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This is how Senate Republicans could push their health bill through without a CBO score

The Washington Post via Getty Images

Senate Republicans may not wait for the Congressional Budget Office to measure the effects of a controversial change to their health care bill that would let insurers sell plans too skimpy to pass muster under Obamacare.

Sen. John Thune, a Republican from South Dakota, reportedly told the Huffington Post's Matt Fuller that Congress might skip the CBO process altogether:

This would be a highly unusual move. It would mean senators would vote without an independent, nonpartisan estimate on how much the bill would cost and how many people would lose or gain insurance. It would also shift responsibility for the assessment to an agency that reports to President Donald Trump. And the president definitely has an interest in the outcome — in fact, the White House was already working to cast doubt on earlier coverage estimates for the health bill.

The CBO estimate of the original version of the health care bill estimated that 22 million fewer Americans would have health insurance as a result. That number didn't help sell the bill to the public. So it's pretty clear why Republicans might want a friendlier analysis of the impact: They want a better outcome.

And here's the thing: They can probably do that.

There is no Senate rule that requires the budget committee to use CBO estimates to calculate the cost or impact of potential legislation. It's just been done that way for decades.

Budget experts say that If Congress wanted to swap in estimates from, say, the White House Office of Management and Budget for the ones typically provided by the CBO, it probably could. Nobody can be 100 percent sure what will be deemed allowable — this is relatively uncharted territory.

When asked in April whether Congress could do this to pass tax reform, this is what Alan Frumin, a former Senate parliamentarian said:

“I don't think ... that there is anything that would prevent the Senate Budget Committee from using OMB projections instead of CBO/JCT projections,” Frumin wrote in an email. He added this catch: “Other than the institutional embarrassment of a house of Congress snubbing its own budgetary experts in favor of those from a different (and Constitutionally competing) branch of the government.”

This has come up before. There were conservative rumblings in 2015 that Republicans could use their own estimates to repeal Obamacare under the same Senate rules. Back in the 1990s, the Senate actually did it when they disagreed with the CBO’s assessment of the sale of oil reserves.

So the idea isn’t that far-fetched. But it would be a big shift from the norm. Whether or not Senate Republicans will end up choosing this route is uncertain. But it raises questions about the partisan nature of giving the responsibility to the Department of Health and Human Services. Tom Price, the Trump appointee who leads the agency, has criticized CBO estimates in the past. Last month, Price told the Atlantic's editor-in-chief, Jeffrey Goldberg, that CBO estimates are flat-out wrong.

"They do a relatively poor job of what the coverage consequences of a health care plan are," Price said. "Their ability — anybody’s ability — to predict what human behavior is going to be without looking at the entire construct, is difficult. I would suggest to you that the numbers the CBO had before with the ACA, and the numbers they have now, are not accurate.”

Maybe Price thinks his department can do a better job.

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