DC Deciphered

 

In Monday’s post I talked about how the GOP is “protesting too much” in trying to convince us that they aren’t rushing their Obamacare replacement bill to passage.  Their desperate attempts to convince us just make it clear they know full well the opposite is true.

But the Party’s protestations did not stop there.  Today’s post is about another way in which the GOP doth protest too much: in advance of the “CBO score” of their health care bill they furiously tried to convince us that the CBO score doesn’t matter.

(If you don’t have time to read the whole post, make sure not to miss the surprise ending . . .)

Why Do We Care About the CBO Score?

These protests were part of an effort to preemptively discredit the CBO before the agency released its “score” of the bill, which was finally released late Monday afternoon. (If you just want a summary of the CBO’s analysis of the GOP plan, skip ahead to the section entitled “What Did the CBO Say About the GOP Plan?”).  The CBO – the Congressional Budget Office – is a non-partisan federal agency that provides Congress with analyses of bills that affect the federal budget.  When they put out such an analysis it’s called a “score.”  So when they score a health care bill, they analyze its overall affect on the budget (how much it will add to or reduce the deficit) and how many people will gain or lose health insurance as a result.

Normally, Congress doesn’t start voting on a bill of this sort until they’ve seen the CBO score.  This is because (a) members want to know the effects of the things they’re voting on, and (b) Congress may want to rework the bill in response to the CBO analysis if it’s unhappy with the results.  That’s what happened when Democrats were working on Obamacare.  They went through numerous rounds (pp 16-18) of CBO scoring, reworking the bill each time to improve the projected outcomes.

But as mentioned in Monday’s post, the GOP has already voted the bill out of two committees, before they had a CBO score on their bill.  This means the members of those two committees voted on the bill without knowing how much the bill would cost or how many people would lose insurance as a result.  Though on the latter question they had a pretty good idea, because several outside groups had already done the analysis, and none of the results were good for the GOP.  The answers ranged from 6 million to 20 million people expected to lose insurance under the GOP plan.  So it made sense that they didn’t want to wait to hear that from the CBO.

So Why Did the GOP Bad Mouth the CBO *Before* the Score Came Out?

So how did the GOP handle the fact that they were proceeding without a CBO score, and that all signs pointed to it being lousy when it finally did arrive?  Simple, they just told everyone the CBO doesn’t know what it’s doing anyway, so who needs them!  So we had Sean Spicer saying at last Wednesday’s press briefing, “If you’re looking at the CBO for accuracy, you’re looking in the wrong place. They were way, way off the last time in every aspect of how they scored and projected Obamacare.”

But that’s not true.  The CBO definitely wasn’t perfect, but their analyses are only supposed to be estimates to give lawmakers, and on several elements of the bill they got very close. And where they were wrong, it was because of certain explainable, mistaken assumptions.  They did better than any other group that tried to make predictions about the law, so if the GOP isn’t going to use their judgment about the effects of the bill, then whose?

And just last year, Spicer touted a CBO analysis of a previous GOP health care plan to try to sell it as a deficit reducer.  I guess just like his boss, Spicer believes he gets to decide on a  whim when the numbers are phony and when they aren’t.

And Spicer’s boss was a huge fan of the CBO when he could use it as a tool for bashing Obama:

Anyway, next up was Mick Mulvaney, Trump’s Budget Director, who said, “We continue to think, and have for a long time, that the CBO is scoring the wrong thing. We don’t think the CBO is counting correctly.”  And Tom Price, Trump’s Secretary of Health and Human Services was on Meet the Press over the weekend saying the  “CBO has been very adept in not providing appropriate coverage statistics.”

Then, GOP members of Congress joined in taking it even further, saying the CBO was not just wrong about Obamacare, but wrong about everything in general.  Sen. Tim Scott said, “The CBO is consistently inconsistent,” Rep. Dave Brat: “The CBO, they’ve scored everything wrong for decades,” and Rep. Glenn Thompson: “To tell you the truth, the CBO, I don’t see where they get it right.” (h/t Talking Points Memo)

And these are just some of the examples. So it was a daily, party-wide effort to discredit the CBO before the agency had even put out a score of the bill. And just in case you might think that some of their concern stemmed from worries about “liberal bias” in government agencies or holdovers from the Obama era controlling the process, the head of the CBO, Keith Hall, was hand selected in 2015 by GOP leaders, including then-Rep. Tom Price and Paul Ryan.  Hall worked in the George W. Bush administration, and he’s known for being a small government guy (skeptical of government spending and regulation) who’s opposed to Obamacare.

What Did the CBO Say About the GOP Plan?

On Tuesday, the CBO score finally came out, and overall it was as bad as most everyone expected it to be.  On the number of people who would become uninsured under the bill, it was actually even worse than anyone had predicted: 24 million people are expected to become uninsured by the year 2026 (14 million uninsured in 2018) due to a combination of people losing private insurance and Medicaid coverage.   The CBO estimates that 7 million fewer people would get insurance through their employers by 2026 because fewer employers would be expected to offer insurance due to the end of the employer mandate.  Some of those people would be able to get coverage on the individual market.

There appeared to be a tiny glimmer of good news for the GOP in that insurance premiums are eventually expected to decrease in 2026 (decrease, as compared to where they would have been that year, not a decrease from where they are right now) by 10% on average.  Premiums are expected to first rise for a few years until 2020, but then eventually start to come down.  However this “good news” isn’t as good as it sounds at first blush because deductibles and other cost sharing would be higher than under Obamacare, especially for low income Americans.

Additionally, that premium decrease is an average. Some people will see bigger decreases, but others will see much more significant increases, particularly older and lower income Americans.  For example:  under the GOP plan, a 21-year-old making $68,200 would pay an average of $1,450 per year for insurance, compared with $5,100 under current law. And for a 64-year-old making same income level, there’d likely be no change in insurance premiums.  But for a 64-year-old making $26,500, the cost of insurance would increase significantly from $1,700 to $14,600 per year.

Overall, the CBO estimates that by 2026, premiums would be 20-25 percent lower for a 21-year old, 8-10 percent lower for a 40-year old, and 20-25 percent higher for a 64 year old.  Again, all averages, dependent on the individual’s income and where they live.  And keep in mind, that part of the reason the average premium cost will come down is because insurance will become so expensive for older Americans that many of them will be forced out of the market. That will leave a younger, healthier pool remaining that – yes – on average is cheaper to insure.  It will also leave millions of people who really need it without insurance.  But don’t expect these details to prevent Republicans from triumphantly declaring that their plan will lower premiums.

One other detail the GOP will surely be happy to tout from the CBO score: the overall effect of the bill is to reduce the deficit by $337 billion (to put it in perspective, the bill cuts Medicaid spending alone by $880 billion over that same time frame), due to the less generous premium subsidies (tax credits) and the massive cuts in Medicaid spending. That’s certainly a positive for them, since a bill that increased the deficit wouldn’t have been allowed through the reconciliation process that they’re using to pass the bill through the senate, and the conservatives in the House would have also rebelled against it.  But $337 billion over 10 years is a drop in the bucket, certainly not enough to weigh against lost insurance for 24 million people.

Oh yeah, and then there’s this:

How Did the GOP React to the Report?

Paul Ryan has apparently decided he likes the CBO report, though that’s based on his own very creative (i.e. completely made up) interpretation of the results.  So he’s just going to go ahead and sell us that version:

And House Majority Leader Kevin McCarthy went with a similar strategy, appearing to comment on the contents of the CBO report, while completely ignoring what the CBO report actually said:

This report by the CBO confirms that this first phase of health care reform, the American Health Care Act, uses conservative and free-market principles that will empower Americans with access, choice and affordability.

But at late afternoon press conference on Tuesday, HHS Secretary Tom Price said “we disagree strenuously” with the CBO’s report, on the basis of the uninsured numbers.  This was immediately followed by Budget Director Mick Mulvaney touting the CBO’s analysis that the plan will eventually lower premiums, saying that was an example of something the report got right.  Like Spicer, Mulvaney appears to be learning from his leader Trump, believe the numbers when they’re good for you, call them phony when they’re not.  Trump manages to get away with it, so why can’t the rest of them?

But oh yeah, Price must have been forgetting one tiny detail when he stood in front of the American people exclaiming that the CBO analyis couldn’t possibly be correct and that the GOP plan would actually cover more people: It turns out the White House (for which Price works) had an internal analysis done that shows the GOP plan will result in even worse uninsured numbers than the CBO found.  The White House analysis shows 26 million people losing insurance over the next decade under the GOP’s health care plan.*

But we all spent the past week watching the GOP protest too much, preemptively, about an analysis that was to be produced by an agency headed by a man they handpicked.  They knew the numbers were going to be bad and, not only did they go ahead and start voting on the plan anyway, they went into overdrive to try to convince us, the American people, their constituents, that we shouldn’t trust the numbers but should trust their words instead.  All while spinning the lies ever further.

*****

*In a late Monday night update, the White House claimed that the document was not an analysis but was simply an attempt to predict what the CBO would find.  But documents viewed by Politico (the source of the original report), indicate that the purpose of the exercise was indeed to analyze the effects of the legislation and predict the outcomes.  You know the Trump White House’s record for veracity.  You decide who you trust on this one.