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Top Republicans can’t agree on basic facts about their health plan

Will people lose coverage under AHCA? Depends which Republican you ask.

Photo by Tom Williams/Getty Images

The Congressional Budget Office is expected to release estimates next week for how many people the new GOP health plan will cover — and top Republicans are divided over what to expect.

This is weird. The only people who have advance access to the CBO numbers are the Republican legislators who actually worked on the bill. They've been working with the budget agency for months now to create a score.

"CBO works with members of Congress and their staff behind closed doors to give members a chance to try out different ideas and see what the consequences would be before they go public with their ideas," former CBO Director Doug Elmendorf recently told me.

If anyone knows what to expect from the CBO numbers, it would be Republicans. You wouldn't know that from their public statements.

The Trump administration says people won't lose coverage under the plan. House Speaker Paul Ryan says they will.

Ryan and Health and Human Services Secretary Tom Price gave interviews today. Each fielded a question about a report from the Brookings Institution estimating that at least 15 million people would lose coverage under the Republican plan.

Here is how Price answered it:

Ryan, however, had a quite different take when he faced the question in a radio interview with Hugh Hewitt.

"We always know you're never going to win a beauty contest when it's free market versus government mandate," he said.

Who is right? Ryan, probably. This isn't especially complex. The GOP plan provides significantly less money than Obamacare for expanding coverage, so the coverage expansion will likely shrink. The American Health Care Act ends the ACA's Medicaid expansion in 2020 and offers tax credits that are 36 percent lower than those currently available under Obamacare. Put those things together and it's hard to see how millions don't lose coverage under AHCA.

The Republicans used to have a way around this — but it didn't work. Most older Republican plans had a way to offer less support for insurance but not necessarily shrink coverage numbers. They wanted to make the benefit package smaller, and require insurers to cover fewer things. Older GOP plans, for example, would end Obamacare mandates for coverage of maternity care or mental health services. This would drive down the cost of insurance and could help keep coverage numbers up.

But Republicans didn't do that in this plan, most likely for two reasons:

  1. They want to move this bill through the budget reconciliation process, which requires that all policies have a direct effect on federal spending. Health insurance regulations ... do not do that.
  2. CBO won't score exceptionally skimpy plans as coverage. The agency posted a memo late last year, seemingly out of nowhere, arguing that health insurance needs to provide “financial protection against high medical costs” for CBO to count the people who buy it as covered.

We're in a situation where people will have less help to buy coverage but the plans they'll have access to won't be much cheaper than what is available now. The question isn't whether people will lose coverage — it's how many will.

Chart of the Day

Center on Budget and Policy Priorities

The GOP plan is bad news if you're an Obamacare enrollee in Alaska. The left-leaning Center on Budget and Policy Priorities ran the numbers on how premium tax credits (the help the government gives middle-income people to buy private insurance) would change under the American Health Care Act.

One of the things that is really different about the GOP tax credits, compared with those in Obamacare, is that they are not tethered to the regional price of health insurance at all. Under the ACA, Obamacare enrollees are limited to paying a certain percentage of their income for a midlevel plan, and a government tax credit will cover the rest of the cost.

Under the GOP plan, everybody gets the same tax credit regardless of how much insurance costs in their area. That's a bummer when you live in an area where health insurance is relatively expensive, such as Alaska, a big, rural state without many doctors. CBPP estimates that Alaskans would see their tax credits decline, on average, by $10,243 each under the GOP plan. Read more from CBPP.

Kliff's Notes: Today's top 3 health policy reads

With research help from Caitlin Davis

  • "Trump Says He’s Open To Negotiation On Obamacare. Here’s His Chance": “The Republican Study Committee is backing two proposed changes to the Obamacare repeal and replace bill now under consideration in the House, both of which concern Medicaid. The first amendment would freeze Medicaid enrollment under Obamacare’s lavish funding rates at the end of this year, two years sooner than the GOP repeal bill. The second amendment would impose work requirements on able-bodied, childless adults enrolled in Medicaid (the Obamacare expansion enrollees). ... If President Trump is really open-minded about negotiating changes to the Republicans’ already-beleaguered repeal and replace bill, these amendments are a good place to start.” —John Daniel Davidson, the Federalist
  • "Is the Republican health care plan designed to fail?": "I do think Republicans went into this process believing that failure was likely, and so tried to hedge against the consequences by putting hard boundaries around the process. They decided that if they were going to fail at this, they were going to fail fast, over the course of a month or two, not waste a year on the project." —Ezra Klein, Vox
  • "GOP health-care bill would drop addiction treatment mandate covering 1.3 million Americans": “Medicaid pays for 49.5 percent of medication-assisted treatment in Ohio, 44.7 percent in West Virginia and 44 percent in Kentucky when the drug buprenorphine, which is used to manage chronic opiate use disorder, is administered, according to Rebecca Farley, vice president of policy at the National Center on Behavioral Health. Public health officials and advocates say there is a nationwide shortage of treatment programs to serve the growing problem of addiction and its effects, including diseases associated with long-term IV drug use such as hepatitis C and HIV.” —Katie Zezima and Christopher Ingraham, the Washington Post

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