Republicans may soon get a preview of the political price of health reform.
Washington is braced for the expected release as soon as Monday of a Congressional Budget Office analysis set to reveal the cost and projected reach — and limits — of coverage for the GOP’s bill to repeal and replace major parts of Obamacare.
If, as expected, the report warns that millions of people currently insured thanks to the Affordable Care Act could lose that coverage, it could rock the debate over the bill — already facing problems due to Republican infighting.
Democrats will be certain to frame attacks on the GOP bill, the American Health Care Act, as taking away health care from those who have it, putting the onus on Republicans to argue why people should back their efforts.
That could prove a millstone for Republican lawmakers — including in blue-collar areas that President Donald Trump won on a promise to provide better and more affordable coverage than Obamacare — in the run-up to midterm elections in 2018.
The White House and congressional Republicans argue that the CBO projections won’t tell the full story, that people who have insurance under Obamacare are hammered by high deductibles and rising premiums and need relief. In such cases, they might have care, but it is hardly affordable, they say.
“The one thing I’m certain will happen is CBO will say, ‘Well, gosh, not as many people will get coverage.’ You know why? Because this isn’t a government mandate,'” House Speaker Paul Ryan said on CBS’s “Face the Nation” Sunday.
Pressed to say how many people might lose coverage, Ryan said, “It’s up to people.”
“We’re not going to make an American do what they don’t want to do,” Ryan said. “You get it if you want it.”
Therefore, it’s not surprising leading GOP figures are downplaying the CBO’s assessment of their plan, which does away with the Obamacare mandate that everyone must have health insurance, offers tax breaks based mainly on age instead of income and cost of coverage, and rolls back an expansion of Medicaid.
“Nobody will be worse off financially in the process that we’re going through,” Health and Human Services Secretary Tom Price said on NBC’s “Meet the Press” Sunday.
“What we want to do is to put in place a system that will allow for folks to select the coverage that they want,” Price said — an answer Breitbart News labeled a possible “Lie of the year.”
Republicans attack CBO
Not only does the CBO score miss the point, Republicans say, the agency itself often gets it wrong.
White House Chief Economic adviser Gary Cohn on Sunday argued that millions of people who now get health care through Obamacare would still have access under the GOP plan — whatever the CBO says.
“In the past, the CBO score has really been meaningless,” Cohn said on “Fox News Sunday.” “They have said that many more people will be insured than are actually insured.”
There is ammunition for both Democrats and Republicans in previous CBO assessments of Obamacare.
When the Affordable Care Act passed in 2010, the agency estimated 21 million would gain coverage through health care exchanges in 2016. Three years later, just before the exchanges opened, the agency upped the figure to 22 million.
For various reasons, the estimate was off: About 10.4 million were enrolled last year, according to the Department of Health and Human Services.
However, the CBO was closer on Obamacare’s overall impact on coverage. In 2010, CBO said the insured rate for non-elderly adults would rise to 92% in 2016. It later revised its forecast to 89%. In the end, 89.7% of Americans under age 65 had insurance last year, according to Centers for Disease Control and Prevention data.
Republicans also argue that the current bill is only the first step in health care reform, and dismantles Obamacare, so therefore the CBO score will not reflect the entirety of the effort.
Still, any suggestion endorsed by a nonpartisan body like the CBO that millions could lose coverage could be uncomfortable reading for Trump, however, given the guarantees he offered during the campaign.
“I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now,” Trump told “60 Minutes” in September 2015.
Perhaps mindful of the political price he may pay for repealing Obamacare, the President has taken to painting the system as a disaster, and blaming any future chaos in the health care market on his predecessor.
“The press is making Obamacare look so good all of a sudden. I’m watching the news, it looks so good. They’re showing these reports about this one gets so much, this one gets so much. First of all, it covers very few people. It’s imploding,” Trump said at the White House on Monday, during a meeting that grouped “victims” of Obamacare.
“The Republicans are frankly putting themselves in a very bad position. I tell this to Tom Price all the time. By repealing Obamacare. Because people aren’t going to see the truly devastating effects of Obamacare. They’re not going to see the devastation in ’17 and ’18 and ’19 — it will be gone by then. Whether we do it or not. It will be imploded off the map.”
Backlash against Republicans?
Democrats know from bitter experience during the first term of the Obama administration that taking on a project as vast and polarizing as health care reform can have painful political consequences. They are now increasingly convinced that Republicans will face a political backlash if millions of Americans lose health insurance or if the Trump-backed reform causes chaos in the insurance markets next year.
It’s a reading of the situation that makes it less likely that sufficient Democrats will eventually agree to join Republicans to beat back a Senate filibuster in the final stage of the legislative drive to remake the health insurance industry — on the replace component of the repeal and replace strategy.
They have their arguments ready for a CBO report that they believe could transform the debate.
“The reality is that Donald Trump promised voters that they would keep their coverage,” said Neera Tanden, president of the liberal Center for American Progress on CNN’s “State of the Union” on Sunday.
“And now we have estimates from this plan that he endorsed that 15 million people would lose it,” she said.
“The reality is here, people relied on him, they voted for him for who’ve got the Affordable Care Act to saying they would keep their coverage and it would get better. And the Ryan plan is less coverage at a highest cost, worse all around.”
The 15 million figure came from a Brookings Institution report on the likely CBO conclusions issued last week, which assesses the number of people expected to lose coverage under the 10-year scoring window for the bill.
Ohio Gov. John Kasich — who has been critical of the bid to narrow the Medicaid expansion that he fears could impact 700,000 people in his state — tried to refocus the debate on Sunday.
“All of this consumption with who gains politically. You know, life is short. And if all you focus in life is what’s in it for me, you’re a loser. You are a big-time loser,” Kasich said on NBC’s “Meet the Press.”
“And this country better be careful we’re not losing the soul of our country because we play politics and we forget people who are in need,” he added.
Movement continues in House
The political tempest likely to be unleashed by the CBO report will further obscure the progress made by Republicans last week, when their bill passed two key House committees after marathon hearings.
It will also fuel the controversy over the pace with which GOP leaders are trying to ram the measure through Congress, which is opening fault lines inside the Republican Party.
House conservatives are balking at what they see as the slow rollback of the Medicaid expansion under Obamacare, which the bill would complete by 2020.
Confusion over the President’s position may also be exacerbating the tumult in Republican ranks. Last week, Trump publicly backed the Ryan bill. Yet in a meeting with conservative critics of the legislation, he appeared to signal he was willing to be flexible about the pace of the Medicaid expansion rollback.
That position might reflect Trump’s desire to come across as the ultimate deal maker, and it could help bring conservatives on board in the House. But it might also alienate more moderate Republicans in the Senate, and disrupt the delicate political equation needed to pilot the bill toward Trump’s desk.
On Friday, White House spokesman Sean Spicer said the President did not, in fact, support speeding up the timeline for rolling back the Medicaid expansion.
“Right now, the date that’s in the bill is what the President supports,” he said.
But conflicting signals from Trump are giving Republican critics of the bill an opening to undermine Ryan’s effort to build quick momentum to get the bill — the first stage of a GOP process to repeal and replace Obamacare — through Congress before it attracts prohibitive opposition.
“You know what I hear from Paul Ryan? ‘It’s a binary choice, young man,'” Kentucky Sen. Rand Paul said on CBS “Face the Nation” on Sunday. “But what does a binary choice mean? His way or the highway.”