Sometimes, the saying goes, you can’t tell the players in a game without a scorecard. What happens when you get the scorecard before you know what teams will take the field in a few weeks for a game played almost two years ago?
That’s what happened this week when the Congressional Budget Office released its analysis of the effects a repeal of Obamacare will have on the economy, the budget, and Americans seeking health insurance coverage.
The report got a significant amount of media attention this week. As Rob Garver reported here on Tuesday, the CBO estimated that passage of HR3762, the Restoring Americans’ Healthcare Freedom Reconciliation Act, would increase the uninsured by 18 million in its first year, then 32 million by the tenth year of its enactment. The report also estimated that the elimination of mandates would accelerate the already existing trend toward a so-called “death spiral” within individual insurance markets as underwriters would have an even higher trend toward high-utilization clients than they do now.
This analysis is, however, largely irrelevant. The new CBO report is an update of an earlier analysis it performed on legislation from nearly two years ago. Republicans pushed HR3762 in 2015 as a vehicle to force President Barack Obama into a veto of a repeal of Obamacare. The sponsors wrote the bill with caution about the consensus limits to the process of budget reconciliation, the only method available for avoiding a filibuster in the Senate.
Republicans plan to repeal most of the rest of Obamacare (except perhaps the Medicare reforms) through other means. There is still significant strategizing as to whether they can repeal more through budget reconciliation than first assumed when writing HR3762 as well.
Charles Blahous, a former deputy director of the National Economic Council under President George W. Bush and a public trustee of Social Security and Medicare from 2010-15, points out the errors in taking the CBO’s report on HR3762 seriously as the totality of Obamacare repeal. The CBO scored only “the parts moving through the budget reconciliation process,” which alone would be “problematic in the ways CBO has identified.”
The initial reports gloss over the fact that even the CBO recognized that adding two other pieces to the repeal – the insurance coverage mandates and community rating requirements – would result in innovation that would add between six and nine million people to the ranks of the insured, and that premiums would be “substantially lower” than presently under full repeal.
Blahous writes that the CBO’s analysis strengthens recent Republican arguments that reconciliation can be used for a full repeal, rather than the HR3762 approach. Those impacts “would have substantial effects on the federal budget,” he notes, “and could well strengthen a tactical argument that repealing these regulatory components of the ACA should also be considered germane for budget reconciliation purposes.”
Why did CBO score an old bill that only covered part of the process, rather than wait a few weeks to see what Republicans plan to offer? The CBO report states that it was “prepared at the request of the Senate Minority Leader, the Ranking Member of the Senate Committee on Finance, and the Ranking Member of the Senate Committee on Health, Education, Labor, and Pensions.” All four are Senate Democrats, led my Minority Leader Charles Schumer (D-NY), an adamant opponent of Republican efforts to repeal Obamacare. The report gives opponents of the incoming administration some significant talking points about legislation that has long since expired but still has usefulness in driving public opinion.
Perhaps Schumer and his Senate allies should have made their argument before the 2016 election, using the previous scoring on partial Obamacare repeal. Oh, wait – they did, and they did in the 2014 midterms as well. Voters delivered their verdict on Obamacare, one of the most discussed policies in both elections, and Democrats lost both times. Reaching back to 2015 for data on an approach that is at best incomplete and at worst expired may give them some talking points, but it won’t make voters love Obamacare or turn their back on their clear decision to replace it with policies that allow for innovation, proper risk management, and economic growth.
The big question will be whether Republicans led by Donald Trump and Paul Ryan can deliver that kind of replacement. The jury may still be out on that, and the details of both repeal and replacement may still be in negotiation. Perhaps we should wait on scoring those outcomes until we see what options Republicans produce, and take our time in analyzing them. Had we done that seven years ago rather than rush a three-thousand-page bill through Congress and trust that we would know what was in the bill after it passed, perhaps we could have avoided much of the damage that has occurred since the passage of Obamacare.