GOP says CBO score on Oba­macare re­peal is flawed, uses older data

The Washington Times Daily - - POLITICS - BY SALLY PER­SONS

A key se­na­tor said Wed­nes­day that the of­fi­cial “score” of the GOP health bill is flawed be­cause it uses out­dated es­ti­mates for how many peo­ple were go­ing to get in­sur­ance un­der Oba­macare — mak­ing sus­pect any com­par­i­son to the new bill.

Sen. Ron John­son, Wis­con­sin Repub­li­can, said the Con­gres­sional Bud­get Of­fice hasn’t up­dated its base­line for Oba­macare en­roll­ment since March 2016, when health care mar­kets were just be­gin­ning to show in­sta­bil­ity, far from the col­lapse he and other Repub­li­cans say is now hap­pen­ing.

His com­plaint is just the lat­est in a string of ques­tions aimed at the CBO, whose dire pre­dic­tions have se­verely dented the po­lit­i­cal prospects for a Repub­li­can Oba­macare re­peal bill.

The CBO says the Se­nate bill that was sup­posed to be taken up this week would leave 22 mil­lion fewer peo­ple with in­sur­ance in a decade, and would in­crease costs for older and sicker cus­tomers, though younger and health­ier cus­tomers would pay far less in pre­mi­ums.

Faced with those num­bers, at least nine Se­nate Repub­li­cans had said they couldn’t vote for the GOP bill — forc­ing lead­ers to shelve it and try to write a new ver­sion.

At the same time, Repub­li­cans have tried to ar­gue with the ref­eree, say­ing CBO has a bad track record when it comes to mak­ing health pro­jec­tions.

The White House said the CBO has “con­sis­tently proven it can­not ac­cu­rately pre­dict how health care leg­is­la­tion will im­pact in­sur­ance cov­er­age.”

While all ex­perts agree that the CBO is the “gold stan­dard” when it comes to pre­dict­ing out­comes of ma­jor leg­is­la­tion like health care, they also stip­u­late that be­hav­ioral out­comes are of­ten un­pre­dictable.

Stan Veuger, a health pol­icy scholar at the Amer­i­can En­ter­prise In­sti­tute, said, “The more state vari­a­tion, the more po­lit­i­cal fore­casts the CBO has to make. Their guess is as good as yours or mine — ex­cept for ask­ing ex­perts what they be­lieve will hap­pen based on past data.”

Sen. James E. Risch, Idaho Repub­li­can, said that’s ex­actly the prob­lem with the GOP bill.

“Scor­ing on this bill is im­pos­si­ble in some in­stances. Scor­ing is done based upon mod­els to which [are] plugged in his­tor­i­cal in­for­ma­tion. We are plow­ing ground that has never been plowed,” he said.

Much of the dif­fer­ence in the num­ber of in­sured un­der Oba­macare ver­sus the GOP bill comes down to how many peo­ple will re­main en­rolled in Med­i­caid, the fed­eral-state part­ner­ship pro­gram that pro­vides health cov­er­age to the poor.

Repub­li­cans say the CBO projects that peo­ple will vol­un­tar­ily give up Med­i­caid even if they still qual­ify — a pre­dic­tion that they said makes no sense.

Crit­ics say the CBO got it wrong in the past on Oba­macare. Orig­i­nally the score­keeper said 23 mil­lion peo­ple would get their in­sur­ance through the health law’s ex­changes by 2016. The ac­tual num­ber was 10.4 mil­lion peo­ple as of early 2016, ac­cord­ing to the Cen­ters for Medi­care & Med­i­caid Ser­vices.

“Ex­change en­roll­ment is roughly half of what they pre­dicted it would be. The ef­fect of the in­di­vid­ual man­date on peo­ple’s be­hav­ior does not ap­pear to be as large as they as­sumed,” said Michael Can­non, who stud­ies health pol­icy at the Cato In­sti­tute.

He said the CBO mis­un­der­stood how peo­ple would re­spond to Oba­macare’s in­di­vid­ual man­date. He said the an­a­lysts also un­der­es­ti­mated how many peo­ple would en­roll in Med­i­caid be­cause states made a more con­certed ef­fort to sign peo­ple up for the pro­gram.

Med­i­caid ex­pan­sion is the area of most un­cer­tainty in the Repub­li­can health care score, say ex­perts, since it tries to pre­dict how states will be­have post-ex­pan­sion.

Matthew Fiedler, a health pol­icy scholar at the Brook­ings In­sti­tute, said that the CBO as­sumes no state that has not al­ready ex­panded their pro­gram will ex­pand with the Repub­li­can bill, and that some states that have ex­panded might scale back their pro­gram.

But he said there’s also a few states that might want to keep their Med­i­caid pro­gram but can’t with the re­duc­tion in the fed­eral match.

The CBO has also missed the mark on cost es­ti­mates for other pro­grams. It pro­jected the 2003 Medi­care pre­scrip­tion drug law would cost some $400 bil­lion over a decade, but the ac­tual cost came in at about half of that.

CBO an­a­lysts re­leased a re­port in 2014 say­ing it over­es­ti­mated en­roll­ment and also pro­jected na­tional pre­scrip­tion drug spend­ing would rise faster than it did.

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