The Congressional Budget Office on Wednesday is set to release a new score for the American Health Care Act, the legislation passed by House Republicans to repeal and replace Obamacare, that will project government savings and how many people could become uninsured if the bill were to become law.
The new score follows amendments that were made to the bill allowing states to opt out of certain Obamacare insurance requirements and adding billions of dollars to pay for patients with high-cost medical needs.
House Republicans drew criticism from Democrats for passing the American Health Care Act without an updated CBO score that included those changes. Previous estimates showed that over a decade Medicaid would be cut by $880 billion, the number of uninsured would increase by 24 million and the deficit would be reduced by $150 billion.
The results have high stakes politically. Previous scores worried centrist House members, 20 of whom voted against the American Health Care Act, and contributed to the bill’s vast unpopularity by the general public. The latest version will help inform the Senate in how it decides to write its bill. Members are meeting about the legislation over Capitol Hill lunches three times a week, and a working group of about a dozen senators meets twice a week.
“The CBO score will matter to us,” said Sen. Roy Blunt, R-Mo. “It might matter even to the House based on what the score is. I think it is unlikely to have any reason for the House to act again.” Some have speculated that the new score would prompt another vote in the House if it does not meet the budget target of reducing the deficit over a decade by at least $1 billion in the Finance Committee and by $1 billion in the Health, Education, Labor and Pensions Committee. House Speaker Paul Ryan said Tuesday that such an outcome was unlikely.
“No, we don’t think that’s the case,” Ryan said, responding to a report in Bloomberg on the possibility. “It’s a technical non-issue is what it is. We’re just, out of an abundance of caution, we’re waiting to send the bill to the Senate.”
An analysis by the Committee for a Responsible Federal Budget projected that the bill would reduce deficits by $35 billion even if 5 million more people enrolled in plans as a result of states taking waivers to opt out of some Obamacare insurer requirements.
Senators said that they viewed the score as a guide.
“We need to see the score and then look at it and determine where it makes sense and where it doesn’t and decide to move forward,” Blunt said.
Sen. John Thune of South Dakota, the third-ranking GOP senator, said the score would be “instructive.”
“There are some things we will build on that the House did,” he said. “When we get that score we will use it as a backdrop to plan some of our Senate options.”
It’s not clear how the Congressional Budget Office will determine which states would use the waivers. Under the Republican bill, states would be able to apply for waivers that would undo the requirement for insurers to cover a wide range of medical provisions and the requirement that they charge customers the same amount, regardless of medical status. To qualify for a waiver, a state would need to demonstrate that changes they implement would allow people to receive coverage and would not increase costs. States also would be eligible for federal funding for high-risk pools, which assist with the coverage of patients with expensive medical needs.
Democrats and some Republicans worry that the waivers would not provide adequate protection for people with pre-existing illnesses. Some centrist Republicans have said the funding for high-risk pools should be significantly higher, while Democrats have pointed to failed attempts at high-risk pools in states before the passage of Obamacare.
Based on contacts with the Congressional Budget Office, Republicans say they feel confident that the agency won’t assume a large number of states request waivers.
Some centrist House Republicans who supported the bill said at the time that they voted for its passage because they did not expect their home states to request waivers. Senate conservatives, however, are encouraging the provision to be an “opt-in” measure in which states would be required to apply to keep the Obamacare requirements.
Sen. Bill Cassidy, a centrist Republican of Louisiana who has introduced is own healthcare bill with Sen. Susan Collins, R-Maine, has said that such a proposal would be a “violation of President Trump’s pledge” to voters. He has said that a bill must cover patients with pre-existing illnesses to get his vote. Republicans can afford to lose only two members, assuming a tie-breaking vote by Vice President Mike Pence, to pass their healthcare bill through reconciliation, which requires only a simple majority of senators.
Rep. Thomas MacArthur, R-N.J., who wrote the amendment that allowed for the waivers, said he wasn’t sure whether the CBO score would result in fewer uninsured people or changes in spending.
“I don’t know,” he said. “I can’t predict how their magic formulas work.”
He cast doubt on the CBO’s ability to score the bill correctly, noting that the agency had fallen short on projections for Obamacare. The agency estimated more people would sign up for the Obamacare exchanges and that fewer people would enroll in Medicaid. It was accurate, however, in projecting that 20 million more people would gain coverage.
“Bear in mind the CBO has been wildly wrong before,” MacArthur said. “I think sometimes they try to answer unanswerable questions, and in doing so they create models that are just wildly off. I don’t believe their numbers from their score. I think they’re wrong.”
Robert King contributed to this report.
