Trade mitigation assistance ��� 8 9 ......... ......... ......... ......... ......... ......... ......... ......... ......... 9 9 Debt service ����������������������������� * 1 1 1 1 1 1 2 2 2 2 5 13 Subtotal, enacted legislation and policy changes ���������� 17 20 3 3 3 3 1 1 1 1 1 33 38 Changes due to reestimates: Discretionary appropriations: Defense base programs ������� 5 –8 –2 2 * –* –* –* –* –* –* –9 –9 –17 2 * 2 –* 2 1 2 –1 * –* 6 8 Non-defense base programs  Overseas contingency operations ������������������������ –* * –* ......... ......... ......... ......... ......... ......... ......... ......... –* –* Subtotal, discretionary appropriations ������������� –12 –6 –2 5 * 1 1 2 –1 * –* –2 –* Social Security ������������������������� –3 –8 –13 –16 –20 –22 –23 –24 –23 –22 –22 –80 –194 Foreign military sales ������������� –2 –2 –4 –9 –9 –9 –8 –6 –7 –8 –5 –33 –67 Child tax credit ����������������������� –7 –7 –6 –6 –7 –6 –6 –6 –6 –6 –6 –32 –62 Medicare ���������������������������������� –1 3 2 –3 –4 –3 –4 –5 –9 –14 –7 –5 –43 Medicaid ���������������������������������� –13 –6 1 7 12 11 11 –* 1 1 2 25 41 Earned income tax credit �������� –2 –2 –2 –2 –3 –3 –3 –3 –5 –5 –4 –12 –32 Mutual mortgage insurance ��� –1 –1 –1 –2 –2 –2 –2 –3 –3 –3 –4 –8 –23 Supplemental Nutrition Assistance Program ������������ –6 –1 –1 –1 –1 –* –1 –1 –1 –1 2 –5 –7 Other programs ����������������������� –10 1 12 3 –1 * 1 2 2 2 –1 15 20 Net interest 2 ���������������������������� –17 –58 –84 –98 –94 –83 –73 –67 –60 –55 –52 –418 –724 Subtotal, reestimates ���������� –73 –88 –100 –124 –129 –115 –107 –111 –112 –111 –97 –555 –1,092 Total change in outlays ������������������� –56 –69 –96 –120 –125 –112 –105 –110 –111 –110 –96 –522 –1,054 Mid-Session estimate ���������������������� 4,473 4,677 4,849 5,057 5,205 5,341 5,566 5,789 6,011 6,337 6,399 *$500 million or less. 1 At the time the Mid-Session Review was prepared, H.R. 3401, the Emergency Supplemental Appropriations for Humanitarian Assistance and Security at the Southern Border Act, 2019, had not been enacted. As a result, the Mid-Session Review includes an allowance to represent the Administration’s pending request that was transmitted to the Congress on May 1, 2019, to address the humanitarian and security crisis at the southern border of the United States. 2 Includes debt service on all reestimates.  SUMMARY TABLES  17  Table S–1.  BUDGET TOTALS (In billions of dollars and as a percent of GDP) Totals 2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  Budget Totals in Billions of Dollars: Receipts �������������������������������������� Outlays ��������������������������������������� Deficit �������������������������������������� Debt held by the public �������������� Gross domestic product (GDP) ������  3,330 4,109 779 15,750 20,236  3,472 4,473 1,001 16,819 21,207  3,632 4,677 1,045 17,931 22,306  3,833 4,849 1,016 19,013 23,454  4,091 5,057 966 20,043 24,649  4,372 5,205 832 20,937 25,902  4,698 5,341 643 21,640 27,221  4,968 5,566 598 22,298 28,596  5,248 5,789 541 22,896 30,012  5,522 6,011 489 23,439 31,478  5,841 6,337 497 23,990 33,017  6,181 6,399 218 24,256 34,629  20,627 25,129 4,502  48,387 55,231 6,845  Budget Totals as a Percent of GDP: Receipts �������������������������������������� Outlays ��������������������������������������� Deficit �������������������������������������� Debt held by the public ��������������  16.5% 20.3% 3.8% 77.8%  16.4% 21.1% 4.7% 79.3%  16.3% 21.0% 4.7% 80.4%  16.3% 20.7% 4.3% 81.1%  16.6% 20.5% 3.9% 81.3%  16.9% 20.1% 3.2% 80.8%  17.3% 19.6% 2.4% 79.5%  17.4% 19.5% 2.1% 78.0%  17.5% 19.3% 1.8% 76.3%  17.5% 19.1% 1.6% 74.5%  17.7% 19.2% 1.5% 72.7%  17.8% 18.5% 0.6% 70.0%  16.7% 20.4% 3.7%  17.1% 19.7% 2.6%  SUMMARY TABLES  2018  2020– 2024  19  Table S–2.  EFFECTS OF BUDGET PROPOSALS ON PROJECTED DEFICITS (Deficit increases (+) or decreases (–) in billions of dollars) Totals 2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  779 3.8%  1,006 4.7%  1,010 4.5%  1,004 4.3%  1,032 4.2%  956 3.7%  850 3.1%  920 3.2%  975 3.2%  1,003 3.2%  1,142 3.5%  969 2.8%  4,851  9,860  Proposals in the 2020 Mid-Session Review: Invest in critical national priorities: Provide defense funding to rebuild and restore the military and protect our Nation ��������������������������������������������������������� Implement the VA MISSION Act of 2018 �������������������������������� Support major investment in infrastructure ��������������������������� Establish Education Freedom Scholarships ���������������������������� Provide paid parental leave ������������������������������������������������������ Debt service ������������������������������������������������������������������������������� Total ��������������������������������������������������������������������������������������  ......... ......... ......... ......... ......... ......... .........  * ......... ......... ......... ......... ......... *  55 6 5 1 1 1 69  75 9 26 5 1 3 119  81 10 40 5 1 7 145  77 10 50 5 2 12 155  72 10 40 5 2 16 145  48 10 19 5 2 20 105  34 10 10 5 3 23 85  22 10 5 5 3 26 71  14 10 5 5 3 28 65  10 10 * 5 3 30 57  360 45 160 21 7 39 632  488 95 199 46 20 166 1,015  Restrain spending to protect and respect American taxpayers: Right-size Government and apply two-penny plan to nondefense discretionary spending ��������������������������������������������� Empowering States and consumers to reform healthcare ������ Address wasteful spending, fraud, and abuse in healthcare ����� Improve drug pricing and payment policies ���������������������������� Improve the welfare system ����������������������������������������������������� Reform Federal student loans �������������������������������������������������� Reform disability programs and test new approaches ������������ Modify retirement and health benefits for Federal employees ��� Implement agricultural reforms ���������������������������������������������� Reform the Postal Service ��������������������������������������������������������� Other spending reductions and program reforms ������������������� Debt service and other interest effects ������������������������������������ Total ��������������������������������������������������������������������������������������  ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... .........  1 ......... ......... ......... ......... ......... ......... ......... ......... ......... –6 –* –5  22 5 –7 –1 –22 –6 –1 –3 –2 –4 –13 –1 –34  –16 14 –22 –4 –30 –11 –2 –3 –5 –8 –18 –2 –107  –56 –25 –33 –5 –32 –16 –2 –7 –6 –8 –13 –7 –210  –87 –32 –40 –7 –33 –20 –2 –9 –7 –9 –20 –14 –278  –116 –48 –47 –9 –33 –22 –2 –11 –7 –10 –23 –24 –352  –145 –66 –53 –10 –34 –24 –5 –12 –7 –10 –24 –36 –427  –173 –88 –65 –10 –35 –25 –8 –13 –7 –11 –32 –50 –518  –200 –108 –71 –11 –35 –27 –12 –14 –7 –12 –21 –67 –585  –227 –129 –78 –12 –35 –28 –17 –15 –7 –13 –61 –87 –710  –253 –153 –84 –12 –35 –28 –21 –17 –7 –13 –75 –110 –809  –253 –1,251 –86 –629 –149 –501 –26 –83 –150 –325 –75 –207 –9 –72 –32 –104 –26 –61 –39 –98 –88 –301 –48 –398 –981 –4,030  Total proposals in the 2020 Mid-Session Review ��������������������  .........  –5  35  12  –65  –123  –207  –322  –433  –515  –645  –751  –349 –3,015  Resulting deficits in the 2020 Mid-Session Review ���������������� Percent of GDP �������������������������������������������������������������������������������  779 3.8%  1,001 4.7%  1,045 4.7%  1,016 4.3%  966 3.9%  832 3.2%  643 2.4%  598 2.1%  541 1.8%  489 1.6%  497 1.5%  218 0.6%  * $500 million or less.  4,502  6,845  MID-SESSION REVIEW  Projected deficits in the baseline ����������������������������������������������� Percent of GDP �������������������������������������������������������������������������������  20  2018  2020– 2020– 2024 2029  Table S–3.  BASELINE BY CATEGORY 1 (In billions of dollars)  2018 Outlays: Discretionary programs: Defense �������������������������������������������������������� Non-defense ������������������������������������������������� Subtotal, discretionary programs ������������ Mandatory programs: Social Security ���������������������������������������������� Medicare 2 ����������������������������������������������������� Medicaid 2 ������������������������������������������������������ Exchange subsidies (including Basic Health Program) �������������������������������������� Other mandatory programs ������������������������� Subtotal, mandatory programs ��������������� Net interest ������������������������������������������������������ Total outlays �������������������������������������������������  2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2024  2020– 2029  623 639 1,262  680 678 1,358  664 682 1,345  673 667 1,341  678 674 1,352  688 679 1,367  701 694 1,394  715 702 1,417  733 717 1,451  752 730 1,481  770 747 1,517  790 763 1,553  3,404 7,164 3,396 7,055 6,800 14,219  982 582 389  1,038 644 406  1,094 702 422  1,153 761 445  1,219 859 469  1,289 889 498  1,365 918 523  1,445 1,035 552  1,530 1,116 590  1,619 1,194 625  1,714 1,371 661  1,813 1,354 700  6,119 14,240 4,128 10,199 2,356 5,484  46 523 2,522 325 4,109  57 599 2,744 377 4,478  56 599 2,872 422 4,639  56 615 3,030 465 4,836  58 647 3,252 515 5,119  60 642 3,378 576 5,321  62 646 3,513 630 5,537  64 682 3,779 678 5,874  66 729 4,031 725 6,207  68 751 4,256 771 6,509  71 814 4,632 816 6,965  75 292 636 785 3,149 6,911 4,727 16,045 37,470 854 2,608 6,453 7,134 25,452 58,142  1,684 205  1,719 221  1,803 253  1,912 282  2,050 314  2,198 368  2,358 409  2,519 429  2,692 427  2,875 411  3,068 424  3,270 10,321 24,744 433 1,626 3,750  855 261 45 10 95 23 41 71 41 3,330  914 278 43 10 98 17 82 49 40 3,473  946 287 46 11 108 19 64 49 42 3,629  1,002 305 47 12 111 20 43 52 45 3,832  1,057 324 47 12 115 21 44 56 47 4,088  1,112 341 46 13 109 22 44 62 50 4,365  1,172 361 47 13 138 24 45 68 53 4,687  1,233 380 48 14 129 26 46 73 56 4,954  1,302 402 51 15 133 27 47 79 59 5,233  1,368 423 52 15 138 28 48 85 62 5,506  1,450 450 55 16 127 30 49 90 65 5,823  1,523 5,289 12,166 474 1,618 3,746 57 233 496 17 61 139 148 582 1,255 31 106 248 50 241 480 97 288 712 66 237 545 6,165 20,601 48,282  Deficit ������������������������������������������������������������������  779  1,006  1,010  1,004  1,032  956  850  920  975  1,003  1,142  969  4,851  9,860  Net interest ������������������������������������������������������ Primary deficit ������������������������������������������������� On-budget deficit ���������������������������������������������� Off-budget deficit/surplus (–) ���������������������������  325 454 785 –6  377 629 1,013 –7  422 588 993 18  465 539 983 21  515 516 1,000 31  576 380 914 42  630 220 795 55  678 241 851 69  725 250 903 71  771 232 920 84  816 326 1,053 89  854 115 862 107  2,608 2,243 4,685 166  6,453 3,407 9,274 585  Receipts: Individual income taxes ����������������������������������� Corporation income taxes �������������������������������� Social insurance and retirement receipts: Social Security payroll taxes ���������������������� Medicare payroll taxes �������������������������������� Unemployment insurance ��������������������������� Other retirement ������������������������������������������ Excise taxes ������������������������������������������������������ Estate and gift taxes ���������������������������������������� Customs duties ������������������������������������������������� Deposits of earnings, Federal Reserve System ��� Other miscellaneous receipts �������������������������� Total receipts ������������������������������������������������  SUMMARY TABLES  Totals  21  Table S–3.  BASELINE BY CATEGORY 1—Continued (In billions of dollars) Totals 2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  22  2018  2020– 2024  Memorandum, budget authority for discretionary programs: 701 719 649 665 681 698 715 733 751 769 789 808 3,409 7,259 Defense ������������������������������������������������������������ Non-defense ����������������������������������������������������� 722 653 584 598 612 628 643 659 675 692 709 727 3,065 6,528 Total, discretionary budget authority ��������� 1,423 1,372 1,233 1,263 1,294 1,326 1,358 1,392 1,426 1,462 1,498 1,535 6,474 13,787 1 Baseline estimates are on the basis of the economic assumptions shown in Table S–9, which incorporate the effects of the Administration’s fiscal policies. 2 The Budget baseline included $187.5 billion in estimated Medicare outlays and $1.73 billion in estimated Medicaid outlays for the proposed rule entitled Fraud and Abuse; Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection for Certain Point-of-Sale Reductions in Price on Prescription Pharmaceuticals and Certain Pharmacy Benefit Manager Service Fees. At the time the Mid-Session Review was prepared, the final rule was under review but has since been withdrawn. As a result, the MSR still includes the estimated impacts of this now-withdrawn regulation.  MID-SESSION REVIEW  Table S–4.  PROPOSED BUDGET BY CATEGORY (In billions of dollars) Totals  Outlays: Discretionary programs: Defense ��������������������������������������������������������� Non-defense �������������������������������������������������� Subtotal, discretionary programs ������������ Mandatory programs: Social Security ���������������������������������������������� Medicare ������������������������������������������������������� Medicaid and Market-Based Health Care Grant �������������������������������������������������������� Exchange subsidies (including Basic Health Program) �������������������������������������� Other mandatory programs ������������������������� Allowance for infrastructure initiative ������� Subtotal, mandatory programs ��������������� Net interest ������������������������������������������������������ Total outlays �������������������������������������������������  2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  623 639 1,262  680 679 1,359  718 710 1,429  748 655 1,403  760 620 1,380  765 594 1,359  772 578 1,350  763 557 1,320  768 544 1,312  774 529 1,303  785 520 1,305  799 510 1,310  3,764 3,157 6,921  7,653 5,818 13,471  982 582  1,038 644  1,093 682  1,152 713  1,218 797  1,287 818  1,362 837  1,442 946  1,526 1,020  1,615 1,100  1,710 1,238  1,809 1,205  6,113 3,847  14,215 9,355  389  406  412  493  490  514  524  538  550  568  586  604  2,432  5,278  46 523 ......... 2,522 325 4,109  57 592 ......... 2,737 377 4,473  56 579 5 2,827 421 4,677  19 579 26 2,982 464 4,849  ......... 620 40 3,165 513 5,057  ......... 607 50 3,275 571 5,205  ......... 608 40 3,371 620 5,341  ......... 639 19 3,584 662 5,566  ......... 675 10 3,781 697 5,789  ......... 690 5 3,978 729 6,011  ......... 738 5 4,276 756 6,337  ......... 697 * 4,316 773 6,399  75 2,993 160 15,619 2,589 25,129  75 6,431 199 35,553 6,207 55,231  1,684 205  1,719 221  1,805 253  1,912 282  2,050 315  2,200 369  2,360 410  2,523 430  2,697 428  2,881 412  3,074 425  3,276 434  10,327 1,628  24,778 3,757  855 261 45 10 95 23 41 71 41  914 278 43 10 98 17 82 49 40  946 287 46 11 109 19 64 49 42  1,002 305 47 14 112 20 43 53 45  1,056 323 48 17 116 21 44 57 47  1,111 341 48 19 110 22 44 62 50  1,171 360 50 22 139 24 45 69 53  1,232 380 51 24 130 26 46 74 56  1,301 402 53 26 134 27 47 79 60  1,367 423 55 27 138 28 48 85 62  1,449 449 59 28 127 30 49 91 65  1,522 473 59 29 149 31 50 97 66  5,286 1,617 239 83 585 106 241 290 238  12,158 3,744 515 217 1,262 248 480 717 547  ......... 3,330  ......... 3,472  –1 3,632  –1 3,833  –4 4,091  –4 4,372  –4 4,698  –4 4,968  –4 5,248  –4 5,522  –5 5,841  –5 6,181  –13 20,627  –35 48,387  Deficit ������������������������������������������������������������������  779  1,001  1,045  1,016  966  832  643  598  541  489  497  218  4,502  6,845  Net interest ������������������������������������������������������ Primary deficit/surplus (–) ������������������������������� On-budget deficit ���������������������������������������������� Off-budget deficit/surplus (–) ���������������������������  325 454 785 –6  377 624 1,008 –7  421 624 1,029 16  464 551 997 19  513 454 939 28  571 262 792 40  620 23 591 52  662 –64 533 65  697 –156 475 66  729 –241 411 78  756 –259 415 82  773 –555 118 100  2,589 1,913 4,348 155  6,207 638 6,299 545  23  Receipts: Individual income taxes ����������������������������������� Corporation income taxes �������������������������������� Social insurance and retirement receipts: Social Security payroll taxes ���������������������� Medicare payroll taxes �������������������������������� Unemployment insurance ��������������������������� Other retirement ������������������������������������������ Excise taxes ������������������������������������������������������ Estate and gift taxes ���������������������������������������� Customs duties ������������������������������������������������� Deposits of earnings, Federal Reserve System ��� Other miscellaneous receipts �������������������������� Allowance for empowering States and consumers to reform healthcare ������������������ Total receipts ������������������������������������������������  SUMMARY TABLES  2018  2020– 2024  Table S–4.  PROPOSED BUDGET BY CATEGORY—Continued (In billions of dollars) Totals 2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2024  2020– 2029  Memorandum, budget authority for discretionary programs: Defense ���������������������������������������������������������  701  719  750  746  760  778  784  752  768  784  800  817  3,818  7,739  Non-defense �������������������������������������������������� Total, discretionary budget authority �����  722 1,423  657 1,376  557 1,307  538 1,284  527 1,287  517 1,295  506 1,290  495 1,247  485 1,253  475 1,259  466 1,266  458 1,275  2,644 6,462  5,023 12,762  389  406  412  370  364  385  392  404  413  427  442  457  1,923  4,066  46 ......... 435  57 ......... 463  56 ......... 468  19 123 512  ......... 126 490  ......... 128 514  ......... 131 524  ......... 134 538  ......... 138 550  ......... 141 568  ......... 144 586  ......... 147 604  75 509 2,507  75 1,213 5,353  Memorandum, empowering States and consumers to reform healthcare—Medicaid and other outlays for healthcare coverage: Medicaid ����������������������������������������������������������� Exchange Subsidies (including Basic Health Program) ������������������������������������������������������� Market-Based Health Care Grant ����������������� Total, outlays ������������������������������������������������ * $500 million or less  24  2018  MID-SESSION REVIEW  Table S–5.  PROPOSED BUDGET BY CATEGORY AS A PERCENT OF GDP (As a percent of GDP) Averages  Outlays: Discretionary programs: Defense ��������������������������������������������������������� Non-defense �������������������������������������������������� Subtotal, discretionary programs ������������ Mandatory programs: Social Security ���������������������������������������������� Medicare ������������������������������������������������������� Medicaid and Market-Based Health Care Grant �������������������������������������������������������� Exchange subsidies (including Basic Health Program) �������������������������������������� Other mandatory programs ������������������������� Allowance for infrastructure initiative ������� Subtotal, mandatory programs ��������������� Net interest ������������������������������������������������������ Total outlays �������������������������������������������������  2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2024  2020– 2029  3.1 3.2 6.2  3.2 3.2 6.4  3.2 3.2 6.4  3.2 2.8 6.0  3.1 2.5 5.6  3.0 2.3 5.2  2.8 2.1 5.0  2.7 1.9 4.6  2.6 1.8 4.4  2.5 1.7 4.1  2.4 1.6 4.0  2.3 1.5 3.8  3.1 2.6 5.6  2.8 2.1 4.9  4.9 2.9  4.9 3.0  4.9 3.1  4.9 3.0  4.9 3.2  5.0 3.2  5.0 3.1  5.0 3.3  5.1 3.4  5.1 3.5  5.2 3.7  5.2 3.5  4.9 3.1  5.0 3.3  1.9  1.9  1.8  2.1  2.0  2.0  1.9  1.9  1.8  1.8  1.8  1.7  2.0  1.9  0.2 2.6 ......... 12.5 1.6 20.3  0.3 2.8 ......... 12.9 1.8 21.1  0.3 2.6 * 12.7 1.9 21.0  0.1 2.5 0.1 12.7 2.0 20.7  ......... 2.5 0.2 12.8 2.1 20.5  ......... 2.3 0.2 12.6 2.2 20.1  ......... 2.2 0.1 12.4 2.3 19.6  ......... 2.2 0.1 12.5 2.3 19.5  ......... 2.2 * 12.6 2.3 19.3  ......... 2.2 * 12.6 2.3 19.1  ......... 2.2 * 13.0 2.3 19.2  ......... 2.0 * 12.5 2.2 18.5  0.1 2.4 0.1 12.7 2.1 20.4  * 2.3 0.1 12.6 2.2 19.7  8.3 1.0  8.1 1.0  8.1 1.1  8.2 1.2  8.3 1.3  8.5 1.4  8.7 1.5  8.8 1.5  9.0 1.4  9.2 1.3  9.3 1.3  9.5 1.3  8.3 1.3  8.7 1.3  4.2 1.3 0.2 0.1 0.5 0.1 0.2 0.3 0.2  4.3 1.3 0.2 * 0.5 0.1 0.4 0.2 0.2  4.2 1.3 0.2 * 0.5 0.1 0.3 0.2 0.2  4.3 1.3 0.2 0.1 0.5 0.1 0.2 0.2 0.2  4.3 1.3 0.2 0.1 0.5 0.1 0.2 0.2 0.2  4.3 1.3 0.2 0.1 0.4 0.1 0.2 0.2 0.2  4.3 1.3 0.2 0.1 0.5 0.1 0.2 0.3 0.2  4.3 1.3 0.2 0.1 0.5 0.1 0.2 0.3 0.2  4.3 1.3 0.2 0.1 0.4 0.1 0.2 0.3 0.2  4.3 1.3 0.2 0.1 0.4 0.1 0.2 0.3 0.2  4.4 1.4 0.2 0.1 0.4 0.1 0.1 0.3 0.2  4.4 1.4 0.2 0.1 0.4 0.1 0.1 0.3 0.2  4.3 1.3 0.2 0.1 0.5 0.1 0.2 0.2 0.2  4.3 1.3 0.2 0.1 0.5 0.1 0.2 0.3 0.2  ......... 16.5  ......... 16.4  –* 16.3  –* 16.3  –* 16.6  –* 16.9  –* 17.3  –* 17.4  –* 17.5  –* 17.5  –* 17.7  –* 17.8  –* 16.7  –* 17.1  Deficit ������������������������������������������������������������������  3.8  4.7  4.7  4.3  3.9  3.2  2.4  2.1  1.8  1.6  1.5  0.6  3.7  2.6  Net interest ������������������������������������������������������ Primary deficit/surplus (–) ������������������������������� On-budget deficit ���������������������������������������������� Off-budget deficit/surplus (–) ���������������������������  1.6 2.2 3.9 –*  1.8 2.9 4.8 –*  1.9 2.8 4.6 0.1  2.0 2.4 4.3 0.1  2.1 1.8 3.8 0.1  2.2 1.0 3.1 0.2  2.3 0.1 2.2 0.2  2.3 –0.2 1.9 0.2  2.3 –0.5 1.6 0.2  2.3 –0.8 1.3 0.2  2.3 –0.8 1.3 0.2  2.2 –1.6 0.3 0.3  2.1 1.6 3.6 0.1  2.2 0.4 2.4 0.2  Memorandum, budget authority for discretionary programs: Defense ���������������������������������������������������������  3.5  3.4  3.4  3.2  3.1  3.0  2.9  2.6  2.6  2.5  2.4  2.4  3.1  2.8  25  Receipts: Individual income taxes ����������������������������������� Corporation income taxes �������������������������������� Social insurance and retirement receipts: Social Security payroll taxes ����������������������� Medicare payroll taxes ��������������������������������� Unemployment insurance ��������������������������� Other retirement ������������������������������������������ Excise taxes ������������������������������������������������������ Estate and gift taxes ���������������������������������������� Customs duties ������������������������������������������������� Deposits of earnings, Federal Reserve System ��� Other miscellaneous receipts �������������������������� Allowance for empowering States and consumers to reform healthcare ������������������ Total receipts ������������������������������������������������  SUMMARY TABLES  2018  Table S–5.  PROPOSED BUDGET BY CATEGORY AS A PERCENT OF GDP—Continued (As a percent of GDP) Averages 2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2024  2020– 2029  Non-defense �������������������������������������������������� Total, discretionary budget authority �����  3.6 7.0  3.1 6.5  2.5 5.9  2.3 5.5  2.1 5.2  2.0 5.0  1.9 4.7  1.7 4.4  1.6 4.2  1.5 4.0  1.4 3.8  1.3 3.7  2.2 5.3  1.8 4.6  Memorandum, empowering States and consumers to reform healthcare— Medicaid and other outlays for healthcare coverage: Medicaid ����������������������������������������������������������� Exchange Subsidies (including Basic Health Program) ������������������������������������������������������� Market-Based Health Care Grant ������������������ Total, outlays ������������������������������������������������  1.9  1.9  1.8  1.6  1.5  1.5  1.4  1.4  1.4  1.4  1.3  1.3  1.6  1.5  0.2 ......... 2.2  0.3 ......... 2.2  0.3 ......... 2.1  0.1 0.5 2.2  ......... 0.5 2.0  ......... 0.5 2.0  ......... 0.5 1.9  ......... 0.5 1.9  ......... 0.5 1.8  ......... 0.4 1.8  ......... 0.4 1.8  ......... 0.4 1.7  0.1 0.4 2.0  * 0.4 1.9  26  2018  * 0.05 percent of GDP or less.  MID-SESSION REVIEW  Table S–6.  MANDATORY AND RECEIPT PROPOSALS (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2020– 2024  2029  2020– 2029  .........  .........  –660  –660  –660  –660  –660  –660  –660  –660  –660  –2,640  –5,940  .........  –22  –22  –23  –23  –24  –24  –24  –25  –25  –26  –114  –238  .........  –25  –25  –25  –25  –25  –25  –25  –25  –25  –25  –125  –250  .........  –20  –20  –20  –20  –20  –20  –20  –20  –20  –20  –100  –200  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –5  –5  .........  .........  .........  .........  .........  .........  –10  –10  .........  –19  –124  –155  –188  –193  –198  –203  –208  –213  –218  –679  –1,719  .........  –411  –432  –454  –476  –499  –523  –547  –571  –596  –621  –2,272  –5,130  .........  –29  –14  1  1  1  1  1  1  1  1  –40  –35  .........  –2  –1  .........  .........  .........  .........  .........  .........  .........  .........  –3  –3  ......... .........  –63 –210  –117 –412  –132 –617  –124 –838  –114 –1,040  –126 –1,081  –154 –1,131  –148 –1,181  –164 –1,181  –164 –1,181  –550 –3,117  –1,306 –8,872  .........  –54  –86  –97  –99  –100  –100  –100  –100  –100  –100  –436  –936  .........  –166  –166  –166  –166  –166  –166  –166  –166  –166  –166  –830  –1,660  .........  –149  –143  –141  –137  –135  –132  –130  –128  –127  –126  –705  –1,348  .........  –680  –778  –769  –759  –758  –791  –815  –817  –827  –825  –3,744  –7,819  .........  –12  –12  –12  –12  –12  –12  –12  –12  –12  –12  –60  –120  .........  .........  –62  –69  –69  –68  –69  –68  –69  –78  –89  –268  –641  .........  .........  –2,253  –2,321  –2,507  –2,488  –2,497  –2,482  –2,504  –2,522  –2,542  –9,569  –22,116  ......... .........  ......... –1,862  ......... –5,327  ......... –5,665  –417 –6,524  –428 –6,729  –423 –6,846  –419 –6,955  –421 –7,054  –418 –7,133  –422 –7,196  –845 –26,107  –2,948 –61,291  .........  –40  –35  –35  –60  –65  –70  –70  –80  –80  –85  –235  –620  27  Mandatory Initiatives and Savings: Agriculture: Establish Food Safety and Inspection Service (FSIS) user fee ������������������� Establish Animal and Plant Health Inspection Service user fee ���������� Establish Packers and Stockyards Program user fee �������������������������� Establish Agricultural Marketing Service user fee ���������������������������� Adjust FSIS holiday and voluntary overtime user fee �������������������������� Eliminate the Rural Economic Development program ����������������� Improve Child Nutrition program integrity ���������������������������������������� Reform commodity purchases under Section 32 ������������������������������������� Establish Forest Service Mineral Program cost recovery fee ������������ Amend land uses cost recovery authority ��������������������������������������� Limit eligibility for agricultural commodity payments to $500,000 Adjusted Gross Income (AGI) ������ Streamline conservation programs ���� Eliminate lower priority Farm Bill programs ��������������������������������������� Eliminate Food for Progress food aid program ���������������������������������� Tighten commodity payment limits and close loopholes ����������������������� Eliminate Livestock Forage program ���������������������������������������� Eliminate the crop insurance 508(h) program ���������������������������������������� Limit Crop Insurance eligibility to $500,000 AGI �������������������������������� Limit Crop Insurance premium subsidies ��������������������������������������� Cap Crop Insurance companies’ underwriting gains ���������������������� Total, Agriculture�������������������������� Commerce: Lease Shared Secondary Licenses ����  2020  SUMMARY TABLES  2019  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  –1,343  –3,077  –4,725  –6,324  –7,643  –8,643  –9,129  –9,999  –10,511  –11,274  –23,112  –72,668  .........  –1,857  –3,232  –4,376  –5,220  –5,840  –6,227  –6,411  –6,563  –6,568  –6,422  –20,525  –52,716  .........  –95  –170  –255  –326  –400  –445  –457  –505  –538  –580  –1,246  –3,771  ......... .........  –3,295 –659  –6,479 –2,094  –9,356 –2,471  –11,870 –2,660  –13,883 –2,726  –15,315 –2,709  –15,997 –2,768  –17,067 –2,769  –17,617 –2,724  –18,276 –2,767  .........  –1,459  –2,842  –4,015  –4,975  –5,688  –6,226  –6,477  –6,819  –7,231  –7,281  –18,979  –53,013  ......... .........  –501 .........  ......... .........  ......... .........  ......... .........  ......... .........  ......... .........  ......... .........  ......... .........  ......... .........  ......... .........  –501 .........  –501 .........  .........  –5,914  –11,415  –15,842  –19,505  –22,297  –24,250  –25,242  –26,655  –27,572  –28,324  .........  860  4,884  4,962  5,019  4,960  4,987  4,971  4,948  4,944  4,974  20,685  45,509  .........  –10  –21  –22  –22  –22  –23  –23  –24  –24  –24  –97  –215  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  12  30  35  42  47  47  49  50  52  52  166  416  ......... .........  –12 –5,064  –30 –6,552  –35 –10,902  –42 –14,508  –47 –17,359  –47 –19,286  –49 –20,294  –50 –21,731  –52 –22,652  –52 –23,374  ......... .........  –550 .........  –615 –847  455 .........  –5 .........  425 .........  –225 .........  225 .........  –225 .........  225 .........  –225 .........  –290 –847  –515 –847  .........  .........  –16  .........  .........  .........  .........  .........  .........  .........  .........  –16  –16  .........  .........  –2,334  –396  –414  –432  –395  –427  –438  –448  –459  –3,576  –5,743  .........  –247  –253  –259  –266  –274  –283  –291  –298  –304  –268  –1,299  –2,743  ......... .........  ......... –797  ......... –4,065  –355 –555  –354 –1,039  –353 –634  –345 –1,248  –337 –830  –337 –1,298  –337 –864  –337 –1,289  –1,062 –7,090  –2,755 –12,619  –44,883 –129,155 –10,610 –24,347  –74,973 –207,016  –166 –416 –54,385 –161,722 MID-SESSION REVIEW  Education: Reform Federal student loans: Create single income-driven student loan repayment plan: Create single income-driven student loan repayment plan 2 ������������������������������������� Eliminate standard repayment cap ����������������������������������������� Use combined AGI to calculate loan payments for married filing separately ������������������� Total, create single income-driven student loan repayment plan����� Eliminate subsidized student loans  Eliminate Public Service Loan Forgiveness ����������������������������������� Eliminate account maintenance fee payments to guaranty agencies ��� Enact student loan risk sharing ������ Total, reform Federal student loans ������������������������������������������ Establish Education Freedom Scholarships 1 ������������������������������� Reduce improper payments in Pell Grants ������������������������������������������� Move Iraq-Afghanistan Service Grants into the Pell Grant program ���������������������������������������� Expand Pell Grants to short-term programs ��������������������������������������� Reallocate mandatory Pell funding to support short-term programs ��� Total, Education���������������������������� Energy: Repeal borrowing authority for Western Area Power Administration (WAPA) ��������������� Divest WAPA transmission assets ��� Divest Southwestern Power Administration transmission assets �������������������������������������������� Divest Bonneville Power Administration transmission assets �������������������������������������������� Reform the laws governing how Power Marketing Administrations establish power rates ���������������������������������������������� Restart Nuclear Waste Fund Fee in 2022 ���������������������������������������������� Total, Energy���������������������������������  2020  28  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  11  34  38  39  40  40  40  42  42  42  162  368  .........  5  80  53  8  2  .........  .........  .........  .........  .........  148  148  .........  3  45  18  13  4  2  .........  .........  .........  .........  83  85  .........  216  216  216  216  216  215  215  215  215  215  1,080  2,155  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  2  2  2  3  3  4  4  5  5  5  12  35  ......... ......... ......... .........  9 14 ......... 50  26 18 1 300  30 32 1 300  30 36 1 300  30 41 1 50  30 47 1 .........  30 43 1 .........  31 42 1 .........  35 42 1 .........  29 42 1 .........  125 141 4 1,000  280 357 9 1,000  .........  480  221  22  7  4  4  .........  .........  .........  .........  734  738  .........  .........  .........  7  8  8  8  21  22  18  18  23  110  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –55  –70  –80  –80  –80  –100  –95  –105  –125  –120  –365  –910  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  29  Health and Human Services (HHS): Create child welfare flexible funding option ������������������������������ Expand the Regional Partnership Grants program ���������������������������� Reauthorize Personal Responsibility Education Program and Sexual Risk Avoidance education ������������ Reauthorize Health Profession Opportunity Grants ��������������������� Mitigate the impact of Temporary Assistance for Needy Families (TANF) and Social Services Block Grant (SSBG) program changes on child care spending ����������������� Expand access to National Directory of New Hires ���������������� Reauthorize Healthy Marriage and Responsible Fatherhood Grants ��� Fund States to provide parenting time services ��������������������������������� Modernize and expand the Court Improvement Program ���������������� Promote family based care �������������� Increase repatriation ceiling ����������� Build the supply of child care ���������� Establish an Unaccompanied Alien Children Contingency Fund �������� Create Child and Family Services review incentives �������������������������� Drug pricing and payment improvements: Public health: Improve 340B program integrity �������������������������������� Establish and collect user fees from the 340B drug discount program from participating covered entities �������������������� Reform exclusivity for first generics to spur greater competition and access �������� Reform 180-day exclusivity forfeiture provision for first generics to increase competition 3 ������������������������� Enhance Food and Drug Administration (FDA) authority to address abuse of petition process 3 ���������������  2020  SUMMARY TABLES  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  ......... .........  ......... –55  ......... –70  ......... –80  ......... –80  ......... –80  ......... –100  ......... –95  ......... –105  ......... –125  ......... –120  ......... –365  ......... –910  .........  .........  –70  –90  –90  –80  –90  –100  –100  –130  –130  –330  –880  .........  .........  –3,040  –5,160  –6,620  –7,980  –9,540  –8,880  –9,580  –11,210  –10,390  –22,800  –72,400  .........  .........  730  1,770  1,840  1,670  1,560  1,170  1,390  2,120  1,150  6,010  13,400  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –10  –20  –20  –30  –30  –30  –30  –30  –40  –40  –110  –280  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  MID-SESSION REVIEW  Revise United States Pharmacopeia compendial requirements for biological products to encourage biosimilar development 3 ������ Codify FDA’s approach to determining new chemical entity exclusivity 3 ���������������� Total, public health��������������� Medicare: Eliminate cost-sharing on generic drugs and biosimilars for low-income beneficiaries �������������������������� Exclude manufacturer discounts from the calculation of beneficiary out-of-pocket costs in the Medicare Part D coverage gap ���������������������������������������� Establish a beneficiary out-of-pocket maximum in the Medicare Part D catastrophic phase ��������������� Give the Secretary authority to contract with pharmaceutical manufacturers entering into new coverage gap discount program agreements on a quarterly basis 3 �������������������� Permanently authorize a successful pilot on retroactive Medicare Part D coverage for low-income beneficiaries �������������������������� Authorize the HHS Secretary to leverage Medicare Part D plans’ negotiating power for certain drugs covered under Part B 3 ���������������������������������� Address abusive drug pricing by manufacturers by establishing an inflation limit for reimbursement of Medicare Part B drugs 3 ������� Improve manufacturers’ reporting of average sales prices to set accurate payment rates 3 ���������������������  2020  30  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –70  –180  –250  –280  –320  –350  –390  –440  –480  –530  –1,100  –3,290  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  ......... .........  ......... –80  ......... –2,580  ......... –3,750  ......... –5,180  ......... –6,740  ......... –8,450  ......... –8,230  ......... –8,760  ......... –9,740  ......... –9,940  ......... –18,330  ......... –63,450  .........  –15  –15  –15  –15  –15  –15  –15  –15  –15  –15  –75  –150  .........  –5  –15  –20  –30  –35  –40  –50  –55  –60  –60  –105  –370  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –100  –100  –100  –100  –100  –100  –110  –110  –110  –110  –500  –1,040  ......... .........  –1,230 –1,350  –1,310 –1,440  –1,390 –1,525  –1,480 –1,625  –1,580 –1,730  –1,680 –1,835  –1,790 –1,965  –1,920 –2,100  –2,050 –2,235  –2,190 –2,375  –6,990 –7,670  –16,620 –18,180  .........  –1,485  –4,090  –5,355  –6,885  –8,550  –10,385  –10,290  –10,965  –12,100  –12,435  –26,365  –82,540  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  31  Modify payment for drugs hospitals purchased through the 340B discount program and require a minimum level of charity care for hospitals to receive a payment adjustment related to uncompensated care 3 ������� Eliminate pass-through payments for drugs, biologicals, and biosimilars ��� Reduce Wholesale Acquisition Cost-based payments 3 �������� Reduce average sales pricebased payments when the primary patent expires to increase competition and reduce gaming 3 �������������������� Total, Medicare���������������������� Medicaid: Clarify authorized generic sales under the Medicaid Drug Rebate Program ���������� Test allowing State Medicaid programs to negotiate prices directly with drug manufacturers and set formulary for coverage ��������� Impose greater penalties for manufacturer reporting of false information or false product data under the Medicaid Drug Rebate Program 3 ������������������������������ Exclude brand name and authorized generic drug prices from Medicaid Federal upper limit �������������� Allow rebates on drugs that exceed 100 percent of the Average Manufacturer Price ��� Total, Medicaid���������������������� Total, drug pricing and payment improvements�������� Address opioids: Prevent abusive prescribing by establishing HHS reciprocity with the Drug Enforcement Administration to terminate provider prescribing authority 3 ���������������������������������  2020  SUMMARY TABLES  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  ......... .........  25 25  20 20  20 20  20 20  20 20  20 20  20 20  20 20  20 20  20 20  105 105  205 205  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  30  40  60  50  50  60  60  50  50  50  230  500  .........  –160  –160  –140  40  90  20  10  20  40  50  –330  –190  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  MID-SESSION REVIEW  Allow States to extend Medicaid coverage for pregnant women with substance use disorder to one year postpartum ���������������� Total, address opioids���������������� Medicare appeals: Improve the Medicare appeals system ��������������������������������������� Address wasteful spending, fraud, and abuse in Medicare: Improve and tailor the way Medicare educates beneficiaries about the program ������������������������������������ Eliminate arbitrary thresholds and other burdens to encourage participation in advanced Alternative Payment Models ��������������������������������������� Simplify and eliminate reporting burdens for clinicians participating in the Meritbased Incentive Payment System �������������������������������������� Tailor the frequency of skilled nursing facility surveys to more efficiently use resources and alleviate burden for topperforming nursing homes ������ Remove timeframe for initial surveys for End Stage Renal Disease facilities under the Bipartisan Budget Act of 2018 ��� Allow Centers for Medicare and Medicaid Services (CMS) flexibility to determine the frequency of Programs of AllInclusive Care for the Elderly program audits ������������������������� Eliminate the unnecessary requirement of a face-to-face provider visit for durable medical equipment ������������������� Remove the redundant requirement that physicians certify that all critical access hospital patients are expected to be discharged within 96 hours of admission ������������������� Create a consolidated hospital quality payment program ��������  2020  32  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –820  –1,160  –2,100  –3,140  –4,140  –5,310  –6,420  –7,590  –8,930  –10,190  –11,360  –49,800  .........  .........  –4,680  –7,310  –8,510  –9,540  –10,630  –11,770  –12,970  –14,210  –15,520  –30,040  –95,140  .........  –400  –1,370  –2,920  –3,890  –4,220  –4,480  –4,760  –5,060  –5,380  –5,700  –12,800  –38,180  .........  –710  –2,750  –5,020  –7,650  –10,410  –12,120  –13,150  –14,280  –15,970  –16,290  –26,540  –98,350  .........  –330  –800  –900  –950  –1,010  –1,070  –1,130  –1,160  –1,220  –1,280  –3,990  –9,850  .........  –620  –1,640  –2,210  –2,450  –2,690  –2,960  –3,250  –3,560  –3,890  –4,290  –9,610  –27,560  .........  –2,630  –7,130  –9,680  –10,890  –12,200  –13,630  –15,200  –16,930  –18,810  –20,880  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –10  –10  –10  –10  –10  –10  –10  –10  –30  –80  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –42,530 –127,980  33  Authorize the Secretary to implement meaningful measures for the End Stage Renal Disease Quality Incentive Program ������������������� Increase End Stage Renal Disease networks funding to match Consumer Price Index 3 �������������� Consolidate and block grant graduate medical education payments ���������������������������������� Modify payments to hospitals for uncompensated care ���������������� Reduce Medicare coverage of bad debts ������������������������������������������ Address excessive payment for post-acute care providers by establishing a unified payment system based on patients’ clinical needs rather than the site of care �������������������������������� Authorize long-term care hospital site neutral exceptions criteria ��� Pay all hospital-owned physician offices located off-campus at the physician office rate ����������� Pay on-campus hospital outpatient departments at the physician office rate for certain services ������������������������������������� Redesign Outpatient Prospective Payment System and Ambulatory Surgical Care payment systems to make riskadjusted payments 3 ����������������� Implement value-based purchasing program for outpatient hospitals and ambulatory surgical centers 3 ������������������������������������� Expand basis for beneficiary assignment for Accountable Care Organizations ������������������ Reform physician self-referral law to better support and align with alternative payment models and to address overutilization 3 ������������������������ Reprioritize primary and preventive care in Medicare ���� Require prior authorization when physicians order certain services excessively relative to their peers 3 �������������������������������  2020  SUMMARY TABLES  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  .........  –580  –1,035  –1,120  –1,195  –1,290  –1,375  –1,470  –1,565  –1,670  –3,930  –11,300  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –20  –10  –10  –20  –20  –20  –20  –30  –30  –30  –80  –210  .........  .........  918  1,136  1,359  1,560  1,616  1,709  1,785  1,840  1,916  4,973  13,839  .........  –890  –1,360  –1,480  –1,570  –1,660  –1,760  –1,850  –1,950  –2,050  –2,170  –6,960  –16,740  .........  –2  –2  –3  –3  –3  –3  –4  –4  –4  –4  –13  –32  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  MID-SESSION REVIEW  Reform and expand durable medical equipment competitive bidding �������������������������������������� Support coverage for innovative alternatives to durable medical equipment for treatment and management of diabetes 3 �������� Allow for Federal/State coordinated review of dual eligible Special Needs Plan marketing materials ���������������� Improve appeals notifications for dually eligible individuals in Integrated Health Plans ���������� Clarify the Part D special enrollment period for dually eligible beneficiaries ���������������� Give Medicare beneficiaries with high deductible health plans the option to make tax deductible contributions to Health Savings Accounts or Medical Savings Accounts 1 ������ Expand prior authorization to additional Medicare fee-forservice items at high risk of fraud, waste, and abuse ����������� Prevent fraud by applying penalties on providers and suppliers who fail to update enrollment records ������������������� Require reporting on clearinghouses and billing agents when Medicare providers and suppliers enroll in the program �������������������������� Ensure providers that violate Medicare’s safety requirements and have harmed patients cannot quickly re-enter the program ������������������������������������ Assess a penalty on physicians and practitioners who order services or supplies without proper documentation �������������� Improve safety and quality of care by publicly reporting Medicare survey and certification reports conducted by accreditation Organizations ���������������������������� Require providers and suppliers to produce Part B records to support Part D investigations or audits ������������������������������������  2020  34  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  –20  –20  –20  –20  –20  –20  –20  –20  –20  –20  –100  –200  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –6,572  –20,704  –31,642  –38,774  –45,418  –51,607  –57,180  –63,179  –70,159  .........  .........  –80  –350  –370  –390  –420  –440  –470  –500  –530  –1,190  –3,550  .........  .........  .........  .........  .........  .........  .........  –6,510  –6,490  –6,470  –6,450  .........  –25,920  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  1  1  1  1  1  1  1  2  7  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –76,038 –143,110 –461,273  35  Pass Treasury collection fees for CMS overpayment collections onto debtor �������������������������������� Improve efficiency and strengthen program integrity efforts in Medicare Parts C and D ������������� Implement targeted riskadjustment pre-payment review in Medicare Advantage �������������������������������� Clarify authority for the Healthcare Fraud Prevention Partnership ������������������������������� Extend flexibility in annual Open Payments reporting deadline ��� Require physician owned distributors to report in Open Payments ���������������������������������� Create authority to revoke or deny Medicare billing privileges based on medical board or independent review organizations ���������������������������� Total, address wasteful spending, fraud, and abuse in Medicare���������������������������� Address wasteful spending, fraud and abuse in Medicaid: Strengthen CMS’s ability to recoup Medicaid improper payments ���������������������������������� Continue Medicaid Disproportionate Share Hospital (DSH) allotment reductions ��������������������������������� Clarify Medicaid treatment of third party payments for DSH allotments ��������������������������������� Address inappropriate financing of Medicaid state share by public providers 3 ���������������������� Prohibit Medicaid payments to public providers in excess of costs 3 ����������������������������������������� Consolidate provider screening for Medicaid and Children’s Health Insurance Program (CHIP) ��������������������������������������� Provide flexibility for enrolling out-of-State providers in Medicaid ����������������������������������� Streamline the Medicaid terminations process ����������������  2020  SUMMARY TABLES  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –850  –880  –920  –960  –1,010  –1,060  –1,110  –1,170  –1,220  –1,280  –4,620  –10,460  .........  .........  –6  .........  .........  .........  .........  .........  .........  .........  .........  –6  –6  .........  –850  –966  –1,270  –1,329  –1,399  –1,479  –8,059  –8,129  –8,189  –8,259  –5,814  –39,929  .........  –8,100  –10,900  –11,500  –12,100  –12,800  –13,400  –14,200  –14,900  –15,800  –16,600  .........  –40  –90  –200  –210  –220  –230  –240  –260  –270  –280  –760  –2,040  .........  .........  –460  –480  –510  –540  –580  –620  –660  –700  –740  –1,990  –5,290  .........  –190  –200  –210  –220  –230  –240  –250  –260  –280  –290  –1,050  –2,370  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –120  –240  –240  –240  –240  –240  –240  –240  –240  –480  –1,080  –2,520  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  ......... .........  ......... –8,450  ......... –11,890  ......... –12,630  ......... –13,280  ......... –14,030  ......... –14,690  ......... –15,550  ......... –16,320  ......... –17,290  ......... –18,390  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  24  32  32  32  32  32  35  35  35  36  152  325  –55,400 –130,300  ......... ......... –60,280 –142,520  MID-SESSION REVIEW  Expand Medicaid Fraud Control Unit review to additional care settings 3 ������������������������������������ Implement pre-payment controls to prevent inappropriate personal care services payments ���������������������������������� Rescind remaining balances from the Medicaid Improvement Fund ������������������������������������������ Total, address wasteful spending, fraud and abuse in Medicaid�������������������������������� Other Medicaid reforms: Implement Medicaid community engagement requirement �������� Allow States to apply asset tests to Modified Adjusted Gross Income standard populations ��� Reduce maximum allowable home equity for Medicaid eligibility ����������������������������������� Require documentation of satisfactory immigration status before receipt of Medicaid benefits ��������������������� Modify the Medicaid fair hearing requirement to eliminate duplicative appeals ������������������ Increase limit on Medicaid copayments for non-emergency use of emergency department ��� Increase flexibility in the duration of section 1915(b) managed care waivers ������������� Provide a pathway to make permanent established Medicaid managed care waivers �������������������������������������� Total, other Medicaid reforms��� CHIP: Strengthen the CHIP safety net for States ���������������������������������� Public health: Provide tax exemption for certain Health Resources and Services Administration (HRSA) and Indian Health Service (IHS) scholarship and loan repayment programs 1 ��������������  2020  36  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  1,800  3,920  2,160  80  40  .........  .........  .........  .........  .........  8,000  8,000  .........  68  248  226  56  16  6  .........  .........  .........  .........  614  620  .........  67  114  59  13  .........  .........  .........  .........  .........  .........  253  253  .........  154  189  73  67  51  36  19  8  3  .........  534  600  .........  2  6  4  .........  .........  .........  .........  .........  .........  .........  12  12  .........  8  29  27  8  3  2  .........  .........  .........  .........  75  77  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  ......... .........  ......... 2,123  ......... 4,538  ......... 2,581  ......... 256  ......... 142  ......... 76  ......... 54  ......... 43  ......... 38  ......... 36  ......... 9,640  ......... 9,887  –6,301  471  .........  .........  .........  .........  .........  .........  .........  .........  .........  471  471  .........  –85  7  .........  .........  .........  .........  .........  .........  .........  .........  –78  –78  .........  –230  –115  .........  .........  .........  .........  .........  .........  .........  .........  –345  –345  ......... .........  ......... –153  2,142 –497  3,044 –1,335  2,960 –2,149  2,873 –2,843  2,943 –3,923  3,071 –4,729  3,201 –5,046  3,268 –5,458  3,348 –5,504  11,019 –6,977  26,850 –31,637  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  37  Align substance use disorder treatment privacy protections with other confidentiality protections �������������������������������� Extend Health Centers through 2021 ������������������������������������������ Extend the National Health Service Corps through 2021 ���� Extend Teaching Health Centers Graduate Medical Education through 2021 ���������������������������� Extend the Special Diabetes Programs for the National Institutes of Health and IHS through 2021 ���������������������������� Extend Family to Family Health Information Centers through 2021 ������������������������������������������ Extend Medicare enrollment assistance programs through 2021 ������������������������������������������ Provide Federal Tort Claim Act coverage for IHS volunteers ���� Authorize IHS to establish concurrent Federal/State jurisdiction at IHS Federal enclave properties �������������������� Provide IHS discretionary use of all Title 38 personnel authorities �������������������������������� Meet IHS loan repayment and scholarship service obligations on a half-time basis ������������������ Reauthorize the Ryan White HIV/ AIDS Program 3 ������������������������ Total, public health������������������� Other health: Provide an appropriation to pay Cost-Sharing Reductions 4 ������� Reduce the grace period for Exchange premiums 1 ��������������� Introduce new minimum required contribution for premium tax credits 1 ������������������������������������� Improve and expand access to Health Savings Accounts 1 ������� Reform medical liability 1 ������������� Prohibit governmental discrimination against health care providers who refuse to cover abortion ��������������������������� Protect the religious liberty of child welfare providers ������������  2020  SUMMARY TABLES  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  12  150  38  .........  .........  .........  .........  .........  .........  .........  200  200  ......... –6,301  ......... 15  ......... 1,687  ......... 1,747  ......... 811  ......... 30  ......... –980  ......... –1,658  ......... –1,845  ......... –2,190  ......... –2,156  ......... 4,290  ......... –4,539  ......... ......... .........  223 830 1,053  456 7,180 7,636  574 9,080 9,654  648 10,070 10,718  713 10,920 11,633  761 11,840 12,601  807 12,790 13,597  861 13,800 14,661  912 14,890 15,802  969 16,130 17,099  2,614 38,080 40,694  6,924 107,530 114,454  –6,301  –13,351  –22,826  –36,176  –47,802  –57,173  –66,093  –78,712  –85,356  –93,710  ......... ......... .........  ......... –199 –64  ......... –177 –9  ......... –186 –2  ......... –196 –10  ......... –210 –3  ......... –222 –19  ......... –238 –5  –967 –249 –21  –5,012 –259 –4  –5,109 –265 –13  ......... –968 –88  –11,088 –2,201 –150  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –11  56  16  .........  .........  .........  .........  .........  .........  .........  61  61  .........  .........  91  152  174  180  187  192  199  –4  –4  597  1,167  .........  –466  –471  –479  –486  –494  –508  –523  –538  –554  –570  –2,396  –5,089  .........  –13  –14  –15  –15  –15  –15  –15  –15  –15  –15  –72  –147  .........  4  5  8  55  37  51  65  81  91  95  109  492  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  ......... .........  –400 –1,149  –543 –1,062  –548 –1,054  –555 –1,033  –561 –1,066  –571 –1,097  –561 –1,085  –552 –2,062  –559 –6,316  –563 –6,444  –2,607 –5,364  –5,413 –22,368  .........  –83  –69  –78  .........  .........  .........  .........  .........  .........  .........  –230  –230  .........  –4  –4  –4  –4  –4  –4  –4  –4  –4  –4  –20  –40  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  ......... .........  260 173  715 642  1,040 958  1,300 1,296  1,300 1,296  1,040 1,036  585 581  260 256  ......... –4  ......... –4  4,615 4,365  6,500 6,230  .........  –3,259  –2,166  –1,696  –1,284  –200  –200  –200  –200  –200  –200  –8,605  –9,605  –99,771 –177,328 –600,970  MID-SESSION REVIEW  Provide CMS Program Management implementation funding �������������������������������������� Modify the U.S. Public Health Service Commissioned Corps retirement pay funding source ��� Total, other health��������������������� Interactions: Medicare interactions ������������������ Medicaid interactions ������������������ Total, Interactions��������������������� Total, Health and Human Services (HHS)�������������������������� Homeland Security: Extend expiring Customs and Border Protection (CBP) fees ������ Increase customs user fees �������������� Increase immigration user fees ������� Establish Electronic Visa Update System user fee 1 �������������������������� Eliminate BrandUSA; make revenue available to CBP ������������ Make full Electronic System for Travel Authorization (ESTA) receipts available to CBP 1 ����������� Establish an immigration services surcharge 1 ������������������������������������ Increase worksite enforcement penalties 1 �������������������������������������� Establish National Flood Insurance Program affordability assistance 5 ������������������������������������ Transfer immigration examination fees ������������������������������������������������ Reauthorize the Oil Spill Liability Trust Fund excise tax 1, 6 �������������� Total, Homeland Security������������� Interior: Cancel Southern Nevada Public Land Management Act balances ������������ Repeal enhanced geothermal payments to counties ������������������� Reauthorize the Federal Lands Recreation Enhancement Act ������ Establish a Public Lands Infrastructure Fund ��������������������� Total, Interior�������������������������������� Justice: Establish a definite annual funding level for the Crime Victims Fund ���  2020  38  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  11  –1,884  –1,917  –2,001  –2,043  729  –4,919  –2,159  –2,202  –2,240  –7,834  –18,625  .........  –5  –244  –131  –55  –4  191  –131  63  61  74  –439  –181  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –31  –26  –29  –18  –18  –19  –19  –20  –21  –19  –122  –220  .........  –22  –104  –171  –162  –31  35  30  3  –23  –47  –490  –492  .........  –325  –207  –109  –19  .........  .........  .........  .........  .........  .........  –660  –660  .........  750  750  1,313  1,962  2,167  2,361  2,548  2,722  2,885  3,033  6,942  20,491  .........  .........  .........  –526  –917  –1,409  –779  –1,001  –1,312  –1,661  –375  –2,852  –7,980  .........  –132  –269  –290  –284  –259  –240  –168  –132  –89  –268  –1,234  –2,131  ......... .........  618 246  481 –1,984  497 –1,860  761 –1,494  499 –1,597  1,342 2,278  1,379 –3,660  1,278 –835  1,135 –1,050  2,390 158  2,856 –6,689  10,380 –9,798  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –224  –1,014  –1,616  –3,003  –4,352  –5,108  –4,971  –4,371  –3,771  –3,284  –10,209  –31,714  .........  .........  34  –12  –17  –17  –17  –17  –17  –17  –17  –12  –97  .........  –32  –32  –32  –32  –32  –32  –32  –32  –32  –32  –160  –320  .........  –6  –6  –6  –6  –6  –6  –6  –6  –6  –6  –30  –60  .........  –160  –818  –1,895  –3,166  –4,558  –5,899  –6,880  –7,510  –7,942  –8,241  –10,597  –47,069  .........  320  693  1,040  1,386  1,737  1,850  1,865  1,875  1,885  1,893  5,176  14,544  .........  –24  –34  –37  –42  –46  –50  –55  –60  –66  –72  –183  –486  .........  –1,005  –1,503  –1,550  –1,604  –1,661  –1,721  –1,782  –1,846  –1,911  –1,978  –7,323  –16,561  .........  –62  –379  –386  –381  –319  –234  –207  –221  –208  –156  –1,527  –2,553  39  Labor: Improve Pension Benefit Guaranty Corporation (PBGC) Multiemployer solvency ��������������� Reform PBGC single-employer premiums �������������������������������������� Expand Foreign Labor Certification fees ������������������������������������������������ Reform the Federal Employees’ Compensation Act ������������������������ Reform the Trade Adjustment Assistance program ���������������������� Increase H–1B American Competitiveness and Workforce Improvement Act filing fee ���������� Establish a paid parental leave program: Provide paid parental leave benefits 1, 6, 7 ������������������������������� Establish an Unemployment Insurance (UI) solvency standard 1, 6 ������������������������������� Improve UI program integrity 1, 6 ������������������������������� Total, establish a paid parental leave program������������������������ Total, Labor����������������������������������� Transportation: Eliminate Off-System Bridges SetAside ��������������������������������������������� Treasury: Increase and extend guarantee fee charged by Governmentsponsored enterprises ������������������ Subject Financial Research Fund to appropriations 1, 6 �������������������������� Increase collections of delinquent Federal non-tax debt �������������������� Increase and streamline recovery of unclaimed assets �������������������������� Implement tax enforcement program integrity cap adjustment 1 �������������� Increase discretionary outlays from tax enforcement program integrity cap adjustment (non-add) ������������ Increase oversight of paid tax return preparers 1 ������������������������� Provide more flexible authority for the Internal Revenue Service to address correctable errors 1 ��������� Repeal the qualified plug-in electric drive motor vehicle credit 1 ����������  2020  SUMMARY TABLES  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  –2  –7  –7  –6  –6  –5  –5  –5  –4  –4  –28  –51  ......... 70  –171 71  –529 –259  –786 –1,176  –865 –1,540  –904 –1,532  –899 –1,489  –863 –1,433  –782 –1,447  –643 –1,474  –502 –1,469  –3,255 –4,436  –6,944 –11,748  328 398  –709 –2,324  –686 –5,233  –195 –7,698  –34 –10,696  ......... –13,433  ......... –15,460  ......... –16,251  ......... –16,297  ......... –16,074  ......... –15,761  .........  –28  –29  –30  –31  –32  –33  –34  –35  –38  –39  –150  –329  ......... .........  3 –36  3 –84  3 –129  8 –173  3 –229  4 –255  4 –266  13 –282  2 –297  5 –314  20 –651  48 –2,065  .........  –234  –269  –278  –288  –298  –309  –320  –331  –103  –269  –1,367  –2,699  .........  2  1  1  1  1  1  1  1  1  2  6  12  .........  .........  1  1  1  1  .........  .........  .........  .........  .........  4  4  ......... .........  ......... –293  ......... –377  ......... –432  ......... –482  ......... –554  ......... –592  ......... –615  ......... –634  ......... –435  ......... –615  ......... –2,138  ......... –5,029  .........  .........  .........  –123  .........  .........  .........  .........  .........  .........  .........  –123  –123  ......... .........  –178 –178  –178 –178  –178 –301  –178 –178  –178 –178  –178 –178  –178 –178  –178 –178  –178 –178  –178 –178  –890 –1,013  –1,780 –1,903  .........  5  4  4  4  4  3  2  1  1  1  21  29  .........  .........  –2,121  –4,400  –6,687  –8,627  –10,191  –11,505  –11,699  –11,762  –11,819  –21,835  –78,811  .........  33  90  92  93  95  98  100  102  104  106  403  913  .........  –1,308  –2,074  –2,910  –3,815  –4,789  –5,832  –6,949  –8,140  –9,409  –10,757  –14,896  –55,983  .........  –194  –601  –1,045  –1,529  –1,900  –2,141  –2,391  –2,650  –2,918  –3,196  –5,269  –18,565  –1,624 –1,624 –39,384 –119,227  MID-SESSION REVIEW  Repeal exclusion of utility conservation subsidies 1 ��������������� Repeal accelerated depreciation for renewable energy property 1 �������� Repeal energy investment credit 1 ���� Repeal credit for residential energy efficient property 1 ������������������������ Total, Treasury������������������������������ Veterans Affairs: Cap Post–9/11 GI Bill flight training programs at public schools ���������� Enhance burial benefits for veterans ���������������������������������������� Reinstate COLA round-down ���������� Standardize and enhance VA Compensation and Pension benefit programs �������������������������� Standardize and improve veteran vocational rehabilitation and education benefit programs ��������� Standardize and improve Specially Adapted Housing programs ��������� Expand the assets included in the Veterans Housing Benefit Program Fund to offset the cost for the maintenance and enhancement of the VA automated underwriting system 3 ������������������� Total, Veterans Affairs������������������ Corps of Engineers: Divest Washington Aqueduct ���������� Reform inland waterways financing 1 ������������������������������������� Total, Corps of Engineers������������� Environmental Protection Agency: Expand use of pesticide licensing fees ������������������������������������������������ General Services Administration (GSA) 8 : Increase employee contributions to 50 percent of cost, phased in at one percent per year 1 ������������������� Implement defined contribution system for term employees 1 �������� Eliminate Federal Employees Retirement System COLA, Reduce Civil Service Retirement System COLA by 0.5 percent ������ Eliminate the Special Retirement Supplement ����������������������������������  2020  40  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  ......... .........  –359 –1,169  –429 –1,598  –502 –2,793  –575 –2,451  –650 –2,270  –729 –1,613  –810 –1,359  –894 –1,340  –980 –1,397  –1,068 –1,421  –2,515 –10,281  –6,996 –17,411  .........  .........  8,630  10,742  13,050  15,037  16,662  18,219  18,655  18,958  19,253  47,459  139,206  ......... .........  ......... .........  –6,441 1,646  –7,668 1,989  –8,908 2,212  –9,816 2,412  –10,400 2,590  –10,873 2,595  –10,646 2,602  –10,346 2,608  –10,046 2,617  –32,833 8,259  –85,144 21,271  .........  .........  .........  –166  –260  –276  –292  –310  –328  –348  –368  –702  –2,348  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –166  –260  –276  –292  –310  –328  –348  –368  –702  –2,348  .........  –2,997  –2,898  –6,661  –8,870  –10,784  –11,848  –13,283  –14,338  –15,490  –16,699  .........  –23  –508  –515  –527  –539  –552  –566  –579  –593  –607  –2,112  –5,009  .........  .........  –17  –41  –50  –50  –50  –50  –50  –50  –50  –158  –408  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –50  –150  –300  –450  –500  –500  –500  –500  –500  –500  –1,450  –3,950  .........  –300  –300  .........  .........  .........  .........  .........  .........  .........  –6,000  –600  –6,600  .........  –350  –450  –300  –450  –500  –500  –500  –500  –500  –6,500  –2,050  –10,550  .........  –4,157  –7,837  –8,384  –9,023  –9,698  –10,388  –11,153  –11,991  –12,802  –12,794  –39,099  –98,227  ......... .........  229 –4,301  –4,743 –13,555  –124 –9,364  –124 –10,174  –124 –10,911  –124 –11,614  –124 –12,393  –124 –13,244  –124 –14,069  –124 –20,075  –4,886 –5,506 –48,305 –119,700  .........  25  37  39  36  33  32  29  28  27  27  170  313  .........  –128  –145  –220  –293  –348  –367  –379  –398  –401  –404  –1,134  –3,083  .........  .........  .........  .........  .........  .........  .........  .........  10,016  –25,932  –34,280  .........  –50,196  –32,210 –103,868  41  Change retirement calculation from high-three years to high-five years ��������������������������������������������� Reduce the G Fund interest rate ����� Loss of mandatory offsetting receipts from GSA proposals ������� Discretionary effect of GSA proposals ��������������������������������������� Postal effect of GSA proposals ��������� Federal Employees Health Benefits (FEHB) Program: Modify the Government contribution to FEHB premiums ���������������������������������� Provide tax preemption for Federal Employees Dental/ Vision Program ������������������������ Total, Federal Employees Health Benefits (FEHB) Program��������������������������������� Total, General Services Administration�������������������������� Other Independent Agencies: Restructure the Consumer Financial Protection Bureau ������� Eliminate the Securities and Exchange Commission Reserve Fund ���������������������������������������������� Mandatory effects of agency eliminations ���������������������������������� Federal Communications Commission: Enact Spectrum License User Fee ��� Conduct spectrum auctions below six gigahertz ����������������������������� Total, Federal Communications Commission��������������������������� Postal Service: Reform the Postal Service ������������ Tennessee Valley Authority: Divest Tennessee Valley Authority transmission assets ������������������� Total, other independent agencies Cross-cutting reforms: Authorize additional Afghan Special Immigrant Visas �������������������������� Eliminate allocations to the Housing Trust Fund and Capital Magnet Fund 1 ������������������������������ Extend Joint Committee mandatory sequestration ��������������������������������  2020  SUMMARY TABLES  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  –203  2026  –236  2027  –237  2028  –253  2029  –277  –303  –692  2020– 2029  .........  –76  –109  –134  –170  –1,998  .........  1,790  –65,715  –91,536  –88,826  –99,336 –110,032 –126,622 –141,822 –156,702 –173,363 –343,623 –1,052,164  ......... .........  ......... 12,101  146,000 –21,840  157,000 –48,712  168,000 –55,639  179,000 –56,400  190,000 –59,250  190,000 –62,080  210,000 –65,221  220,000 –68,273  .........  13,891  58,445  16,752  23,535  23,264  20,718  1,298  2,957  –4,975  –15,230  135,887  .........  .........  –700  –5,300  –15,940  –22,980  –30,460  –36,140  –40,500  –47,300  –54,000  –44,920 –253,320  ......... ......... .........  ......... 1,000 –10,000  –23,240 750 –21,000  –31,417 250 –5,000  –39,529 ......... .........  –47,574 ......... –750  –55,551 ......... –750  –52,459 ......... –750  –69,296 ......... –750  –76,060 ......... –750  –82,749 –141,760 –477,875 ......... 2,000 2,000 –750 –36,750 –40,500  .........  –9,000  –44,190  –41,467  –55,469  –71,304  –86,761  –89,349 –110,546 –124,110 –137,499 –221,430 –769,695  .........  4,891  14,255  –24,715  –31,934  –48,040  –66,043  –88,051 –107,589 –129,085 –152,729  ......... ......... .........  –17,401 –1,099 .........  –19,734 –1,447 .........  –21,348 –1,519 .........  –21,934 –1,552 .........  –22,533 –1,613 .........  –23,095 –1,609 .........  –23,659 –1,601 .........  –23,504 –1,620 .........  –23,364 –1,624 .........  ......... .........  –545 4  –608 5  –608 7  –608 8  –608 9  –608 10  –608 11  –608 13  –608 14  –608 15  –2,977 33  –6,017 96  .........  –24  –40  –58  –66  –76  –77  –79  –81  –84  –86  –264  –671  ......... .........  35 –1,360  –42 –1,632  –52 –1,700  –63 –1,700  –74 –1,700  –150 –1,700  –163 –1,700  –177 –1,700  –242 –1,700  –257 –1,700  –196 –8,092  –1,185 –16,592  .........  17  21  22  22  22  22  22  22  22  22  104  214  .........  –1,736  –6,525  –6,625  –6,823  –6,944  –7,064  –7,295  –7,454  –7,641  –7,973  –28,653  –66,080  ......... .........  22 –22,087  41 –29,961  60 –31,821  79 –32,637  98 –33,419  78 –34,193  59 –35,013  40 –35,069  21 –35,206  230,000 650,000 1,690,000 –71,867 –170,490 –497,181  140,655  –85,543 –629,040  –23,209 –102,950 –219,781 –1,600 –7,230 –15,284 ......... ......... .........  2 300 500 –35,394 –149,925 –324,800  MID-SESSION REVIEW  Improve clarity in worker classification and information reporting requirements 1 �������������� Empowering States and consumers to reform healthcare: Proposal modeled after the Graham-Cassidy-HellerJohnson bill: Medicaid reforms ��������������������� Market-based healthcare grant programs ������������������������������� Other ����������������������������������������� Total, proposal modeled after the GrahamCassidy-Heller-Johnson bill ������������������������������������� Additional deficit reduction: Medicaid reforms ��������������������� Market-based healthcare grant programs ������������������������������� State implementation �������������� Other ����������������������������������������� Total, additional deficit reduction ��������������������������� Total, empowering States and consumers to reform healthcare������������������������������ Reform welfare programs: Reform the Supplemental Nutrition Assistance Program ��� Reduce TANF block grant ������������ Strengthen TANF ������������������������� Eliminate the TANF Contingency Fund ������������������������������������������ Get noncustodial parents to work ��� Strengthen Child Support enforcement and establishment ��������������������������������������������������� Establish a Child Support technology fund ������������������������ Eliminate SSBG ��������������������������� Shift SSBG expenditures to Foster Care and Permanency �������������� Require Social Security Number for Child Tax Credit, Earned Income Tax Credit, and credit for other dependents 1 �������������� Promote Opportunity and Economic Mobility Demonstrations ������������������������ Total, reform welfare programs���  2020  42  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  –5  –26  –8  –39  –158  –292  –432  –580  –742  –839  –236  –3,121  .........  100  100  100  100  100  –2,480  –5,073  –9,094  –13,636  –17,769  500  –47,552  .........  –316  –568  –741  –940  –1,044  –1,133  –1,214  –1,285  –1,352  –1,409  –3,609  –10,002  .........  –784  –800  –865  –821  –782  –867  –888  –907  –997  –885  –4,052  –8,596  .........  .........  –76  –200  –240  –265  –280  –295  –305  –314  –325  –781  –2,300  .........  .........  .........  –21  –22  –23  –25  –26  –28  –30  –32  –66  –207  .........  .........  3  15  25  28  21  24  22  21  22  71  181  .........  .........  –382  –98  –69  –46  –34  –23  –11  2  13  –595  –648  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –1  –5  –11  –18  –27  –35  –43  –41  –17  –181  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –2  –3  –4  –5  –5  –6  –6  –7  –8  –14  –46  .........  .........  .........  –1  –2  –2  –1  –1  –1  .........  –2  –5  –10  .........  –36  –34  –33  –32  –30  –28  –27  –26  –26  –24  –165  –296  .........  –12  –77  –100  –110  –135  –161  –181  –237  –254  –251  –434  –1,518  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  –4  –12  –20  –24  –29  –32  –34  –37  –39  –43  –89  –274  43  Reform Federal disability programs and improve payment integrity: Improve Supplemental Security Income (SSI) youth transition to work �������������������������������������� Test new approaches to increase labor force participation ���������� Reduce 12 month retroactive Disability Insurance (DI) benefits to six months �������������� Create a family maximum benefit structure for SSI disabled children in multirecipient families ������������������������������������� Offset overlapping unemployment and disability payments 1, 6 ������������������������������ Eliminate Workers Compensation reverse offsets ��������������������������� Change the representative fee and approval process ��������������� Simplify administration of the SSI program ����������������������������� Allow State hearing officers to hold disability hearings ����������� Provide additional debt collection authority for civil monetary penalties (CMPs) and assessments ������������������������������ Eliminate travel reimbursement for claimants’ representatives ��� Allow Government-wide use of CBP entry/exit data to prevent improper payments ������������������ Modernize the Commissioner’s collection of evidence to determine entitlement or eligibility ����������������������������������� Authorize Social Security Administration (SSA) to use all collection tools to recover funds in certain scenarios ������������������ Hold fraud facilitators liable for overpayments ��������������������������� Expand mandatory electronic filing of W–2s 1 �������������������������� Increase overpayment collection threshold for Old Age, Survivors, and Disability Insurance ���������������������������������� Use death master file to prevent improper payments ������������������ Exclude SSA debts from discharge in bankruptcy ����������  2020  SUMMARY TABLES  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals  Improve collection of pension information from States and localities ������������������������������������ Total, reform Federal disability programs and improve payment integrity ���������������� Support major investment in infrastructure: Implement an infrastructure initiative ����������������������������������� Establish a Federal Capital Revolving Fund 9 ���������������������� Total, support major investment in infrastructure �������������������� Total, cross-cutting reforms���������� Total, mandatory and receipt proposals ����������������������������������������  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  .........  18  28  24  –474  –1,135  –1,614  –1,735  –1,645  –1,547  –1,429  –1,539  –9,509  .........  –1,039  –1,846  –1,952  –2,657  –3,537  –6,949  –9,938  –14,175  –18,964  –23,022  –11,031  –84,079  .........  4,750  23,750  38,000  47,500  38,000  19,000  9,500  4,750  4,750  .........  152,000  190,000  .........  269  2,046  2,167  2,001  1,834  267  201  134  67  1  8,317  8,987  ......... .........  5,019 –13,395  25,796 8,027  40,167 –18,636  49,501 –18,154  39,834 –45,680  –5,903  –48,586  19,267 9,701 4,884 4,817 1 –88,489 –123,888 –142,556 –205,021 –246,104  44  2019  2020– 2024  160,317 198,987 –87,838 –893,896  –57,585 –100,073 –120,998 –165,063 –219,704 –277,831 –305,606 –383,275 –437,636 –492,305 –2,116,357  Note: For receipt effects, positive figures indicate lower receipts. For outlay effects, positive figures indicate higher outlays. For net costs, positive figures indicate higher deficits. 1 The estimates for this proposal include effects on receipts. The receipt effects included in the totals above are as follows: 2019  2021  2022  2023  2024  2025  2026  2027  2028  2020– 2024  2029  2020– 2029  .........  860  4,884  4,962  5,019  4,960  4,987  4,971  4,948  4,944  4,974  20,685  45,509  .........  .........  918  1,126  1,339  1,540  1,596  1,679  1,745  1,800  1,856  4,923  13,599  .........  24  32  32  32  32  32  35  35  35  36  152  325  .........  –47  20  .........  .........  .........  .........  .........  .........  .........  .........  –27  –27  .........  .........  –38  .........  .........  .........  .........  .........  .........  .........  .........  –38  –38  ......... .........  ......... –18  2,024 –67  2,874 –96  2,795 –119  2,714 –136  2,776 –187  2,898 –149  3,026 –33  3,089 .........  3,170 .........  10,407 –436  25,366 –805  .........  –34  –38  –42  –47  –52  –58  –64  –72  –79  –88  –213  –574  .........  .........  .........  .........  .........  .........  1  .........  .........  –209  –216  .........  –424  .........  –466  –471  –479  –486  –494  –508  –523  –538  –554  –570  –2,396  –5,089  .........  –13  –14  –15  –15  –15  –15  –15  –15  –15  –15  –72  –147  MID-SESSION REVIEW  Establish Education Freedom Scholarships�������������������������������������� Give Medicare beneficiaries with high deductible health plans the option to make tax deductible contributions to Health Savings Accounts or Medical Savings Accounts ������������������������������������������� Provide tax exemption for certain Health Resources and Services Administration (HRSA) and Indian Health Services (IHS) scholarship and loan repayment programs �������� Reduce the grace period for Exchange premiums������������������������������������������� Introduce new minimum required contribution for premium tax credits������������������������������������������������ Improve and expand access to Health Savings Accounts������������������������������ Reform medical liability����������������������� Establish Electronic Visa Update System user fee��������������������������������� Make full Electronic System for Travel Authorization (ESTA) receipts available to CBP ������������������������������� Establish an immigration services surcharge������������������������������������������� Increase worksite enforcement penalties��������������������������������������������  2020  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars) Totals 2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  ......... .........  –400 .........  –543 .........  –548 –535  –555 –799  –561 –881  –571 –962  –561 –1,037  –552 –1,109  –559 –1,174  –563 –1,235  –2,607 –2,215  –5,413 –7,732  ......... .........  ......... .........  ......... .........  –526 6  –917 16  –1,409 33  –779 49  –1,001 87  –1,312 108  –1,661 135  –375 61  –2,852 55  –7,980 495  .........  .........  51  51  51  51  51  51  51  51  51  204  459  .........  –160  –818  –1,895  –3,166  –4,558  –5,899  –6,880  –7,510  –7,942  –8,241  –10,597  –47,069  .........  –19  –19  –21  –24  –26  –29  –32  –35  –39  –43  –109  –287  .........  –410  –620  –652  –685  –720  –757  –795  –834  –875  –918  –3,087  –7,266  .........  –62  –379  –386  –381  –319  –234  –207  –221  –208  –156  –1,527  –2,553  .........  –2  –7  –7  –6  –6  –5  –5  –5  –4  –4  –28  –51  ......... 70  –171 71  –529 –259  –786 –1,176  –865 –1,540  –904 –1,532  –899 –1,489  –863 –1,433  –782 –1,447  –643 –1,474  –502 –1,469  –3,255 –4,436  –6,944 –11,748  328 .........  –709 –178  –686 –178  –195 –178  –34 –178  ......... –178  ......... –178  ......... –178  ......... –178  ......... –178  ......... –178  –1,624 –890  –1,624 –1,780  .........  .........  –2,121  –4,400  –6,687  –8,627  –10,191  –11,505  –11,699  –11,762  –11,819  –21,835  –78,811  .........  33  90  92  93  95  98  100  102  104  106  403  913  .........  –12  –11  –11  –11  –11  –10  –10  –10  –10  –9  –56  –105  .........  –64  –72  –65  –66  –66  –66  –66  –67  –68  –70  –333  –670  .........  –82  –119  –145  –185  –218  –249  –258  –276  –299  –324  –749  –2,155  .........  1,022  836  3,517  3,759  4,085  4,016  4,147  4,415  4,708  4,861  13,219  35,366  .........  –1,736  –3,522  –3,621  –3,725  –3,833  –3,951  –4,087  –4,236  –4,403  –4,586  –16,437  –37,700  .........  .........  .........  .........  2  6  10  13  18  21  24  8  94  398  –2,573  –1,656  –3,119  –7,385  –11,030  –13,421  –15,688  –16,483  –17,269  –16,242  –25,763 –104,866  45  Reauthorize the Oil Spill Liability Trust Fund excise tax����������������������� Provide paid parental leave benefits���� Establish an Unemployment Insurance (UI) solvency standard���� Improve UI program integrity�������������� Subject Financial Research Fund to appropriations����������������������������������� Implement tax enforcement program integrity cap adjustment������������������ Increase oversight of paid tax return preparers������������������������������������������� Provide more flexible authority for the Internal Revenue Service to address correctable errors ����������������������������� Repeal the qualified plug-in electric drive motor vehicle credit����������������� Repeal exclusion of utility conservation subsidies���������������������� Repeal accelerated depreciation for renewable energy property��������������� Repeal energy investment credit���������� Repeal credit for residential energy efficient property������������������������������� Reform inland waterways financing���� Increase employee contributions to 50 percent of cost, phased in at one percent per year ������������������������������� Implement defined contribution system for term employees��������������� Expand mandatory electronic filing of W–2s�������������������������������������������������� Eliminate allocations to the Housing Trust Fund and Capital Magnet Fund �������������������������������������������������� Improve clarity in worker classification and information reporting requirements �������������������� Empowering States and consumers to reform healthcare������������������������������ Require Social Security Number for Child Tax Credit, Earned Income Tax Credit, and credit for other dependents ��������������������������������������� Offset overlapping unemployment and disability payments��������������������������� Total receipt effects of mandatory proposals ���������������������������������������  2020  SUMMARY TABLES  2019  2020– 2024  Table S–6.  MANDATORY AND RECEIPT PROPOSALS—Continued (Deficit increases (+) or decreases (–) in millions of dollars)  46  2 The single income-driven repayment plan proposal has sizable interactive effects with the proposals to eliminate subsidized loans and Public Service Loan Forgiveness. These effects, $19.7 billion over 10 years, are included in the single income-driven repayment plan subtotal. 3 Estimates were not available at the time of MSR publication. 4 Fully fund CSR payments for qualified health plans that did not increase premium to account for non-payment of CSRs. 5 While this proposal increases outlays to provide means-tested assistance to low-income policyholders, the National Flood Insurance Program is also accelerating premium increases on other policyholders that currently do not pay full-risk premiums. 6 Net of income offsets. 7 The paid parental leave proposal consists of $28,223 million in benefit and program administration costs, offset by $7,732 million in savings associated with increased State revenues. 8 The President’s Budget proposes to transfer functions of the Office of Personnel Management to the GSA. For additional information on this reorganization proposal, please consult the “Reorganization” chapter of the Analytical Perspectives volume of the 2020 Budget. 9 The Federal Capital Revolving Fund is capitalized with $10 billion in mandatory funds in 2020. Agency repayments to the fund are reflected as offsetting collections, which reduce the total outlays estimated from the fund over the 10-year window. However, the initial $10 billion in capitalization funding is fully expended by 2024.  MID-SESSION REVIEW  Table S–7.  PROPOSED DISCRETIONARY FUNDING LEVELS IN THE 2020 MID-SESSION REVIEW (Net budget authority in billions of dollars) Totals  Defense: Current Law Funding Levels 1 ���������������������������������������������������������������������������� Proposed Base Changes 2 ���������������������������������������������������������������������������������� Defense Cap Adjustments: 3 Emergency Requirements ����������������������������������������������������������������������������� Overseas Contingency Operations levels �����������������������������������������������������  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  647 .........  576 .........  590 .........  605 +135  620 +138  635 +139  651 +91  667 +91  684 +90  701 +89  719 +88  6,448 +862  3 69  9 165  ......... 156  ......... 20  ......... 20  ......... 10  ......... 10  ......... 10  ......... 10  ......... 10  ......... 10  9 420  Total, Defense ��������������������������������������������������������������������������������������������������������  719  750  746  760  778  784  752  768  784  800  817  7,739  Non-Defense: Current Law Funding Levels 1 ���������������������������������������������������������������������������� Proposed Base Changes 2 ����������������������������������������������������������������������������������  613 .........  543 .........  556 –24  570 –49  584 –73  599 –98  613 –122  629 –148  644 –173  661 –199  677 –224  6,076 –1,110  Proposed Base Funding ��������������������������������������������������������������������������������������  613  543  532  521  511  501  491  481  471  462  453  4,966  Federal Employee Retirement Cost Share Reduction Proposal: 4 ������������������������������������������������������������������������������������  .........  .........  –6  –8  –9  –10  –10  –11  –11  –10  –10  –85  Non-Defense Cap Adjustments: Overseas Contingency Operations 5 �������������������������������������������������������������������� Emergency Requirements ����������������������������������������������������������������������������������� Program Integrity ������������������������������������������������������������������������������������������������ Disaster Relief 6 ���������������������������������������������������������������������������������������������������� Wildfire Suppression ��������������������������������������������������������������������������������������������  8 22 2 12 .........  ......... ......... 2 14 2  ......... ......... 3 7 2  ......... ......... 3 7 2  ......... ......... 4 7 2  ......... ......... 4 7 2  ......... ......... 5 7 2  ......... ......... 5 7 2  ......... ......... 5 7 2  ......... ......... 5 7 2  ......... ......... 5 7 2  ......... ......... 40 81 23  Total, Non-Defense Cap Adjustments ��������������������������������������������������������������  43  19  12  13  13  14  14  14  14  15  15  143  Total, Non-Defense with all Adjustments �������������������������������������������������������  657  562  538  526  515  505  495  484  475  466  458  5,024  Total, Discretionary Budget Authority �����������������������������������������������������������  1,376  1,312  1,284  1,286  1,293  1,289  1,247  1,252  1,259  1,266  1,275  12,763  47  Memorandum - Appropriations Counted Outside of Discretionary Caps: 21st Century Cures Appropriations 7 ������������������������������������������������������������������� 1 1 * 1 1 * * * ......... ......... ......... 4 Non-BBEDCA Emergency Funding 8 ������������������������������������������������������������������� ......... –5 ......... ......... ......... ......... ......... ......... ......... ......... ......... –5 * $500 million or less. 1 The current law funding levels presented here are equal to 2019 Enacted funding levels and the caps estimated for 2020 and 2021 in the Balanced Budget and Emergency Deficit Control Act of 1985 (BBEDCA) with separate categories of funding for “defense” (or Function 050) and “non-defense” (NDD) programs and include Office of Management and Budget (OMB) estimates of Joint Committee enforcement (also known as “sequestration”). For 2022 through 2029, programs are assumed to grow at current services growth rates. 2 Consistent with the 2020 Budget, the 2020 Mid-Session Review (MSR) proposes funding levels at the existing 2020 BBEDCA cap levels for defense and NDD programs. In 2021, the Administration proposes no change to the existing defense and NDD caps but would fund defense programs at the existing cap while beginning an annual two percent (or “2-penny”) decrease to NDD programs. After 2021, the 2020 MSR proposes defense caps through 2029 that resource national defense requirements while NDD caps are proposed that would continue the 2-penny decrease for each year. 3 The 2020 MSR holds the national defense base budget to the current law BBEDCA caps levels for national defense programs in 2020 and 2021. In order to fully resource national defense requirements, funding above the current law caps will also be necessary. The 2020 MSR increases Overseas Contingency Operations (OCO) amounts in 2020 and 2021 to nearly $165 billion and $156 billion, respectively. These amounts fund direct war costs, enduring in-theater support, and certain base budget requirements. In addition, more than $9 billion is requested in 2020 as an emergency requirement to address border security and hurricane recovery. After 2021, which is the final year of the discretionary caps in current law, outyear OCO amounts for 2022 and 2023 would be $20 billion in each year and $10 billion in 2024, consistent with the outyear OCO amounts included in OMB’s 2019 Mid-Session Review. 2025 through 2029 amounts reflect a notional $10 billion placeholder for OCO consistent with a potential transition of certain OCO costs into the base budget while continuing to fund contingency operations. The placeholder amounts for 2025 through 2029 do not reflect specific decisions or assumptions about OCO funding in any particular year.  SUMMARY TABLES  2019  Table S–7.  PROPOSED DISCRETIONARY FUNDING LEVELS IN THE 2020 MID-SESSION REVIEW—Continued (Net budget authority in billions of dollars)  48  4 This adjustment reflects savings from a reform proposed in the 2020 MSR that would reduce Federal agency costs through changes to current civilian employee retirement plans. After 2021, the Administration supports reductions to its proposed NDD caps for this reform. 5 The 2020 MSR continues the Administration’s policy to shift NDD OCO amounts into base discretionary funding. No NDD OCO amounts are proposed in 2020 or the outyears. 6 “Disaster Relief” appropriations are amounts designated as such by the Congress provided they are for activities carried out pursuant to a Presidential disaster declaration under the Robert T. Stafford Disaster Relief and Emergency Assistance Act. These amounts are held to a funding ceiling that is determined annually according to a statutory formula. The Administration is requesting more than $14 billion for Disaster Relief in 2020 to address significant and unprecedented recovery needs of recent hurricanes and wildfires. The 2020 MSR does not explicitly request disaster-designated appropriations in any year after 2020 and a placeholder of approximately $7 billion is included in each of the outyears. 7 The 21st Century Cures Act permitted funds to be appropriated each year and not counted towards the discretionary caps so long as the appropriations were specifically provided for the authorized purposes. These amounts are displayed outside of the discretionary totals for this reason and the levels included through the budget window reflect authorized levels. 8 The 2020 MSR includes permanent cancellations of balances of emergency funding in the Departments of Energy and Housing and Urban Development that were not designated pursuant to BBEDCA. These cancellations are not being re-designated as emergency, therefore no savings are being achieved under the caps nor will the caps be adjusted for these cancellations.  MID-SESSION REVIEW  Table S–8.  2020 DISCRETIONARY OVERVIEW BY MAJOR AGENCY (Net budget authority in billions of dollars)  Base, Overseas Contingency Operations (OCO), and Program Integrity Discretionary Funding: Cabinet Departments: Agriculture 2 ���������������������������������������������������������������������������������������������������������� Commerce ������������������������������������������������������������������������������������������������������������� Defense  3 ��������������������������������������������������������������������������������������������������������������� Education �������������������������������������������������������������������������������������������������������������� Education, excluding Pell Grant cancellations ����������������������������������������������� Pell Grant cancellations ����������������������������������������������������������������������������������� Energy ������������������������������������������������������������������������������������������������������������������ National Nuclear Security Administration ���������������������������������������������������� Other Energy ���������������������������������������������������������������������������������������������������� Health and Human Services (HHS): 4,5 ��������������������������������������������������������������� Homeland Security (DHS) ����������������������������������������������������������������������������������� Housing and Urban Development (HUD): HUD gross total (excluding receipts) ��������������������������������������������������������������� HUD receipts ���������������������������������������������������������������������������������������������������� Interior ������������������������������������������������������������������������������������������������������������������ Justice ������������������������������������������������������������������������������������������������������������������� Labor ��������������������������������������������������������������������������������������������������������������������� State and Other International Programs 2,6 �������������������������������������������������������� Transportation ����������������������������������������������������������������������������������������������������� Treasury 7 �������������������������������������������������������������������������������������������������������������� Veterans Affairs ��������������������������������������������������������������������������������������������������� Major Agencies: Corps of Engineers ����������������������������������������������������������������������������������������������� Environmental Protection Agency ���������������������������������������������������������������������� National Aeronautics and Space Administration ����������������������������������������������� National Science Foundation ������������������������������������������������������������������������������� Small Business Administration �������������������������������������������������������������������������� Social Security Administration (SSA) 4 ��������������������������������������������������������������� Other Agencies ��������������������������������������������������������������������������������������������������������� Changes in mandatory programs ����������������������������������������������������������������������������  2020 Request  Dollar  Percent  20.8 12.3 718.3 60.1 64.0 –3.9 31.7 16.5 15.2 89.6 51.7  –3.5 +0.8 +33.4 –10.3 –7.1 –3.3 –3.8 +1.3 –5.2 –12.4 +2.0  –14.4% +6.6% +4.9% –14.7% –10.0% N/A –10.8% +8.9% –25.4% –12.2% +4.1%  53.8 –9.1 14.0 30.7 12.1 56.0 26.5 12.8 86.6  44.1 –6.5 12.5 29.2 10.9 42.8 21.4 13.1 93.1  –9.7 +2.6 –1.6 –1.4 –1.2 –13.2 –5.1 +0.3 +6.5  –18.0% –28.2% –11.3% –4.7% –9.7% –23.6% –19.2% +2.3% +7.5%  7.0 8.8 21.5 8.1 0.7 10.5 21.4 .........  5.0 6.2 22.6 7.1 0.7 10.1 19.1 –20.0  –2.0 –2.7 +1.1 –1.0 –* –0.4 –2.2 –20.0  –29.1% –30.1% +5.2% –12.5% –0.3% –3.5% –10.5% N/A  Subtotal, Base, OCO, and Program Integrity Funding ������������������������������������  1,339.9  1,296.0  –43.9  –3.3%  Other Funding, including Cap Adjustments: Emergency Requirements: Agriculture ����������������������������������������������������������������������������������������������������������� Commerce ������������������������������������������������������������������������������������������������������������� Defense ����������������������������������������������������������������������������������������������������������������� Education �������������������������������������������������������������������������������������������������������������� HHS ����������������������������������������������������������������������������������������������������������������������  5.5 0.9 2.7 0.2 0.3  ......... ......... ......... ......... .........  –5.5 –0.9 –2.7 –0.2 –0.3  N/A N/A N/A N/A N/A  49  24.3 11.6 685.0 70.5 71.1 –0.6 35.5 15.1 20.4 102.0 49.6  SUMMARY TABLES  2019 Enacted 1  2020 Request less 2019 Enacted  Table S–8.  2020 DISCRETIONARY OVERVIEW BY MAJOR AGENCY—Continued (Net budget authority in billions of dollars)  2020 Request  Dollar  50  2019 Enacted 1  2020 Request less 2019 Enacted Percent  DHS ���������������������������������������������������������������������������������������������������������������������� HUD ���������������������������������������������������������������������������������������������������������������������� Interior ������������������������������������������������������������������������������������������������������������������ Transportation ����������������������������������������������������������������������������������������������������� Corps of Engineers ����������������������������������������������������������������������������������������������� Environmental Protection Agency ���������������������������������������������������������������������� Other Agencies ����������������������������������������������������������������������������������������������������� Subtotal, Emergency Requirements �����������������������������������������������������������������������  0.5 4.1 0.3 1.7 3.3 0.4 0.2 20.1  ......... ......... ......... ......... ......... ......... ......... .........  –0.5 –4.1 –0.3 –1.7 –3.3 –0.4 –0.2 –20.1  N/A N/A N/A N/A N/A N/A N/A N/A  Emergency Request: Allowance for Humanitarian and Border Supplemental Request 8 �������������������  4.5  .........  –4.5  N/A  Disaster Relief:  DHS ����������������������������������������������������������������������������������������������������������������������  12.0  14.1  +2.1  +17.3%  Wildfire Suppression: Agriculture ����������������������������������������������������������������������������������������������������������� Interior ������������������������������������������������������������������������������������������������������������������  ......... .........  2.0 0.3  +2.0 +0.3  N/A N/A  Subtotal, Wildfire Suppression ��������������������������������������������������������������������������������  .........  2.3  +2.3  N/A  Non-BBEDCA Emergency Appropriations: Energy and HUD 10 �����������������������������������������������������������������������������������������������  .........  –4.9  –4.9  N/A  Subtotal, Other Funding �����������������������������������������������������������������������������������������  36.6  11.5  –25.1  –68.7%  9  Total, Discretionary Budget Authority ���������������������������������������������������������������  MID-SESSION REVIEW  1,376.4 1,307.4 –69.0 –5.0% Defense Total ������������������������������������������������������������������������������������������������������������� 719.1 750.0 +30.9 +4.3% Non-Defense Total ���������������������������������������������������������������������������������������������������� 657.4 557.4 –99.9 –15.2% * $50 million or less. 1 The 2019 Enacted levels include changes that occur after appropriations are enacted that are part of budget execution such as transfers, reestimates, and the rebasing as mandatory any changes in mandatory programs enacted in appropriations bills. 2 Funding for Food for Peace Title II Grants is included in the State and Other International Programs total. Although the funds are appropriated to the Department of Agriculture, the funds are administered by the U.S. Agency for International Development (USAID). 3 The Department of Defense funding level in this presentation includes $9.2 billion requested in 2020 as an emergency requirement to address border security and hurricane recovery. 4 Funding from the Hospital Insurance and Supplementary Medical Insurance trust funds for administrative expenses incurred by SSA that support the Medicare program are included in the HHS total and not in the SSA total. 5 The total for HHS includes amounts authorized under the 21st Century Cures Act, which permitted funds to be appropriated each year for certain activities and not counted toward the discretionary caps so long as the appropriations were specifically provided for the authorized purposes. 6 The State and International Programs total includes funding for the Department of State, USAID, Treasury International, and 12 international agencies.  Table S–8.  2020 DISCRETIONARY OVERVIEW BY MAJOR AGENCY—Continued 7 The total for the Department of the Treasury includes $0.4 billion for a new cap adjustment related to program integrity in the Internal Revenue Service. See the “Budget Process” chapter of the Analytical Perspectives volume of the 2020 Budget for more information on this adjustment. 8 This allowance represents the Administration’s pending supplemental request that was transmitted to the Congress on May 1, 2019 to address to humanitarian and security crisis at the southern border of the United States. 9 “Disaster Relief ” appropriations are amounts designated as such by the Congress provided they are for activities carried out pursuant to a Presidential disaster declaration under the Robert T. Stafford Disaster Relief and Emergency Assistance Act. These amounts are held to a funding ceiling that is determined annually according to a statutory formula. the Administration is requesting $14.1 billion for Disaster Relief in 2020 to address significant and unprecedented recovery needs of recent hurricanes and wildfires. 10 The 2020 Mid-Session Review proposes to eliminate the Title 17 Innovative Technology Loan Guarantee Program and the Advanced Technology Vehicles Manufacturing Loan Program in the Department of Energy. This proposal includes a permanent cancellation of most of the remaining balances of emergency funding that were not designated pursuant to BBEDCA. This total also includes some smaller emergency cancellations in HUD. These cancellations are not being re-designated as emergency, therefore no savings are being achieved under the caps nor will the caps be adjusted for these cancellations.  SUMMARY TABLES  (Net budget authority in billions of dollars)  51  52  Table S–9. ESTIMATED SPENDING FROM 2020 BALANCES OF BUDGET AUTHORITY: DISCRETIONARY PROGRAMS (In billions of dollars) Total Outlays from end-of–2020 balances: 2021 ��������������������������������������������������������������������������������������� 727.6 2022 ��������������������������������������������������������������������������������������� 298.9 2023 ��������������������������������������������������������������������������������������� 135.3 2024 ��������������������������������������������������������������������������������������� 72.5 2025 ��������������������������������������������������������������������������������������� 34.7 2026 ��������������������������������������������������������������������������������������� 21.5 2027 ��������������������������������������������������������������������������������������� 10.6 2028 ��������������������������������������������������������������������������������������� 6.7 2029 ��������������������������������������������������������������������������������������� 3.5 Note: Required by 31 USC 1106(a)(3). Balances as of the end of 2020 include unspent balances of discretionary budget authority provided in 2020 and prior years, as well as unspent balances of mandatory contract authority that is subject to discretionary obligation limitations.  MID-SESSION REVIEW  Table S–10.  OUTLAYS FOR MANDATORY PROGRAMS UNDER CURRENT LAW 1 (In billions of dollars) Totals  Outlays: Human resources programs: Education, training, employment and social services ������������������������������������������������������������ 3 Health ������������������������������������������������������������������ 490 Medicare �������������������������������������������������������������� 582 Income security ��������������������������������������������������� 426 Social security ����������������������������������������������������� 982 Veterans’ benefits and services �������������������������� 101 Subtotal, human resources programs ������������ 2,583 Other mandatory programs: International affairs ������������������������������������������� –1 Energy ����������������������������������������������������������������� –3 Natural resources and environment ������������������ 3 Agriculture ���������������������������������������������������������� 16 Commerce and housing credit ���������������������������� –5 Transportation ���������������������������������������������������� 1 Justice ������������������������������������������������������������������ 5 General government ������������������������������������������� 7 Undistributed offsetting receipts ����������������������� –98 Other functions ��������������������������������������������������� 15 Subtotal, other mandatory programs ������������� –61 Total, outlays for mandatory programs under current law ������������������������������������������������������ 2,522 1 This table meets the requirements of 31 USC 1106(a)(2).  2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  2020– 2029  43 527 644 444 1,038 116 2,813  25 537 702 454 1,094 127 2,937  28 557 761 464 1,153 132 3,095  29 586 859 487 1,219 150 3,329  30 618 889 491 1,289 149 3,466  30 648 918 494 1,365 148 3,602  30 683 1,035 517 1,445 169 3,880  30 727 1,116 537 1,530 179 4,119  31 767 1,194 547 1,619 189 4,346  31 810 1,371 571 1,714 215 4,713  31 140 294 851 2,946 6,784 1,354 4,128 10,199 561 2,390 5,123 1,813 6,119 14,240 197 706 1,655 4,807 16,429 38,294  –3 –2 2 31 –29 1 9 8 –98 11 –69  –4 –1 4 25 –10 2 11 10 –110 9 –65  –5 –1 5 23 –6 2 7 8 –108 10 –65  –7 –3 5 21 –4 1 5 8 –112 9 –77  –9 –3 5 16 –6 1 3 8 –110 7 –88  –9 –5 5 16 –4 1 2 8 –113 9 –89  –8 –4 4 17 –1 1 2 8 –128 8 –101  –6 –4 4 18 1 2 2 8 –118 7 –88  –7 –4 3 18 1 2 2 8 –121 8 –90  –8 –2 3 19 1 3 6 8 –125 12 –81  –5 –1 3 19 1 4 6 8 –127 12 –80  2,744  2,872  3,030  3,252  3,378  3,513  3,779  4,031  4,256  4,632  4,727 16,045 37,470  –34 –14 23 101 –30 7 28 42 –552 44 –384  SUMMARY TABLES  2018  2020– 2024  –38 –17 23 93 –20 7 20 40 –571 43 –825  53  Table S–11.  FEDERAL GOVERNMENT FINANCING AND DEBT (In billions of dollars)  Financing: Unified budget deficit: Primary deficit/surplus (–) ����������������������������������������������� Net interest ���������������������������������������������������������������������� Unified budget deficit ��������������������������������������������������� As a percent of GDP ������������������������������������������������� Other transactions affecting borrowing from the public: Changes in financial assets and liabilities: 1 Change in Treasury operating cash balance �������������� Net disbursements of credit financing accounts: Direct loan and Troubled Asset Relief Program (TARP) equity purchase accounts ����������������������� Guaranteed loan accounts ��������������������������������������� Net purchases of non-Federal securities by the National Railroad Retirement Investment Trust (NRRIT) �������������������������������������������������������������������� Net change in other financial assets and liabilities 2 ���  Estimate 2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  454 325 779 3.8%  624 377 1,001 4.7%  624 421 1,045 4.7%  551 464 1,016 4.3%  454 513 966 3.9%  262 571 832 3.2%  23 620 643 2.4%  –64 662 598 2.1%  –156 697 541 1.8%  –241 729 489 1.6%  –259 756 497 1.5%  –555 773 218 0.6%  225  *  .........  .........  .........  .........  .........  .........  .........  .........  .........  .........  91 –9  46 24  67 2  68 *  66 –2  66 –3  65 –4  65 –3  61 –3  58 –3  58 –3  52 –3  * –2  –1 .........  –1 .........  –1 .........  –1 .........  –1 .........  –1 .........  –1 .........  –1 .........  –* .........  –* .........  –* .........  305 –*  69 –*  68 –*  67 –*  63 –*  62 –*  61 –*  61 –*  57 –*  54 –*  54 –*  49 –*  305  69  67  67  63  61  60  61  57  54  54  48  1,084  1,069  1,112  1,082  1,029  894  703  659  598  543  551  266  Changes in Debt Subject to Statutory Limitation: Change in debt held by the public ��������������������������������������� Change in debt held by Government accounts ������������������� Change in other factors ������������������������������������������������������� Total, change in debt subject to statutory limitation �����  1,084 172 10 1,266  1,069 166 2 1,238  1,112 108 3 1,224  1,082 149 2 1,233  1,029 117 2 1,149  894 150 2 1,046  703 196 2 902  659 134 2 794  598 128 2 728  543 24 2 569  551 –30 2 523  266 78 2 346  Debt Subject to Statutory Limitation, End of Year: Debt issued by Treasury ������������������������������������������������������ Adjustment for discount, premium, and coverage 3 ������������ Total, debt subject to statutory limitation 4 ��������������������  21,438 37 21,475  22,674 39 22,713  23,896 40 23,936  25,129 41 25,170  26,276 42 26,319  27,320 44 27,364  28,221 45 28,266  29,015 45 29,060  29,743 45 29,788  30,311 46 30,357  30,833 47 30,880  31,178 47 31,226  Debt Outstanding, End of Year: Gross Federal debt: 5 Debt issued by Treasury �������������������������������������������������� Debt issued by other agencies ����������������������������������������� Total, gross Federal debt ���������������������������������������������� As a percent of GDP �������������������������������������������������  21,438 24 21,462 106.1%  22,674 23,896 25,129 26,276 24 22 21 20 22,698 23,919 25,150 26,296 107.0% 107.2% 107.2% 106.7%  27,320 19 27,340 105.6%  28,221 18 28,239 103.7%  29,015 16 29,031 101.5%  29,743 15 29,758 99.2%  30,311 13 30,324 96.3%  30,833 12 30,845 93.4%  31,178 11 31,189 90.1%  MID-SESSION REVIEW  Subtotal, changes in financial assets and liabilities ��� Seigniorage on coins ��������������������������������������������������������� Total, other transactions affecting borrowing from the public ������������������������������������������������������������������ Total, requirement to borrow from the public (equals change in debt held by the public) �����  54  Actual 2018  Table S–11.  FEDERAL GOVERNMENT FINANCING AND DEBT—Continued (In billions of dollars)  Held by: Debt held by Government accounts �������������������������������� Debt held by the public 6 �������������������������������������������������� As a percent of GDP ����������������������������������������������������� Debt Held by the Public Net of Financial Assets: Debt held by the public �������������������������������������������������������� Less financial assets net of liabilities: Treasury operating cash balance ������������������������������������ Credit financing account balances: Direct loan and TARP equity purchase accounts ������� Guaranteed loan accounts ������������������������������������������� Government-sponsored enterprise preferred stock �������� Non-Federal securities held by NRRIT ��������������������������� Other assets net of liabilities ������������������������������������������ Total, financial assets net of liabilities ����������������������� Debt held by the public net of financial assets ������� As a percent of GDP ���������������������������������������������  Estimate 2019  2020  2021  2022  2023  2024  2025  2026  2027  2028  2029  5,713 15,750 77.8%  5,879 16,819 79.3%  5,988 17,931 80.4%  6,136 19,013 81.1%  6,253 20,043 81.3%  6,403 20,937 80.8%  6,599 21,640 79.5%  6,733 22,298 78.0%  6,861 22,896 76.3%  6,885 23,439 74.5%  6,855 23,990 72.7%  6,933 24,256 70.0%  15,750  16,819  17,931  19,013  20,043  20,937  21,640  22,298  22,896  23,439  23,990  24,256  385  385  385  385  385  385  385  385  385  385  385  385  1,372 5 113 26 –60 1,840 13,910 68.7%  1,418 29 113 24 –60 1,909 14,910 70.3%  1,485 30 113 23 –60 1,977 15,955 71.5%  1,553 30 113 22 –60 2,043 16,970 72.4%  1,619 29 113 21 –60 2,107 17,936 72.8%  1,685 25 113 20 –60 2,168 18,768 72.5%  1,750 22 113 19 –60 2,229 19,411 71.3%  1,815 18 113 19 –60 2,290 20,008 70.0%  1,876 15 113 18 –60 2,347 20,549 68.5%  1,934 12 113 18 –60 2,402 21,037 66.8%  1,992 9 113 17 –60 2,456 21,534 65.2%  2,044 6 113 17 –60 2,505 21,751 62.8%  SUMMARY TABLES  Actual 2018  * $500 million or less. 1 A decrease in the Treasury operating cash balance (which is an asset) is a means of financing a deficit and therefore has a negative sign; that is, the reduction in cash balances reduces the amount that would otherwise be borrowed from the public. An increase in checks outstanding (which is a liability) is also a means of financing a deficit and therefore also has a negative sign. 2 Includes checks outstanding, accrued interest payable on Treasury debt, uninvested deposit fund balances, allocations of special drawing rights, and other liability accounts; and, as an offset, cash and monetary assets (other than the Treasury operating cash balance), other asset accounts, and profit on sale of gold. 3 Consists mainly of debt issued by the Federal Financing Bank (which is not subject to limit), the unamortized discount (less premium) on public issues of Treasury notes and bonds (other than zero-coupon bonds), and the unrealized discount on Government account series securities. 4 The statutory debt limit is approximately $21,988 billion, as increased effective March 2, 2019. 5 Treasury securities held by the public and zero-coupon bonds held by Government accounts are almost all measured at sales price plus amortized discount or less amortized premium. Agency debt securities are almost all measured at face value. Treasury securities in the Government account series are otherwise measured at face value less unrealized discount (if any). 6 At the end of 2018, the Federal Reserve Banks held $2,313.2 billion of Federal securities and the rest of the public held $13,436.4 billion. Debt held by the Federal Reserve Banks is not estimated for future years.  55  EXECUTIVE OFFICE OF THE PRESIDENT OFFICE OF MANAGEMENT AND BUDGET WASHINGTON, D.C.