CBO Score Casts Even More Doubt On Senate Health Care Reform Bill
Once again, a bad CBO score is casting doubt on a Republican health care reform bill.
Late yesterday, the Congressional Budget Office released its score for the Better Care Reconciliation Act, the Senate’s version of the “replace” part of the Republican plan to repeal and replace the Affordable Care Act, and it seems likely to make an already difficult road to passage even harder for Mitch McConnell and the Senate GOP leadership team to navigate:
WASHINGTON — The Senate bill to repeal the Affordable Care Act was edging toward collapse on Monday after the nonpartisan Congressional Budget Office said it would increase the number of people without health insurance by 22 million by 2026.
Two Republicans, Senators Susan Collins of Maine and Rand Paul of Kentucky, said Monday that they would vote against even debating the health care bill, joining Senator Dean Heller of Nevada, who made the same pledge on Friday. Senator Ron Johnson of Wisconsin hinted that he, too, would probably oppose taking up the bill on a procedural vote expected as early as Tuesday, meaning a collapse could be imminent.
“It’s worse to pass a bad bill than pass no bill,” Mr. Paul told reporters.
Ms. Collins wrote on Twitter on Monday evening that she wanted to work with her colleagues from both parties to fix flaws in the Affordable Care Act, but that the budget office’s report showed that the “Senate bill won’t do it.”
The report left Senator Mitch McConnell of Kentucky, the majority leader, with the unenviable choices of changing senators’ stated positions, withdrawing the bill from consideration while he renegotiates, or letting it go down to defeat — a remarkable conclusion to the Republicans’ seven-year push to repeal President Barack Obama’s signature domestic achievement.
But the budget office put Republicans in an untenable position. It found that next year, 15 million more people would be uninsured compared with current law. Premiums and out-of-pocket expenses could shoot skyward for some low-income people and for people nearing retirement, it said.
The legislation would decrease federal deficits by a total of $321 billion over a decade, the budget office said.
Mr. McConnell, the chief author of the bill, wanted the Senate to approve it before a planned recess for the Fourth of July, but that looks increasingly doubtful. Misgivings in the Republican conference extend beyond just a few of the most moderate and conservative members, and Mr. McConnell can lose only two Republicans.
At least some of Ms. Collins’s concerns could be shared by Senators Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia, whose rural states would face effects similar to those in Maine.
“If you were on the fence, you were looking at this as a political vote, this C.B.O. score didn’t help you,” said Senator Lindsey Graham, Republican of South Carolina. “So I think it’s going to be harder to get to 50, not easier.”
He added, “I don’t know, if you delayed it for six weeks, if anything changes.”
Under the bill, the budget office said, subsidies to help people buy health insurance would be “substantially smaller than under current law.” And deductibles would, in many cases, be higher. Starting in 2020, the budget office said, premiums and deductibles would be so onerous that “few low-income people would purchase any plan.”
The budget office report was a major setback to Senate Republican leaders, but it was too early to declare the legislation dead, and turmoil in health insurance markets could still induce Congress to take action this year. Many people thought the House repeal bill was dead after Speaker Paul D. Ryan pulled it from the floor on March 24, but a slightly revised version was narrowly approved by the House six weeks later.
Senator John Thune of South Dakota, a member of the Republican leadership, suggested that leaders would press forward with the Senate bill. He said that an argument could be made for delaying it “if you thought you were going to get a better policy,” but that that was not the case.
“This is the best we can do to try and satisfy all the different perspectives in our conference,” Mr. Thune said, adding that he did not think the politics would improve by waiting. “It’s time to fish or cut bait.”
In addition to the impact on the private insurance market, the CBO also projected that the bill would result in some 4,000,000 people losing employer-provided health insurance due to increased costs:
Rour million people would lose employer-provided insurance coverage in 2018 if the Senate’s plan to repeal ObamaCare became law, the Congressional Budget Office (CBO) projected on Monday.
The nonpartisan budget analyst attributed the drop to the GOP’s plan to repeal ObamaCare’s two central mandates: the requirement to have health insurance and the requirement that most large employers provide it.
“Under current law, the prospect of paying the employer mandate penalty tips the scale for some businesses and causes them to decide to offer health insurance to their employees. Thus, eliminating that penalty would cause some employers to not offer health insurance,” the CBO wrote.
“Similarly, the demand for insurance among employees is greater under current law because some employees want employment-based coverage so that they can avoid paying the individual mandate penalty. Eliminating that penalty would reduce such demand and would cause some employers to not offer coverage or some employees to not enroll in coverage they were offered.”The number of people losing employer-provided coverage under the Senate’s legislation is an increase from the bill passed by the House last month. The CBO in May assessed that 2 million people would lose employer-provided coverage in 2018 under the House legislation.
Effectively, that means that some 26,000,000 people are projected to lose coverage under the Senate bill if it is enacted into law in its current form. The report also finds that health insurance premiums will rise under the plan, at least in the short-term, and the end of Federal subsidies will mean that we’ll see a return of the high deductible plans that many Americans have complained about since the Affordable Care Act went into effect. This will have the combined impact of pricing many low-income people out of the insurance market at the same time that it purports to cut Federal reimbursement to the states for Medicaid. The result of this will either be that the number of uninsured will most likely increase even more than the CBO is currently estimating. In other words, as FiveThirtyEight’s Percy Bacon puts it, this CBO score is bad news for a Senate Republican leadership already facing a tough week ahead.
Critics of the plan will have a field day pointing out the inequities. (“Premiums for a 64-year old with middle income go from $6,800 under ACA to $20,500 under BCRA.”) Older and poorer people will get hit the worst, according to the CBO. “CBO and JCT expect that this legislation would increase the number of uninsured people substantially. The increase would be disproportionately larger among older people with lower income — particularly people between 50 and 64 years old with income of less than 200 percent of the federal poverty level.” The notion that the bill doesn’t cut Medicaid is given the back of the hand. (“Enrollment in Medicaid would be lower throughout the coming decade, with 15 million fewer Medicaid enrollees by 2026 than projected under current law in CBO’s March 2016 baseline … Some of that decline would be among people who are currently eligible for Medicaid benefits, and some would be among people who CBO projects would, under current law, become eligible in the future as additional states adopted the ACA’s option to expand eligibility.”)
As we said, this is not a bill about providing cheaper, better health care to the masses. It’s not about helping older or rural Americans. It’s about taking hundreds of billions of dollars out of Medicaid and giving the money to rich people in the form of tax cuts. The CBO report makes clear what a total disgrace the bill really is.
All of this came on just the first day of what is clearly a crucial week for the Senate bill. Senate Majority Leader Mitch McConnell has set an end of the week deadline for a final Senate vote on the bill, and even after the release of the CBO report he and the other members of the leadership team appeared to remain committed to that team. Standing in the way of that, though, are a number of Senators who have already said that they are opposed to the bill and would vote against it, a number that increased to six late yesterday when Senator Susan Collins of Maine announced that she was opposed to the bill. Collins joins conservative Senators Rand Paul, Ted Cruz, and Mike Lee in opposition, although they oppose the bill for reasons completely opposite those that Collins cites as the basis for her decision. Also opposed to the bill is Nevada Senator Dean Heller, who likely would not survive re-election in 2018 if he voted for the bill, and Wisconsin Senator Ron Johnson, who has been among those arguing that more time is needed for the Senate to consider the bill. Late yesterday, Johnson said he would vote to block the bill later this week if it is brought up for a vote. Additionally, several other Republican Senators remain non-committal on the bill, including a mix of conservative and more moderate Republicans ranging from Alaska’s Lisa Murkowski to .Ohio Senator Rob Portman. If a roll call were taken this morning, in fact, it’s unclear if the Senate bill would manage to get 40 votes in favor it, never mind the 50 that it would need to pass the Senate with Vice-President Pence’s tie-breaking vote.
The next 48 to 72 hours will be crucial for the passage of this bill. If the Senate is even going to get to the point of debating the bill before they vote on it, they first need to get it to the floor. Since the bill is being presented under the Senate’s budget reconciliation procedures, McConnell only needs fifty (plus one) votes to get there, but right now it’s not even clear he can get there. As of this morning four Senators — Susan Collins, Rand Paul, Dean Heller, and Ron Johnson — have said they would vote against opening debate on the bill and a number of other Senators remain undecided on that issue. If he can’t win this vote and at least begin debate on the bill today, then it’s unlikely that McConnell will be able to get the vote before the end of the week that he’s aiming for. Even if he gets that vote, though, he still has to find a way to deal with the fact that there are at least six Republican Senators, and perhaps more after the release of the CBO score, who have said they would vote against the bill in a final vote if it stayed in its current form, and that’s not going to be easy given the fact that the objections to the bill from the right and the middle seem completely opposed to each other.
Stay tuned, it’s going to be a rocky road in the Senate this week. In the meantime, here’s the CBO report: