Nonpartisan scorekeeper in hot seat in GOP's ACA de-funding fight

The American Health Care Act fight

Dave Dillon, an actuary, said he believes an AHCA penalty that's supposed to encourage healthy people to pay for coverage is too small. (Image: Thinkstock) Dave Dillon, an actuary, said he believes an AHCA penalty that's supposed to encourage healthy people to pay for coverage is too small. (Image: Thinkstock)

(Bloomberg) — A nonpartisan body of number-crunchers who evaluate the costs of bills for Congress has become the unlikely lightning rod in the debate over the GOP’s plan to de-fund the Affordable Care Act.

Democrats want to delay debate until the body, the Congressional Budget Office, comes up with its analysis of the proposal — including an estimate on the number of people who could lose health coverage. Republicans, meanwhile, pressed ahead and panned the scorekeepers, which a lawmaker called “some unelected bureaucrats.”

Related: CBO: Repealing ACA would cost $353 billion over next decade

The heated argument over the CBO added to disputes over the bill’s tax cuts and coverage impact that bogged down two House committees’ sessions on Wednesday, and both are likely to drag late into the night. The plan is facing many roadblocks, including from within the GOP, and Democrats are taking every opportunity to say Republicans are moving recklessly to gut the ACA.

“What this bill needs is some extreme vetting,” said Rep. Lloyd Doggett, a Texas Democrat. “If you have nothing to hide, a week will not impair your effort.”

The White House jumped in, saying CBO’s estimates on the ACA itself, which was passed in 2010, haven’t proved accurate.


‘Way, way off’

“They were way, way off last time in every aspect of how they scored and projected Obamacare,” Press Secretary Sean Spicer said at a press briefing Wednesday. “It will be scored, but the idea that that’s any kind of authority based on the track record that occurred last time is a little far-fetched.”

The CBO, which is led by Keith Hall, an economist and former George W. Bush administration official who was selected by House Republicans in 2015, didn’t comment directly on the remarks, but pointed to a written answer it made March 3 to a question on how its ACA cost estimates have aligned with reality. The gross costs of the provisions were predicted at $214 billion for 2019 at the time, a projection now down to $148 billion.

Attempts to estimate the impact of the GOP’s American Health Care Act are bound to spark partisan bickering, as Republicans, who control the presidency and both houses of Congress, push to quickly fulfill their campaign pledge of repealing Obamacare.

The ACA brought health insurance to about 20 million individuals. About 6 million to 10 million people could lose health coverage under the AHCA plan, S&P Global Ratings said Tuesday. The Joint Committee on Taxation released estimates on the cost of rolling back the ACA’s taxes in the GOP bill, finding it would cut them by about $575 billion over a decade, mainly on the wealthy and health-insurance companies.

Related: Cadillac plan tax math may shape ACA attack

Republicans say that beginning debate before the CBO report is available isn’t unusual. The report will be published on Monday, according to House Democratic Leader Nancy Pelosi. The CBO wouldn’t confirm the date, saying it’s working on the report.

“We’re not going to let some unelected bureaucrats in Washington stop us from fulfilling our promise to the American people,” said Steve Scalise, a Louisiana Republican.

Some of the CBO’s early projections on the ACA have proved too high, including enrollment in the law’s exchanges. But others have proven more accurate, including the decline in the uninsured rate.

“Predicting the effects of large policy changes is always difficult, but CBO’s predictions for the ACA in 2010 were much more accurate than the predictions of many Republican opponents of the law,” Doug Elmendorf, who led CBO at the time, said by email.


Destabilizing markets

In the absence of a CBO score, there are other signs that the GOP law could destabilize the individual market, leading to coverage losses, according to Dave Dillon, a fellow of the Society of Actuaries. The law’s penalty on those who wait to buy coverage won’t do much to push more people to buy health plans. And while the changes in how premiums and subsidies are calculated may benefit young people, it’s not clear that it will be enough to get them to buy health plans either, he said.

At the House committees, though, the discussions devolved into a back-and-forth about the CBO.

“We had a CBO score,” Rep. Diana DeGette, a Colorado Democrat, said of the 2009 committee discussion on the Obamacare bill.

Chairman Greg Walden disputed her, but Joe Barton, a Texas Republican, was more appeasing.

“We want one too,” he said. “We’re all God’s children. We all want a CBO score.”

Related:

GOP ACA change bill may favor commercial health

 

Republicans new Obamacare draft under shroud of secrecy

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