CBO: 24M would lose health in­sur­ance

Older Amer­i­cans would pay more un­der Oba­macare re­place­ment; deficit would fall, bud­get of­fice projects.

Austin American-Statesman - - FRONT PAGE - By Elise Viebeck, Amy Gold­stein, Kelsey Snell and Mike Debo­nis Wash­ing­ton Post

House Speaker WASH­ING­TON — Paul Ryan’s pro­posal to re­vise the Af­ford­able Care Act would lower the num­ber of Amer­i­cans with health in­sur­ance by 24 mil­lion while re­duc­ing the fed­eral deficit by $337 bil­lion by 2026, con­gres­sional bud­get an­a­lysts said Monday.

Ac­cord­ing to a Con­gres­sional Bud­get Of­fice pro­jec­tion, 14 mil­lion fewer peo­ple would have health in­sur­ance next year alone. Pre­mi­ums would be 15 per­cent to 20 per­cent higher in the first year com­pared with the Af­ford­able Care Act and 10 per­cent lower on av­er­age af­ter 2026. By and large, older Amer­i­cans would pay “sub­stan­tially” more and younger Amer­i­cans less, the re­port said.

The re­port from the Con­gres­sional Bud­get Of­fice fu­eled con­cerns that the GOP health care plan would prompt a dra­matic loss

in health in­sur­ance cov­er­age, po­ten­tially con­tra­dict­ing Pres­i­dent Don­ald Trump’s vow that health care re­form would pro­vide “in­sur­ance for ev­ery­body” and threat­en­ing sup­port from mod­er­ate Repub­li­can law­mak­ers.

Yet it also boosted House lead­ers’ ef­forts to per­suade skep­ti­cal con­ser­va­tives, who felt that the mea­sure did not go far enough in re­peal­ing the Af­ford­able Care Act, to sup­port what the CBO now pre­dicts will be deficit-re­duc­ing leg­is­la­tion.

The anal­y­sis im­me­di­ately prompted a clash of re­ac­tions be­tween the White House and Repub­li­can lead­ers. Trump’s bud­get di­rec­tor, Mick Mul­vaney, said the re­port is “just ab­surd,” and Health and Hu­man Ser­vices Sec­re­tary Tom Price said: “We dis­agree stren­u­ously” with it.

Ryan de­fended the re­port, say­ing that it proves that the pro­posal will “dra­mat­i­cally” re­duce the deficit and usher in “the most fun­da­men­tal en­ti­tle­ment re­form in a gen­er­a­tion.”

“Our plan is not about forc­ing peo­ple to buy ex­pen­sive, one-size-fits-all cov­er­age,” he said. “It is about giv­ing peo­ple more choices and bet­ter ac­cess to a plan they want and can af­ford. When peo­ple have more choices, costs go down. That’s what this re­port shows.”

The re­lease of the CBO’s re­port marks the be­gin­ning of a new phase in the de­bate over the week-old health care bill, which is mov­ing through the House on an ac­cel­er­ated timetable de­spite op­po­si­tion from Repub­li­cans, Democrats and vir­tu­ally ev­ery sec­tor of the U.S. health care in­dus­try. Con­ser­va­tive Repub­li­cans, in par­tic­u­lar, have de­manded changes to the mea­sure in ex­change for their sup­port.

The CBO re­port of­fered con­clu­sions that might neu­tral­ize some con­ser­va­tive con­cerns, per­haps soft­en­ing those mem­bers’ op­po­si­tion to the mea­sure.

The con­ser­va­tive House Free­dom Cau­cus did not im­me­di­ately pro­vide a re­sponse to the re­port.

At the same time, some mod­er­ate Repub­li­cans ex­pressed con­cerns about the num­ber of peo­ple who would lose cov­er­age.

“These kinds of es­ti­mates are go­ing to cause re­vi­sions in the bill, al­most cer­tainly,” said Sen. Su­san Collins, R-Maine.

“I don’t think that the bill that is be­ing con­sid­ered now is the bill that ul­ti­mately will be the one that we vote on in the Se­nate.”

Democrats cited the CBO num­bers to sup­port their flatout op­po­si­tion to the plan.

“The CBO score shows just how empty the pres­i­dent’s prom­ises, that ev­ery­one will be cov­ered and costs will go down, have been,” said Se­nate Mi­nor­ity Leader Charles Schumer, D-N.Y. “This should be a loom­ing stop sign for the Repub­li­cans’ re­peal ef­fort.”

“I would hope that this would make the Repub­li­cans say ‘we can’t do this,’” said Sen. Patty Mur­ray, of Wash­ing­ton, a mem­ber of Demo­cratic lead­er­ship.

“Twenty-four mil­lion peo­ple lose their cov­er­age, it is to­tal chaos to the coun­try and I hope they pause, say ‘This is not what we should be do­ing,’ and move on.”

The White House has spent the past week en­gaged in a charm of­fen­sive aimed at bring­ing con­ser­va­tives on board, as well as an ef­fort to dis­credit the CBO be­fore it re­leased num­bers that might cast the plan in a neg­a­tive light.

“If you’re look­ing to the CBO for ac­cu­racy, you’re look­ing in the wrong place,” White House spokesman Sean Spicer said last week.

Ryan had pre­dicted that the CBO would fore­cast a loss in cov­er­age, but he had also sug­gested that those af­fected would be ex­er­cis­ing their choice not to buy health plans, a choice that is pe­nal­ized un­der the Af­ford­able Care Act.

“CBO will say, ‘Well, gosh, not as many peo­ple will get cov­er­age,’ ” Ryan said Sun­day in an ap­pear­ance on CBS’s “Face the Na­tion.” “You know why? Be­cause this isn’t a gov­ern­ment man­date.”

“It’s up to peo­ple,” he said. “Peo­ple are go­ing to do what they want to do with their lives be­cause we be­lieve in in­di­vid­ual free­dom in this coun­try.”

The Af­ford­able Care Act has in­creased cov­er­age by 20 mil­lion to 22 mil­lion — al­most half of those through the in­sur­ance mar­kets the law cre­ated for peo­ple who can­not get af­ford­able cov­er­age through a job, and the rest through an ex­pan­sion of Med­i­caid in 31 states and the Dis­trict of Columbia.

Ac­cord­ing to the re­port, an es­ti­mated 52 mil­lion peo­ple would be unin­sured in 2026, com­pared with 28 mil­lion who would lack in­sur­ance that year un­der the cur­rent law.

“Ob­vi­ously, we want to im­prove those cov­er­age num­bers,” said Se­nate Ma­jor­ity Whip John Cornyn, R-Texas. “But when you don’t pun­ish peo­ple for their re­fusal to buy a gov­ern­ment-ap­proved in­sur­ance (plan), some peo­ple are go­ing to make the de­ci­sion not to buy it.”

This rea­son­ing would only ac­count for the im­me­di­ate in­crease in the unin­sured, ac­cord­ing to the CBO.

Even­tu­ally, many peo­ple would lose health in­sur­ance be­cause the leg­is­la­tion’s tax cred­its would be less gen­er­ous than those in the cur­rent law and be­cause some states might undo the ex­pan­sion of their Med­i­caid pro­grams.

“All I can tell you it is a work in progress,” Cornyn said of the bill.

The Trump ad­min­is­tra­tion led a broad ef­fort to un­der­cut the CBO over the week­end, in­clud­ing point­ing out flaws in its fore­casts for the Af­ford­able Care Act.

“If the CBO was right about Oba­macare to be­gin with, there’d be 8 mil­lion more peo­ple on Oba­macare to­day than there ac­tu­ally are,” said Mul­vaney, di­rec­tor of the White House Of­fice of Man­age­ment and Bud­get. “Some­times we ask them to do stuff they’re not ca­pa­ble of do­ing, and es­ti­mat­ing the im­pact of a bill of this size prob­a­bly isn’t the best use of their time.”

“The CBO es­ti­mate five, six, seven years ago when this started, they es­ti­mated that over 20 mil­lion peo­ple would have cov­er­age at the end of the 10 year win­dow,” Price said on NBC’s “Meet the Press.” “In fact, it’s about half of that right now. So CBO has been very adept in not pro­vid­ing ap­pro­pri­ate cov­er­age sta­tis­tics.”

Price, the for­mer chair­man of the House Bud­get Com­mit­tee, had pre­vi­ously cel­e­brated the se­lec­tion of CBO Di­rec­tor Keith Hall in 2015, say­ing he would bring an “im­pres­sive level of eco­nomic ex­per­tise and ex­pe­ri­ence.”

In pri­vate meet­ings last week, Trump sug­gested he was open to sig­nif­i­cant changes to the bill to ap­pease hard-lin­ers skep­ti­cal of the bill. By the end of the week, how­ever, the White House clar­i­fied it was sid­ing with House Repub­li­can lead­ers on at least one re­quest from the hard-lin­ers: speed­ing up cuts to Med­i­caid el­i­gi­bil­ity.

“Right now, the date that’s in the bill is what the pres­i­dent sup­ports,” Spicer told re­porters. “It’s not a ques­tion of ne­go­ti­a­tion,” he added.

On Fri­day, mem­bers of the House Free­dom Cau­cus re­mained split over which el­e­ments more ur­gently needed change. Some called for chang­ing the Med­i­caid timetable, while oth­ers urged the elim­i­na­tion of ba­sic ben­e­fit re­quire­ments for health plans.

On Sun­day, a grow­ing group of con­ser­va­tives was still threat­en­ing to kill the plan un­less GOP lead­ers agreed to rene­go­ti­ate parts of it.

“He will not have the votes,” Sen. Rand Paul, R-Ky., said of Ryan on CBS’ “Face the Na­tion.” “Ev­ery­body is be­ing nice to ev­ery­body be­cause they want us to vote for this, but we’re not go­ing to vote for it.”

In Jan­uary, Trump had promised to re­place the ACA with a plan that pro­vided “in­sur­ance for ev­ery­body.”

“There was a phi­los­o­phy in some cir­cles that if you can’t pay for it, you don’t get it. That’s not go­ing to hap­pen with us,” Trump said in a Jan. 15 in­ter­view with The Wash­ing­ton Post.

“It’s not go­ing to be their plan,” Trump said of peo­ple cov­ered un­der the Af­ford­able Care Act. “It’ll be an­other plan. But they’ll be beau­ti­fully cov­ered. I don’t want sin­gle-payer. What I do want is to be able to take care of peo­ple.”

GETTY IM­AGES

The re­port from the Con­gres­sional Bud­get Of­fice po­ten­tially con­tra­dicts Pres­i­dent Don­ald Trump’s vow to pro­vide “in­sur­ance for ev­ery­body.”

J. SCOTT APPLEWHITE / AP

House Speaker Paul Ryan de­fended the Con­gres­sional Bud­get Of­fice re­port, say­ing it proves the pro­posal will re­duce the deficit and usher in “the most fun­da­men­tal en­ti­tle­ment re­form in a gen­er­a­tion.”

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