The Congressional Budget Office report on the GOP’s Wealthcare Act was … devastating. Turns out the White House estimate was even worse. (More)
“In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law”
You can read the CBO’s summary and download the entire report, but here’s the key passage for people who think a ‘health care’ bill should actually provide … health care:
CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.
Later, following additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program, the increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026. The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment – because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.
The CBO projections also show that a promise President Trump and his advisers have made multiple times – that Trump would draft a bill that covered everyone, or that no one would lose coverage under his plan – to be flatly false.
Just this weekend, Health and Human Services Secretary Tom Price said, “We don’t believe that individuals will lose coverage at all.” CBO says this is not the case whatsoever.
The Republican bill offers less help to people who buy their own insurance than Obamacare currently does. It also hugely pares back the Medicaid expansion, which covers millions of low-income Americans.
The CBO report lays bare that, taken together, those changes mean million fewer Americans would have coverage.
Yes, it really is that bad.
“Wildly wrong on the initial estimates of Obamacare”
Which of course means the CBO is lying:
“I just have the headlines, but not the context,” said Sen. James Lankford (R-OK), declining to comment on the report. Though he had not yet read the CBO’s analysis, Lankford did defend Health and Human Services Secretary Tom Price’s assertion that it is not “believable.” Lankford, like many of his Republican colleagues and many in the Trump administration, inaccurately cited the CBO’s past reports on Obamacare to cast doubt on the office’s credibility.
“The White House is only saying what everyone knew already,” he said. “The initial CBO estimates, if you go back, ended up being inflated by 10 million or more. That’s not an accusation, that’s a fact.”
Sen. John McCain (R-AZ) joined in on the bashing of the CBO, saying they were “wildly wrong on the initial estimates of Obamacare.” But McCain admitted to reporters that he has some concerns, especially because Arizona is one of the states that took federal funding to expand Medicaid to hundreds of thousands of people. Under the bill, hundreds of billions of dollars are cut from Medicaid over time.
“The CBO’s predictions were not as accurate as we would have liked, but they were more accurate than the uninformed guesses of a lot of people at the time, and more accurate than the informed guesses of many other organizations,” Douglas Elmendorf, the director of the CBO from 2009 to 2015, told TPM. “I wish we had done better, but I am proud of what we did.”
They have particularly harped on the four-decade-old agency’s handling of the Affordable Care Act (ACA), noting correctly that about half of the people the CBO projected to enroll in Obamacare’s individual health insurance exchanges ended up doing so.
That, says Brookings Institute’s Matthew Fiedler, who served as chief economist of President Obama’s Council of Economic Advisers, is missing the point.
“While the CBO was off on where people would get their coverage, they did pretty well on how many people would gain coverage overall,” he explained to TPM. “They expected the uninsured rate to fall roughly by half, in the long run, from where it was in 2010. If you look at the actual data we have today, the uninsured rate has fallen by about 43 percent. It’s a fairly modest error, and there’s probably more room to make progress if the law is left in place.”
Simply, more people gained coverage through Medicaid expansion than the CBO projected, while fewer bought plans through the federal exchange. And while the total number covered did not quite reach the CBO’s forecast, that was because the U.S. Supreme Court let states opt-out of Medicaid expansion, and many GOP-led states did. Blaming the CBO for a ‘failure’ that Republicans intentionally caused … is an exercise in misdirection.
“This is not an analysis of the bill in any way whatsoever”
A White House analysis of the GOP plan to repeal and replace Obamacare shows even steeper coverage losses than the projections by the Congressional Budget Office, according to a document viewed by POLITICO on Monday.
The executive branch analysis forecast that 26 million people would lose coverage over the next decade, versus the 24 million CBO estimates. The White House has made efforts to discredit the forecasts from the nonpartisan CBO.
So, obviously, the White House analysts meant something else:
“This is not an analysis of the bill in any way whatsoever,” White House Communications Director Michael Dubke told POLITICO. “This is OMB trying to project what CBO’s score will be using CBO’s methodology.”
See, it wasn’t White House staffers estimating what the Wealthcare Act would do. It was White House staffers estimating what the CBO estimate would be! As excuses go, that’s right up there with dogs and homework. Just sayin’.
“Under the GOP’s bill, the more help you need, the less you get”
The Congressional Budget Office’s analysis of the GOP’s American Health Care Act is one of the most singularly devastating documents I’ve seen in American politics. For a thorough explanation of the findings, read Sarah Kliff’s explainer. [I linked to it above.] But here is the one-sentence summary: Under the GOP’s bill, the more help you need, the less you get.
The AHCA would increase the uninsured population by about 24 million people – which is more people than live in New York state. But the raw numbers obscure the cruelty of the choices. The policy is particularly bad for the old, the sick, and the poor. It is particularly good for the rich, the young, and the healthy.
In other words, Republicans go out of their way to pamper the rich, and they hope to concoct regulations that will let insurers cover fewer kinds of treatment, with higher deductibles and co-pays. That’s great if you’re young and health – and lucky enough not to get a serious illness or injury. But if you already have medical problems, or you’re at an age where they tend to happen more often … well … you’re screwed.
“One of the largest, most significant income redistribution programs the U.S. government has ever considered – from the poor to the wealthy rather than the other way around”
It is, as Vox’s Dylan Matthews calls it, class warfare by the rich against the poor:
The Congressional Budget Office’s assessment of Republicans’ plan to replace Obamacare is a description of one of the largest, most significant income redistribution programs the US government has ever considered – from the poor to the wealthy rather than the other way around.
The plan, the CBO concludes, would take more than $1 trillion away from programs targeting poor and middle-class families, to fund an $883 billion tax cut targeted at the wealthy. It is upward income redistribution of a truly massive scale.
“No legislation enacted in recent decades cut low-income programs this much – or even comes close,” Robert Greenstein, the founder and president of the Center on Budget and Policy Priorities and Washington’s leading advocate for poor and low-income Americans, says.
You should read Matthews’ entire explanation. It’s chilling.
And for those who insist this would never have happened – that Democrats would have gained stronger majorities in 2010 and 2014 and retained the White House last year, if only they’d focused on a truly “populist” agenda …
… well, there’s new data on that theory, and it’s not pretty for Sanders-style populism. But I’ll save that for tomorrow.
Photo Credit: Alex Wong (Getty Images)
Good day and good nuts