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Today in Obamacare: CBO is becoming a big obstacle for repeal and replace

Congressional Budget Office Director Keith Hall Holds Briefing On Economic Outlook Photo by Alex Wong/Getty Images

GOP versus CBO: This is what a wonky showdown looks like The nonpartisan Congressional Budget Office estimates that Obamacare repeal, on its own, would leave 32 million Americans without health coverage by 2026. The key details, via my colleague Andrew Prokop:

-18 million more people would become uninsured in the first full year after the bill’s enactment — rising to 32 million more people by 2026;

-premiums in the individual insurance marketplaces would soar — they’d go up 20 to 25 percent above currently projected increases in the first full year after repeal, and “would about double by 2026”;

-and access to coverage on the individual markets would plummet — about half of the US population would live in areas “that would have no insurer participating” in the individual market, CBO projects.

Republican leadership moved quickly to discredit the numbers, arguing that they were “misleading” because they didn’t include any replacement plan. “Today’s report shows only part of the equation — a repeal of Obamacare without any transitional policies or reforms to address costs and empower patients,” Sen. Orrin Hatch (R-UT), who chairs the Senate Finance Committee, said in a statement.

The reason CBO did not score a Republican replacement plan, of course, is because Republicans have not offered a replacement plan yet.

A conservative take on the CBO report you should read — It comes from Chris Jacobs, a former Republican staffer for the Senate Finance Committee. He makes an interesting point that the new report could encourage Republican legislators to pursue more aggressive repeal, not less:

In a paradoxical way, the CBO report actually makes a strong case for expanding the scope of last year’s reconciliation bill. The paper notes on several occasions that repealing Obamacare’s insurance subsidies, and effectively repealing the individual mandate, while leaving its insurance regulations in place, would harm insurance markets. For instance, CBO notes that, “The number of people without health insurance would be smaller if, in addition to the changes in [last year’s reconciliation bill], the insurance market reforms mentioned above were also repealed.”

Congress chose not to litigate the question of whether Obamacare’s major insurance mandates were budgetary in nature, and thus could be included in a budget reconciliation bill, last year. It should do so now. The findings of this CBO paper, along with other scoring estimates, give ample ammunition to those who consider it entirely consistent with past Senate precedents to include repeal of the major insurance regulations in budget reconciliation.

CBO is about to be at the center of a high-profile debate — and the agency doesn’t seem to backing down. I was surprised last month when, seemingly out of nowhere, CBO issued a fierce warning to Republicans about how it would score future health care plans.

The agency put up a blog post that said it won’t let Republicans count especially skimpy coverage as health insurance. It argued that health insurance needs to provide “financial protection against high medical costs” for CBO to count the people who buy it as covered.

Republicans hadn’t even submitted a replacement plan yet, at least not publicly. So it seems notable that CBO proactively decided to go ahead and lay down the ground rules for scoring in a very public way.

A former CBO director explains what is likely happening behind the scenes right now — A few weeks ago I spoke with former CBO director Doug Elmendorf, who currently serves as dean of the Harvard Kennedy School of Government. He walked me through what he believes is likely happening right now between the agency and Congress, and the type of events that might have precipitated the blog post mentioned above. This is what he told me:

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 their consequences would be for the federal budget and for health insurance coverage before they go public with their ideas. Once a member has at least a piece of legislation publicly available, any estimate that exists is made public immediately.

I think that is just the right approach for CBO to take. Members of Congress and staff say, “We’d like to try out the following policy change and see what effects it has.” CBO analysts use their models to understand how proposed changes in policy affect the numbers. Members will often come back and say, “That’s not quite what I wanted, what if I change this or change that.” Members of Congress can iterate through policies. For members of both parties, they both explore alternatives that only become public as any particular proposal becomes legislation.

Chart of the day —

A striking new poll from NBC News and the Wall Street Journal finds that for the first time since 2009 or so, the American public suddenly thinks the Affordable Care Act is a “good idea.” More from Matthew Yglesias.

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

“Trump's HHS pick doesn't want to flaunt his own Obamacare bill at confirmation hearing”: “In the lead-up to his confirmation hearings, Price has been kept out of the Trump transition team's efforts to craft an Obamacare replacement plan. According to a senior transition official, the incoming administration wants Price to be inoculated from questions about what Trump's alternative to the Affordable Care Act looks like when he faces probing senators this week.”

“Here’s how Donald Trump could replace Obamacare without courting disaster”: “In 2006, Price partnered with Tammy Baldwin, a liberal House Democrat who has since joined the Senate, to release H.R. 5864, ‘The Health Care Partnership Through Creative Federalism Act.’ The bill asked states to submit health reform proposals that would lead to ‘increased health coverage and access.’ Those proposals would be sent to a bipartisan commission for evaluation and certification. If the commission agreed that the proposal was likely to lead to better health care and more coverage, it would be sent to Congress for fast-track consideration. Funding would be provided through some combination of repurposing existing federal money and adding in new grants. The proposals would then be closely studied so other states could learn from their success or failure.”

“GOP governors fight their own party on Obamacare repeal”: “This rift between state and federal GOP officials is the real battle on Obamacare at a time when Democrats have only marginal power in Congress. The voices of even a handful of Republican governors intent on protecting those at risk of losing coverage could help shape an Obamacare replacement and soften the impact on the millions who depend on the law.”


Watch: Obamacare in Trump country

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