Outgoing Congressional Budget Office Director Keith Hall said Republicans deserve responsibility for blowing their effort to repeal Obamacare, but he deflected any accountability for his office’s biggest failure.
To be sure, Hall is not wrong about Republicans being ultimately responsible for their own legislative failures. In the past, I have pulled no punches in describing how Republicans pursued a slipshod process for repealing the law, compounding errors that have their origins in the years they spent focusing on scoring daily messaging victories rather than the hard work of trying to coalesce around an alternative healthcare approach.
But at the same time, by drastically overestimating the effect of the individual mandate, CBO analysts made the coverage losses from any repeal seem a lot more significant, which made it that much harder for Republican leaders to get centrists on board.
“I made a real decision not to, in real time, defend our work because I really do think of us as referees or umpires,” Hall told Roll Call.
He went on, “If I go back to that referee analogy, it’s a coach screaming at the referees, ‘You blew the game for me.’ … In fact, if you want to blame somebody — I’m on the way out so I can say this — if Congress really wanted to change Obamacare, they’re the ones that blew it with their process, not CBO. We just called it like we saw it.”
He said of the GOP’s process, “There wasn’t much debate, there were no hearings, there was very little discussion about what the details were.”
The idea that reducing subsidies toward the purchase of insurance was “almost a no-brainer,” according to Hall. Yet what was much more debatable was the magnitude of the coverage losses, and CBO’s estimates were heavily influenced by its erroneous assumptions about the mandate.
To extend the referee analogy, a team should play well enough so that they can survive a bad call by the referee, but that doesn’t absolve the referee from influencing the outcome by botching a call.
By 2017, there was already significant evidence, from the first few years of actual experience with Obamacare markets, that the mandate was much less influential than assumed when Obamacare was first passed. But the CBO still treated it as incredibly powerful.
In one version of the House bill, for instance, the CBO found that, before any cuts to actual spending went into effect, 14 million fewer people would be insured and that “most of the reductions in coverage … would stem from repealing the penalties associated with the individual mandate.” Incredibly, the CBO estimated that 5 million fewer people would enroll in free Medicaid mainly due to the elimination of the penalties. The mandate elimination accounted for more than half of the 24 million the CBO said the Republican plan would reduce coverage for overall over a decade.
Earlier this year, the Centers for Medicaid and Medicare Services estimated that the elimination of the individual mandate would have a significantly smaller impact than the CBO long estimated. CMS actuaries revealed that 2.5 million more people would go without insurance in 2019 due to the repeal of the individual mandate’s penalties, and the impact would be “smaller” thereafter.
Hall’s CBO itself also eventually downgraded its assumptions about the impact of the individual mandate. But not before its estimates had a significant effect on the policy debate.
Not only did the CBO’s model assume more coverage losses from the elimination of the mandate, which made it harder for Republicans to win over the votes for repeal, but in doing so, it also assumed significantly more in savings from repealing the mandate, which helped the math of the 2017 Republican tax bill.
So the two biggest policy stories of 2017 — the failed repeal effort and the passage of the tax cut — were significantly influenced by the failure of the CBO’s mandate model. If Hall is going to be going after the Republicans for their legislative process, he should also be accountable for CBO’s own significant errors.
