ENRICH Act 2026: Breaking Down the CBO Score and What $6.2B Over 10 Years Actually Means

The Congressional Budget Office score for the ENRICH Act was released in March, and the $6.2B net cost estimate is going to be the central battleground in the markup. I want to break down what that number actually means — and why the offset projections may be the more important story.

The CBO Methodology

The $6.2B is the net cost after projected offsets from reduced hospitalizations and ER utilization. The gross spending number is approximately $11.4B over 10 years. CBO used conservative utilization assumptions — specifically, they assumed only 35% uptake among eligible beneficiaries in year one, ramping to 60% by year five.

Why the Offsets May Be Understated

The CBO score was completed before the MANNA and Second Harvest readmission data was available. If the 31% readmission reduction figure from the JAMA study is applied to even a portion of the eligible Medicare population, the offset calculation shifts substantially.

The Political Reality

With 19 Senate co-sponsors and a June markup timeline, the math needs to work for moderate Democrats and deficit-hawk Republicans. Advocates should be prepared to present the ROI case clearly and quantitatively.