Here’s why the CBO report is bad news for Republicans on health care

The following article by Paige Winfield Cunningham was posted on the Washington Post website May 25, 2017:

The final word is in: The House Republican bill to replace large parts of the Affordable Care Act would save $119 billion over a decade but cost 23 million Americans their health coverage.

Those figures are actually pretty similar to initial estimates for the House’s American Health Care Act — before Republicans added in some last-minute amendments changes.

Yet when the CBO released its score late Wednesday afternoon, it reignited a heated debate in Washington over the ongoing GOP effort to ditch big provisions in President Obama’s health-care law – an issue that took a temporary back seat amid all the drama over President Trump’s relationship with Russia and his treatment of former FBI Director James B. Comey.

Democrats and ACA backers ripped into the GOP measure, noting that it would roll back most of the progress made toward reducing the country’s uninsured and could result in plans becoming impossibly expensive for some people, especially older Americans.

Democrats were quick to start bashing the numbers:

Republicans were less unified — when they responded at all, that is — with House leadership defending the bill while some moderate lawmakers said it falls far short.

Speaker Paul D. Ryan (R-Wis.) championed the fact that the bill is estimated to lower the deficit, and premiums — which, as we’ve noted before, is a new focus for Republicans as they’ve set aside some of their other Obamacare criticisms.

House Majority Leader Kevin McCarthy (R-Calif.) chimed in:

Senate Republicans were far more muted, however. Majority Leader Mitch McConnell (R-Ky.) did not even issue a statement, and downplayed expectations in a Reuters interview yesterday:  “I don’t know how we get to 50 (votes) at the moment. But that’s the goal. And exactly what the composition of that (bill) is I’m not going to speculate about because it serves no purpose,” he said.

But at least one outspoken Senate Republican seemed to suggest that Republicans would be better off leaving Obamacare in place:

Here’s what some other Republican lawmakers said, according to my colleagues Juliet Eilperin and Kelsey Snell: 

• Sen. David Perdue (R-Ga.) in a statement: “Regardless of any CBO score, it’s no secret Obamacare is collapsing under its own weight. Doing nothing is not an option.”
• New York Rep. John Faso (R) questioned whether the waivers would affect one-sixth of the population, as the CBO projected: “Frankly I doubt any state would try to take advantage of that provision,” he said. “I think that is completely out of the ballpark.”
• House Freedom Caucus Chair Mark Meadows (R-N.C.), who helped craft the House-passed measure, warned that any changes the Senate might concoct still have to pass the House.

But mostly, Republicans were pretty silent, as noted by my former colleague Jen Haberkorn at Politico:

Although Tom Price seems to think the scores are, well, wrong.

Medical associations, who have panned the GOP bill, also were not impressed:

See how Washington reacted to the big health-care news:

Here at The Health 202, we’re mostly relieved the CBO didn’t wait until 8:15 p.m. to release the score, as some had rumored on Twitter. Just in case you don’t have time to read the entire 41-page report, we’ve got five takeaways right here:

1. The GOP plan would lower monthly insurance premiums, but probably not by enough for Republicans to make a strong case for their bill.

A big, swirling question has been how many states might opt out of Obamacare requirements that insurers ignore health status when pricing premiums (called “community rating”) and cover certain essential health benefits outlined by the federal government.

In order to get conservatives on board with their legislation, House Republicans added an amendment giving states this opt-out possibility, with the idea that easing insurer mandates would help lower premiums. To score the bill, the CBO had to estimate how many states might go this route. Here’s what it found:

–About half the U.S. population lives in states that would keep the essential health benefits and community-rating requirements. Average premiums for people buying plans on their own would be about 4 percent lower in 2026 compared to current law, mostly because younger, healthier people would buy plans.

–About one-third of the population lives in states that would partially opt out. Average premiums in those states would be 20 percent lower in 2026 compared to current law, mostly because plans would cover fewer services.

–About one-sixth of the population lives in states that would entirely opt out. Premiums in these states would be lower on average but vary significantly because insurers could charge those with preexisting conditions much, much more.

2. Even if premiums go down, many Americans would still pay more under the GOP plan because they would receive fewer government subsidies.

The CBO estimated staggering cost increases for older Americans who don’t earn much, especially those in their 60s who aren’t yet eligible for Medicare. For example, a 64-year-old earning $26,500 a year would have to pay about 850 percent more for their plan under the GOP bill compared to under the ACA.

Here’s a handy visual:

And some pointed reaction from other health-care wonks. From the Kaiser Family Foundation’s Larry Leavitt:

From Sarah Kliff at Vox:

Fair point about millenials from the Huffington Post’s Elise Foley:

3. The ACA fell far short of expectations in expanding health coverage. But now Democrats have a fresh opportunity to focus on how the GOP bill would do even worse in that department.

Democrats were swift to respond to the CBO estimate yesterday, blasting Republicans for trying to reverse the ACA’s advances.

“It was irresponsible for the House to vote for the GOP health bill before a CBO analysis was available,” said Ron Pollack, former director of Families USA and one of the ACA’s biggest proponents. “Now that it exists, however, anyone still supporting the bill is probably a prime candidate for a conscience implant.”

Some former Obama administration officials held a call late Wednesday to highlight what they see as its biggest shortcomings – and warn the Senate to go a different route.

“This report is a warning shot to the Senate, because they are marching down the same disastrous repeal path the House did,” said Leslie Dach, former senior counselor to Health and Human Services Secretary Sylvia Mathews Burwell.

4. Now Senate Republicans can really get to work on their own health-care bill. But if they want to beef up its coverage provisions, they only have $119 billion to work with.

The next steps for replacing Obamacare are complicated for Republicans. If they want to make subsidies for low-income Americans more generous, or restore some of the Medicaid cuts, they’ll have to dip into the bill’s deficit reduction or perhaps keep some of the ACA’s taxes.

And the CBO score is likely to motivate moderates to press leadership even harder for a health-care bill that preserves coverage for more people. They were quick to distance themselves from the House bill yesterday, criticizing its coverage shortcomings and promising they’ll come up with something better.

Sen. Susan Collins (R-Maine) touted her efforts with Sens. Bill Cassidy (R-La.) to work toward a bipartisan compromise. Cassidy, for his part, issued just about the shortest press release we at The Health 202 have ever seen, making a reference to his recent appearance on Jimmy Kimmel in which he said any ACA replacement must take care of people with preexisting conditions.

“Congress’s focus must be to lower premiums with coverage which passes the Jimmy Kimmel Test,” Cassidy said. “The AHCA does not. I am working with Senate colleagues to do so.”

View the post here.