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ACA Waiver Proposals Are Hard to Score: CBO Chief

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The head of the Congressional Budget Office has told one of the agency’s critics in the House that predicting how the lawmaker’s Affordable Care Act (ACA) change proposals would work is hard.

Keith Hall, director of the Congressional Budget Office, gave the CBO’s side today in a public letter addressed to Rep. Tom MacArthur, R-N.J.

“I can report that all of the people at CBO are tasked with maintaining a culture of objectivity, impartiality and nonpartisanship,” Hall writes in the letter.

(Related: Health Bill May Shut Out One-Sixth of Sick: CBO)

The CBO is an arm of Congress that helps members of Congress analyze how proposed legislation might work, and how existing laws, regulations and programs are working.

Waiver Proposals

MacArthur, who was the head of a risk management and benefit plan administration firm in New Jersey, has tried to reconcile differences between Republicans in Congress who want to minimize government involvement in health insurance and those who are open to more involvement by developing state ACA rule waiver proposals.

MacArthur has suggested letting a state decide whether it wants to keep the ACA major medical benefits package requirements, and whether it wants to keep the current ACA restrictions on medical underwriting in place.

MacArthur has blasted CBO reports showing that his proposal and other Republican ACA change proposals would drive up health coverage costs and increase the number of uninsured people.

He met with Hall on July 12 to talk about his concerns about the CBO, according to Hall.

ACA Waiver Scoring

Hall writes in his letter about the step the CBO takes to ensure objectivity and its approach to estimating how money will have health coverage.

When the CBO came up with projections for the 2016 insured rate, and the number of people who would have ACA exchange plan coverage in 2016, in March 2016, those projections turned out to be correct, Hall writes.

Hall also talks about why the CBO did not try to estimate how MacArthur’s state ACA waiver proposals might affect health insurance premiums in states that applied for waivers.

Waiving the ACA rules might cut coverage costs for some people, but it would increase premiums for others, Hall writes.

Analysts “were uncertain how high those premiums could go, because insurers there might decide to not offer policies with high premiums, and their decisions are hard to predict,” Hall writes.

The uncertainty would have little effect on the number of people of coverage, but it could have a big effect on the accuracy of premium projections, Hall says.

Budget analysts can come up with a rough idea of how many states might apply for waivers, without necessarily predicting which states will adopt waivers, by looking at how states have handled benefits mandates and underwriting in the past, Hall says.

Local hospitals, local medical providers and local insurers may also affect states’ decisions about waivers, Hall says.

Insurers would ask for waivers, but other market participants could oppose the requests for waivers, Hall says.

— Read Health Insurance Bill Dealmaker Draws Fire From Both Sides on ThinkAdvisor.

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