The American Health Care Act, the House Republicans’ proposal for repealing and replacing large parts of Obamacare, has had a rough start in life. It was introduced by House leaders on March 6 to a chorus of groans from all ends of the party. Freedom Caucus members and some other conservatives opposed its refundable tax credit and thought its Medicaid reforms took too long to get going. Many of the conservatives most engaged in the details of health care in recent years, meanwhile, thought its credit was not well designed to allow most people to obtain at least catastrophic coverage, and they worried about some peculiar features that seemed counterproductive. The hope of Republican leaders to rush the bill through the House and then the Senate in record time seemed implausible.
And then on March 13, the Congressional Budget Office made things even worse. The agency’s modelers projected that, while the bill would significantly reduce the deficit and ultimately reduce premium costs in the individual market, it would leave about 24 million more people without insurance in ten years than would have been the case under Obamacare.
To see how harsh an assessment that is, consider that in January the CBO projected that a bill that simply repealed all of Obamacare — its taxes, mandates, subsidies, and regulations of insurance — would leave 23 million more people without coverage in ten years. So a full repeal alone would actually leave more people covered than does the Republicans’ repeal and replacement, in the agency’s judgment. But things are not nearly so simple, of course, and the CBO’s assessment might actually point toward improvements that could strengthen the Republican approach.
Defenders of the Republican bill have responded to CBO’s score of it by questioning the agency’s health-care modeling and its past performance. Critics of the bill have responded by pointing to the proposal’s numerous peculiar flaws. Both sides are right.
Without question, CBO’s health-care model has enormous problems. The congressional scorekeeper has always exaggerated the effectiveness of blunt rules like Obamacare’s individual mandate. Its baseline Medicaid projections have long overestimated growth rates in ways that make conservative reforms look like bigger cuts than they turn out to be. And its insistence that competition does not lead to business-model innovation in insurance has led it astray before too — as in its vast exaggeration of the cost of the Bush administration’s Medicare prescription-drug benefit in 2003. Continue…
seriously, what a fucking mess… feel like i’ve been hearing about healthcare in one way or another for the past decade now, and they still can’t seem to get together and figure it out… but i guess that’s simply asking too much.