The Congressional Budget Office is expected to release its cost estimate for the House-passed ObamaCare replacement Wednesday afternoon, which could force House Republicans to revisit their health care plan.
Partnering with the Joint Committee on Taxation, the CBO has already released two budgetary scores on the AHCA.
But in an atypical move, the House passed a new version of the contentious legislation on May 4 — without a final audit from the CBO.
Here’s a look at how the third score could impact the future of the legislation.
What is the Congressional Budget Office?
A nonpartisan federal agency, the CBO provides analyses of budgetary and economic issues, typically before the House or Senate vote on a piece of legislation. The agency does not make policy decisions or endorsements but provides an analysis on what impact a bill would have on the budget.
“It simply informs the Congress on what they’re about to do. It doesn’t actually keep them from doing it if they want to, but it often has political effect,” Dr. Philip Joyce, author of “The Congressional Budget Office: Honest Numbers, Power, and Policymaking,” told Fox News.
The CBO was formed in 1974 due to the Congressional Budget and Impoundment Control Act — signed into law by former President Richard Nixon.
Why does a CBO score matter?
When it comes to health care, the CBO cost estimate is able to determine a unique portion of the legislation’s impact that isn’t solely financial — and that is the number of people who are insured under the plan, according to Joyce.
“In part of doing an estimate of what the cost would be, [the CBO] actually has to determine how many people would be covered or not covered in terms of the provisions of the health care legislation,” Joyce, a University of Maryland professor of public policy, said. “It’s not part of the cost, although it feeds into the cost, but it’s definitely something that people can grab onto who may be concerned about the effect of the legislation on the availability of health care.”
Secondly, the CBO score provides an estimate of the fiscal impact of the legislation and how it could affect the overall deficit.
Joyce said one component of the CBO score isn’t exactly more important than another but predicted that Republicans would focus more on the cost estimates whereas Democrats would focus more on the number of people who could be left uninsured.
“But if somebody is looking for a reason to oppose … the American Health Care Act, they’re more likely to oppose it based on the number of people who are not going to be covered so the Democrats are more likely to grab onto that estimate,” he said.
What was the CBO’s last score?
The Congressional Budget Office has already issued two estimations for different versions of the AHCA — one on March 13 and the following on March 23.
The first estimate predicted that the health care legislation could reduce federal deficits by $337 billion from 2017 to 2026.
But the score also predicted that 24 million people would be left uninsured under the AHCA — including approximately 14 million people immediately. However, House Speaker Paul Ryan, R-Wisc., argued that the number included people who would simply opt out of insurance whereas under the Affordable Care Act, Americans were required to be insured or face a penalty.
The second CBO score estimated that the AHCA would reduce the deficit by $150 billion over a 10-year span. Yet it still concluded that 24 million people would be left without insurance.
What can we expect with the new score?
Joel White, president of the Council for Affordable Health Coverage, said he does not think that the updated CBO score will be much different from past scores, but it can “still bear significant consequence and will again highlight some of the imperfections of the House-passed bill that the Senate must reconcile, including coverage losses, a rocky transition period and gaps in the bill’s policies on preexisting conditions.”
“ObamaCare is failing Americans through increased costs and fewer coverage options. It must be reformed,” White said. “But the most recent CBO projections of the House bill showed significant increases in premiums in 2018 and 2019 and massive losses in coverage over the next decade. We expect today’s score to show a similar pattern.”
“ObamaCare has already put Americans through enough headache as it is, and consumers should not have to see things get worse before they get better,” he added. “The CBO score will serve as an important reminder that, when it comes to replacing ObamaCare, we have more work to do, and we need to get this right,” White said.
Could the House have to vote on the health care legislation — again?
It’s been a few weeks since House Republicans passed their legislation aimed to dismantle and replace former President Barack Obama’s legacy health care bill — and it still has not gone to the Senate.
By waiting to send the bill over to the Senate, Ryan can enact an “arcane part of the budget process called reconciliation,” Joyce said.
Reconciliation can make passing the health care legislation in the Senate easier as it prevents a filibuster, Joyce said — but the process comes with its own unique set of rules and hurdles.
Specifically, the new legislation will need to save at least $2 million as well as make other deficit reductions. Should the CBO report find that the bill does not save money, the House could be forced to redo the legislation yet again and hold another vote.
In March, the House GOP was forced to pull its health care legislation and rework the bill as it couldn’t garner enough support as it was.
Is the MacArthur amendment a game changer?
The MacArthur amendment — from Rep. Tom MacArthur, R-N.J. — was a late provision to the newest version of the AHCA and succeeded in appeasing some conservative lawmakers as it allows states to opt out of two key ObamaCare provisions.
First, the amendment allows states to do away with the community ratings provision. Under ObamaCare, this provision required insurers to provide the same price for insurance regardless of any factor, including race, gender and preexisting conditions.
The amendment also allows for a state to define its own essential health benefits whereas under ObamaCare, insurers were required to cover a set litany of essential health benefits, such as maternity care.
Joyce predicted that the MacArthur amendment could make a “significant difference” to the CBO cost estimate as it could lower the amount of savings predicted in the first CBO report.
“I think the big thing to focus on, the big difference between this bill and the original bill really has to do with the MacArthur amendment, and the thing to focus on is really comparing the two to each other,” he said. “What is it that the changes in this particular bill will do in respect to changing that CBO cost estimate?”
What has the response been to previous CBO scores?
With the past CBO reports, Democrats have seized upon the certain numbers in the scores — including the number of uninsured under the AHCA — to slam political opponents.
Democrats have even raised the alarm that “people will die” should the AHCA be passed.
“This isn’t football. It’s not about scoring points. [The AHCA] will devastate Americans’ healthcare,” Sen. Elizabeth Warren, D-Mass., tweeted earlier this month. “Families will go bankrupt. People will die.”
And Rep. David Cicilline, D-R.I., said from the House floor earlier in May that “tens of thousands of Americans will die if this bill passes.”
“That’s a fact,” Cicilline said.
Republicans have focused on the deficit reduction portions of the CBO report.
Following the first CBO estimate in mid-March, Ryan heralded the report as it “confirms that the American Health Care Act will lower premiums and improve access to quality, affordable care.”
“When people have more choices, costs go down. That’s what this report shows,” Ryan said.