The Senate is expected to release a new version of its health care bill Thursday, hoping to “fix” enough problems to garner enough Republican support and get a better score from the Congressional Budget Office.
The Better Care Reconciliation Act, released in late June, was a flop, decried by conservatives and moderates alike. The CBO found that version of the bill would slash more than $770 billion in Medicaid spending and leave 22 million more uninsured than under current law. It also found many low-income Americans would simply forgo insurance rather than buy into high-deductible plans.
Senate Majority Leader Mitch McConnell is hoping for a different CBO score this time. The revised bill is likely to include fewer tax cuts for the wealthy and more financial aid for people who buy private coverage, and it loosens Obamacare’s insurance regulations, allowing for more bare-bones health plans. Health policy experts say the changes will still likely amount to a CBO score projecting millions uninsured.
Will that be enough to get hesitant senators on board? And what kind of CBO score are they looking for?
I caught up with Sen. Bill Cassidy (R-LA), who has been active health care negotiations, to ask him this question. He couldn’t set a number.
“You are asking me what number am I comfortable with — well, I don’t know,” Cassidy said. “What I think is reasonable.”
What’s reasonable? Cassidy poked holes in the CBO’s methodology instead.
By questioning the CBO’s model altogether — something Republicans have been doing since the first draft of the House’s health care bill had an estimate of 24 million uninsured — Cassidy appeared to be preempting another bad score.
There’s no question that the CBO has been off in its projections in the past, but it’s still the only official estimation of the bill’s effects. And it’s becoming clear that Republicans’ only defense of their health bill, projected to cover fewer people, is to just claim, on intuition, that that won’t happen.
Below is a transcript of our conversation, slightly edited for style and clarity.
What does a good CBO score look like to you?
A good CBO score. President Trump said he wanted people covered, care for preexisting conditions, and lower premiums. That’s the beginning of it.
But knowing that these reforms will leave some people uninsured, what level are you comfortable with?
Clearly the model that CBO uses is heavily weighted toward the individual mandate. Now the CMS model — the actuaries — had, like, 12 million more people insured than the CBO model. Same data, but one had 12 million more people insured than the other.
So you know the CBO score is going to be not great in that sense because we don’t have the individual mandate. Now, that was one of President Trump’s pledges — to get rid of the individual mandate. So you are asking me what number am I comfortable with — well, I don’t know. You don’t know until you see it. But when you look at it, you have to accept that they are using a paradigm that the American people have rejected, which is the individual mandate. And because their model is so heavily dependent upon it, there’s going to be some fudge factor that you have to use when you look at their numbers.
So even if the only official score comes back and says that tens of millions of people will be left uninsured with this bill — where do you draw that line then with that fudge factor?
What I think is reasonable. That’s one example.
So what’s reasonable?
The Senate bill relative to the House bill put $15 billion up in the first two years to lower premiums. The CBO gave no credit to that. It was as if $30 billion had not been spent to stabilize the market and lower premiums. Now, intuitively, you know there are people who are not buying insurance that cannot afford, that if you are lowering premiums by that much someone more is going to buy it, but that model doesn’t take that into account.
Now, can I give you a number? I can’t give you a number. But what I can say is that when you look at it, intuitively there is a problem with their model. I think the CMS actuaries kind of picked up on that. They actually gave credit, as I recall off the top of my head, for the fact that $15 billion had been spent for two successive years to lower premiums. So that’s it.