As the Republican-controlled Congress has battled with itself to pass a bill repealing and replacing Obamacare, the Congressional Budget Office’s analyses of the effects of various pieces of legislation have made it harder to get to “yes.” Time and again, the CBO has said GOP proposals would result in large declines in the number of Americans with health insurance.
The Trump administration and members of Congress have been angry and dismissive of the CBO, an agency created to deliver non-partisan analysis of the effects, fiscal and otherwise, of proposed legislation.
Now, according to a report from the Independent Journal Review, GOP leaders are considering a plan that would let them bypass the CBO entirely on a key element of their most recent legislative proposal. The idea is to substitute a “budget score” produced instead by the Department of Health and Human Services.
Despite the fact that the CBO is now run by Keith Hall, a respected economist who also happens to be a conservative Republican, White House Office of Management and Budget Director Mick Mulvaney has tarred CBO as a partisan operation that is operating in the service of a left-wing political agenda.
“At some point, you've got to ask yourself, has the day of the CBO come and gone?” Mulvaney said in an interview The Washington Examiner last month. He added, “We always talk about it as the nonpartisan Congressional Budget Office. Given the authority that that has, is it really feasible to think of that as a nonpartisan organization?”
HHS Secretary Tom Price has gone after CBO for describing huge reductions in proposed spending on Medicaid as “cuts,” insisting that spending hundreds of millions of dollars as cuts is unfair, because the actual dollar amount being spent will still rise.
“There are no cuts to the Medicaid program,” he insisted last month to incredulous interviewers. He added, “I know that the media loves to talk about the cuts that the CBO talks about, but again, what the Congressional Budget Office measures is spending as if nothing changes at all as if the program is doing just fine thank you very much.”
Now, with the Senate running low on time to pass a health care bill using a 2017 budget reconciliation measure — an impossibility after the end of September — Republicans may ask Price’s agency to provide a vital assessment of a key provision of the latest iteration of its bill, the Better Care Reconciliation Act.
Released on Thursday, the most recent version of the bill includes a proposal championed by Texas Sen. Ted Cruz, called the Consumer Freedom Option. It would allow insurance companies to offer bare-bones health insurance policies that do not adhere to the minimum requirements that became law under the Affordable Care Act.
That means that healthy Americans would have the option of selecting insurance policies that do not cover many things that policies are currently required to cover, such as prescriptions drugs, hospital stays, mental health and addiction treatment, and more. Insurers could only offer those plans, though, if they also provided at least one policy option that is fully compliant with ACA requirements.
For many Americans, at least, the bill would likely achieve one of the GOP’s overriding goals in restructuring the health insurance market: It would lower premiums. However, there are a couple of trade-offs.
First, the plan would likely concentrate people with pre-existing conditions in the ACA-compliant health plans, creating a risk pool made up of people who are, on average, much more expensive to cover than those who believe they can get away with a bare-bones policy. Experts warn that this could ultimately price many people out of the market as premiums for ACA-compliant plans spike.
In addition, the people who purchase bare-bones policies might technically have insurance coverage, but wouldn’t have substantial protection from huge financial losses in the event that they need expensive medical treatment for an unexpected illness or injury.
Republicans are insisting that the reason they may consider bypassing the CBO in this case is that it could take weeks for the agency to score the Cruz provisions. But Republican leaders, including Senate Majority Leader Mitch McConnell, are demanding a vote on passage of the BCRA next week. McConnell has already cut the Senate’s August recess nearly in half to create time for other legislative priorities, and the idea of waiting weeks for a CBO score is understandably not appealing.
There’s also another likely explanation for wanting to hand the budget scoring duties over to a much more GOP-friendly HHS. The CBO has warned that when it assesses coverage levels, people with that type of skimpy “insurance” allowed under the Cruz plan won’t be counted as having coverage because they won’t be protected from financial disaster if they need expensive treatment.
A finding in line with CBO’s previous statements would likely say that the new GOP bill produces far more Americans counted as not having coverage than many GOP lawmakers can stomach, given the fact that the GOP health plan is already extraordinarily unpopular with the public.
Facing what is likely their last shot at repealing and replacing the Affordable Care Act, GOP leaders in the Senate may view a route that skirts the CBO as the most promising path forward.