GOP senators are having a hard time pinpointing just how many uninsured they can live with

Senate leaders unveiled another revised health care bill on Thursday, and once again, several Republican senators would not say if they would vote for it. Instead, many of them said they were reviewing it, seeking expert analysis and waiting for the Congressional Budget Office to release its score.

But several GOP senators struggled on Thursday when asked to pinpoint what a sufficient score would be for a “yes” vote — in terms of how many more Americans the plan would leave uninsured.

Republicans were hoping this version of the Better Care Reconciliation Act would get a better score from the CBO this time, after it found the original draft would slash more than $770 billion in Medicaid spending and leave 22 million more uninsured than under current law. The revised bill includes 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 millions uninsured.

Vox asked four Senate Republicans what they considered a “good” score — and how they draw the line between too many people uninsured and a number they can justify.

“We look at the CBO score, we look at other analysts and research done on this proposal and look forward to finding that legislation that repairs the damage done by the Affordable Care Act,” Sen. Cory Gardner (R-CO) said, talking around the question. Gardner did not commit to voting for the first draft of the bill.

Sen. Jeff Flake (R-AZ) laughed at the question altogether. Flake, who sits in one of two vulnerable 2018 Senate seats, came out against the original draft of the BCRA. He seemed happier about the revisions but wouldn’t give his position. Asked about a CBO score that would likely show tens of millions losing their health insurance, Flake deflected.

“There are a lot of people uninsured now,” he said.

Below are the transcripts of my interviews, slightly edited for clarity.

Sen. Jeff Flake (R-AZ): “There are a lot of people uninsured now”

Photo by Mark Wilson/Getty Images

Tara Golshan

What does a good CBO score look like to you?

Jeff Flake

[Laughs] One where we are fiscally sustainable moving ahead.

Tara Golshan

So how do you draw the line if this bill will probably leave tens of millions uninsured as well —

Jeff Flake

Well, I’m not sure. There are a lot of people uninsured now.

Tara Golshan

But if this score does come back and it says 22 million more than the current law would be uninsured, where do you draw the line? How do you draw the line there?

Jeff Flake

We will address that when we come to it.

Sen. Cory Gardner (R-CO): “It’s a number of analyses we will be looking at”

Photo by Alex Wong/Getty Images

Tara Golshan

What does a good CBO score look like to you?

Cory Gardner

I think a good understanding of the bill is important. We look at the CBO score, we look at other analysts and research done on this proposal, and look forward to finding that legislation that repairs the damage done by the Affordable Care Act.

Tara Golshan

I’m just curious — how do you set the lines here? If the CBO comes back with tens of millions more uninsured —

Cory Gardner

Again it’s a number of analyses we will be looking at.

Sen. Lindsey Graham (R-SC): “They’ve got nobody to blame but themselves”

Photo by Chip Somodevilla/Getty Images

Tara Golshan

What does a good CBO score look like to you?

Lindsey Graham

Uhhh. Reduces the deficit. Fourteen million people are going to drop their health care if they don’t have a mandate. But that’s their choice. But they’ll be taken care of in this — a good CBO score would be one that keeps the deficit reduction in place, because we have a deficit we have to deal with.

Tara Golshan

Right, so knowing that this leadership bill — that health experts say that it will still likely leave tens of millions —

Lindsey Graham

Fourteen million people drop their coverage voluntarily the day you do away with the mandate. They’ve got nobody to blame but themselves. They could keep their coverage, but they choose to drop it.

Tara Golshan

So that’s where you draw the line? You just say okay —

Lindsey Graham

No. I just say that the idea of how best to cover people is done locally, not nationally. The money will go further at the state level than it will ever go in Washington.

Tara Golshan

And you expect your proposal to have a better CBO score?

Lindsey Graham

I don’t know yet.

Sen. Bill Cassidy (R-LA): “What number am I comfortable with — well, I don’t know”

Photo by Mark Wilson/Getty Images

Tara Golshan

What does a good CBO score look like to you?

Bill Cassidy

A good CBO score. President Trump said he wanted people covered, care for preexisting conditions, and lower premiums. That’s the beginning of it.

Tara Golshan

But knowing that these reforms will leave some people uninsured, what level are you comfortable with?

Bill Cassidy

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.

Tara Golshan

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?

Bill Cassidy

What I think is reasonable. That’s one example.

Tara Golshan

So what’s reasonable?

Bill Cassidy

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.

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