Affordable Care Act

CBO Says the GOP's Updated Obamacare Repeal Bill Would Be Worse for the Deficit

The Republican health care bill would still reduce insurance by 24 million and raise insurance premiums before 2020.

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Jeff Malet Photography/Newscom

On Monday, House GOP leadership released a package of updates to the health care bill in the form of a manager's amendment. The changes, which included a carve out for New York state legislators and bonuses to states that implement work requirements in Medicaid, were designed to appease holdouts, many of whom are members of the House Freedom Caucus, a group of conservative lawmakers.

The changes aren't likely to win over many conservative lawmakers, however, because the main effect would be to cut the health care bill's projected deficit reduction in half. The initial version of the law would reduce the deficit by about $337 billion over a decade, according to the Congressional Budget Office. But according to an updated CBO score released tonight, the new version incorporating the manager's amendment would only cut the deficit by about $150 billion. And what deficit reduction there is would take eight years to actually kick in, thanks to the way the bill's tax and spending provisions are timed.

On all the other major measures, the CBO's estimates remain the same. The bill would still reduce insurance coverage by 24 million, relative to current law, a decade from now. Individual market premiums would still rise by 15 to 20 percent more than they otherwise would between now and 2020, and then fall relative to the trendline after 2020 (at least for younger people).

The manager's amendment, in other words, made no difference in the CBO's estimates of the law's performance, except to make it worse for the budget.

The CBO's new estimate does not account for other changes Republicans are reportedly considering making to the bill, like eliminating Obamacare's essential health benefits rules. But it's hard to imagine that any conservative holdouts will look at the new score and come away pleased.

It certainly doesn't provide backers of the bill with any useful talking points. When the CBO score for the original bill was released, Speaker of the House Paul Ryan praised it, saying that the CBO score confirmed that the health care bill would reduce the federal deficit by $337 billion. The CBO has now confirmed that the latest version of the bill reduces the deficit by a lot less.

With a vote on the bill delayed until tomorrow, and possibly longer, the bill is already struggling to pick up enough support to pass. The CBO's latest report isn't likely to boost its chances.

NEXT: House Delays Obamacare Repeal Vote Because There Still Isn't Enough Support to Pass It

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  1. If you like your lifestyle, you can keep your lifestyle…

  2. which included a carve out for New York state legislators

    Cornhusker Kickback Part Deux: Now It’s Our Turn!

  3. included a carve out for New York state legislators

    designed to appease holdouts, many of whom are members of the House Freedom Caucus, a group of conservative lawmakers.

    Does not compute.

    1. Scroll down to NY State section.

      Commenting here sucks

  4. I don’t know why we are even discussing the CBO score when they were so far off with Obamacare. They were WAY WAY off about insurer profitability. They projected that reinsurance payments lowered premiums by about 10% in 2014, further study showed net reinsurance payments equaled about 20% of premiums?double what CBO expected.

    The list goes on. Until CBO can prove itself to be non-partisan and accurate in its predictions I question the use of its projections.

    1. You do know the CBO director is a Republican appointee, right?

      1. What does that have to do with his or her point?

        1. If the CBO is partisan right now it’s more likely in the GOP’s favor, and if anything is underestimating the costs of the bill.

        2. MarkLastname covered it — saying that you’re not going to believe the CBO’s negative scoring of a Republican-sponsored piece of legislation because the CBO hasn’t proved itself to be non-partisan (and how can the CBO prove that anyway?) when the director of the CBO is a Republican appointee is bizarre unless you have some proof that Keith Hall (the CBO director) is some sort of deep-cover Democratic mole who cleverly fooled the chairs of the House and Senate Budget Committees (who were both Republicans at time of Hall’s appointment in 2015) into appointing him.

    2. I don’t think it’s about partisanship. I think it’s about assumptions.

      If you ask the CBO, “If we assume socialism is awesome, will central planning work this time?” of course they will answer “yes”. So their predictions are based on, at best, flawed assumptions. And it’s kinda stupid to be trying to make predictions on such a vast scale anyway. Hayek and all that.

      1. Yea agreed. And it seems like a slightly lighter ocare so i dont understand the amount losing coverage

      2. Yep. For instance, if Congress was considering a bill that doubled all tax rates, the CBO would predict a doubling of tax revenues. Would that actually happen? Hell, no.

    3. Yes, I think that it is better to enact legislation without a score.

      And ignore the CBO which states that their estimates have uncertainties and assumptions built into them, and are very likely to be off when implementation does not follow. When Medicaid expansion as planned was halted by the SCOTUS, well, assumptions are off.

  5. How would it reduce insured by 24 million when aca resulted in only 20 million new mainly medicaid

    1. Because all non-US citizens legal or not would be deported or sent to concentration camps, because Trump is literally Hitler II or something, and some of them have employer provided insurance.

      1. Uhhh, that was a math question. 24 is more than 20..

    2. In fairness, the whole 30% surcharge thing really is dumb. That alone will likely cause a bunch to drop insurance. Why carry insurance for years and years when you can drop insurance now, then when you get sick, sign up for insurance and pay a paltry 30% surcharge on that one year’s premium in order to get it all paid for? People will be gaming the system like crazy if that actually goes through.

      They don’t want “free market health care”. They want Obamacare-lite, and they are adopting a really stupid version of it.

      1. Well ya but that is going on now

        1. Under Obamacare, one big way to game the system is to sign up for insurance and not pay the bill. Under Ryancare, the big way to game the system is to not even get insurance at all. Those two lead to different predictions on who gets insurance.

          1. Why bother doing that? Just pay or not pay the penalty which was small and uneforceable essentially. Sign up when you need it since you can’t be denied

      2. The mandate while i dont agree with it is kind of a joke

      3. Yeah but they assume that the mandate leads to large increases in coverage. But the things you are saying also apply to the mandate which is very weak as well.

        1. Yeah but they assume that the mandate leads to large increases in coverage

          The insurance industry demanded it, then the Dems fucked up and kept it too small,

          Obama had campaigned AGAINST the mandate, saying it would have to be HUGE. Instead he said we had to reduce costs first — which his original proposal would have — with an explicit alternative to a public option, but REPUBLICANS REFUSED –which forced him to deal with his far right,

          Obama proposed a centrist plan to get more Republicans than his far-left wing … exactly like Kennedy’s tax cuts. But THIS GOP is dominated by partisan asshole — in league with the libertarian establishment.

      4. You can’t have free market health care without legalizing all drugs and medical devices and ceasing to license doctors and nurses.

        1. So????

          For now, why not simply restore what we had, that worked. 100% treatment for ALL who sought it, regardless of age or income .. paid 100% voluntarily … no government and no health insurance industry

          Are you one of those Authoritarian Minds that objects to anything less than some theory of perfection?
          Even Ayn Rand said that was nuts.

    3. Because there are 320 million in the USA, not all of whom were on Medicaid

      1. Ok cool so why would the non-medicaid folks lose coverage? And by what mechanism?

        1. Ok cool so why would the non-medicaid folks lose coverage? And by what mechanism?

          In a free market every one of them got treatment if they merely sought it, all paid voluntarily.

          Today’s fiscal conservatives (aka goobers) babble about the glories of private charity … but know NOTHING about it.

      2. Because there are 320 million in the USA, not all of whom were on Medicaid

        How is that relevant to anything? Anything at all?
        Does ANYONE disagree with that (allowing for popultion changes? Ever?

    4. Because 8 years have passed and medical inflation is always quite a bit higher than incomes growth (and esp for the more marginal/erratic incomes). And at that income level, rents are already squeezing things.

      1. Ok but that doesnt explain this law vs the current one why it would result in much more without insurance.

        I am talking proposed vs baseline. What you said seems to happen either way. It isnt as if aca is affordable healthcare

        1. The number of uninsured rises by about 7-8 million every 10 years and has pretty steadily for 40 years or so. It’s an item in the low income budget that gets squeezed. Freezing off the Medicaid expansion and eliminating the mandate again puts us back on that trend line – which is now higher than it was 8 years ago.

          1. Freezing off the Medicaid expansion and eliminating the mandate again puts us back on that trend line –

            That trend-line CREATED by government health care MUST be restored … even if people die … and even if the unTREATED was 0% before FDR.

            You confuse coverage with treatment … precisely like the other proggies.
            And you place government-created trend lines above human compassion that has existed for over 400 years — orf paid treatment, and thousands of tears before ir was transactional.
            .
            You are a SEVERE THREAT to individual liberty. And simple humanity

  6. Deficits Shmeficit… just pass the damn bill.

    Look, Republicans don’t care about the deficit.
    reason.com Republicans posing as libertarians don’t care about the deficit
    The bill was slammed through committee before a CBO score was obtained.

    Just pass the damn bill.

    1. Per the article it says it would reduce the deficit slightly. Do you want them to completely get rid of it? I am not sure

    2. Deficits Shmeficit… just pass the damn bill.

      Fine for YOU — who wants a Democrat landslide next yeat …

      reason.com Republicans posing as libertarians don’t care about the deficit

      Yeah, but those dumbdfucks are all in the commentariat.

      The bill was slammed through committee before a CBO score was obtained.

      Along with every single bill in the last 43 years. It’s gummint, so they have all these crazy rules — like they refuse — REFUSE — to score a bill before it exists. Imagine that!

  7. “The Republican health care bill would still reduce insurance by 24 million and raise insurance premiums before 2020.”

    I read a local story about a baby with a heart defect. There’s no way it could survive without heart surgery, but obviously you can’t cut into the chest of a baby. So the baby had to die.

    Actually, that isn’t a true story–the idea that you can’t save something long term because of short term pain–how ridiculous is that?

    Private payer rates can’t come down without undoing the ObamaCare Medicaid expansion.

    http://www.aha.org/research/re…..art4-6.pdf

    That the Ryan plan doesn’t undo the ObamaCare expansion completely until 2020 makes it politically palatable to do it. Doesn’t mean the effort shouldn’t be supported. Any “solution” that doesn’t undo the ObamaCare Medicaid expansion isn’t actually addressing the cause of the problem.

    And how many of those supposed 24 million people who won’t have any insurance after the individual mandate only buy insurance because of the individual mandate? The progressives are using law enforcement, the IRS, to impose their own personal preferences on other people. They’re basically acting like fundamentalist Christians do on creationism, gay marriage, and prayer in public schools. They should be ashamed of themselves.

    1. Private payer rates can’t come down without undoing the ObamaCare Medicaid expansion.

      No. The two are unrelated . PLUS your link to a table that shows that Medicare and Medicaid pay less than private insurers which is (a) common knowledge and (b) irrelevant.to … whatever your point is.

      Doesn’t mean the effort shouldn’t be supported. Any “solution” that doesn’t undo the ObamaCare Medicaid expansion isn’t actually addressing the cause of the problem.

      Umm, in a free market it would expand IMMENSELY … to 100% of low-incomes — as it was for the 500 years before Medicare and Medicaid.

      Problem is, NOBODY on the fiscal right has a freaking clue how to restore the OUTCOMES of a free market. So the progs will continue kicking their asses.

      And how many of those supposed 24 million people who won’t have any insurance after the individual mandate only buy insurance because of the individual mandate?

      Ummm. Medicaid is free, and the exchanges get large subsidies. Have you been following ANY of this?

      The progressives are using law enforcement, the IRS, to impose their own personal preferences on other people

      Even MORE bullshit. THE PEOPLE want universal treatment, and have ALWAYS paid for it. THAT is what the people want. Conservatives/libertarians are too fucking stupid to restore that — and blame everyone else for their incompetence.

      1. “Medicaid is free”

        But not really, right?

        Not everyone qualifies for medicaid. Otherwise, everyone would migrate there to escape the penaltax, the premiums, deductibles, etc. The people who receive subsidies to buy healthcare almost certainly made too much money or couldn’t meet certain standards to qualify for medicaid.

        Ken mentioned that people were forced to purchase insurance by the individual mandate. Or they had to buy new ones when their non compliant plans were cancelled. Most of them almost certainly did not qualify for medicaid. This is old news.

        You realize that people still have to worry about a whole bunch of out of pocket costs even after receiving subsidies?

        1. KenSchulz: And how many of those supposed 24 million people who won’t have any insurance after the individual mandate only buy insurance because of the individual mandate?

          Mike Hihn: Ummm. Medicaid is free,and the exchanges get large subsidies. Have you been following ANY of this?

          But not really, right?

          It’s free to the people we’re talking about. I corrected your bullshit what was said.

          Not everyone qualifies for medicaid

          Umm, the people now on it do.
          The crazier Republicans and libertarians want to scale that back — in defiance of what the people want. and have been willing to pay for — for over a century.

          Otherwise,…

          Irrelevant

          Ken mentioned that people were forced to purchase insurance by the individual mandate. Or they had to buy new ones when their non compliant plans were cancelled. Most of them almost certainly did not qualify for medicaid. This is old news.

          NOT WHAT I QUOTED … now we know why you LIED about the dialogue. Shame on you.

          You realize that people still have to worry about a whole bunch of out of pocket costs even after receiving subsidies?

          Yeah I also know how many feet are in a mile, which is also irrelevant to the portion you lied about so shamelessly.

          But thanks for sharing your feeeeeeeeee-lings, snowflake

  8. The fact that the spending reductions are delayed until the 2020 election year has been one obstacle to gaining conservative votes for the bill, as some members are skeptical that the most hotly contested elements of the legislation would actually be implemented in the height of an election, especially if Republican majorities are reduced in the 2018 midterms.

    Skeptical, eh? You mean after only a few dozen times of getting conned with promises of getting paid next Tuesday for a hamburger today they’re starting to get reluctant to hand over more hamburgers?

  9. Before LBJ’s Medicare/Medicaid debacle, NO Americans (in general) were denied treatment because of age or income … nor were any humans since the 1500s, when the first fraternal organizations began providing humanitarian aid.

    Healthcare remains the dumbfuck failure for fiscal conservatives, including the entire libertarian establishment — who for two decades or so have been TOTALLY clueless on the dynamics of free markets.

    Instead of reciting memorized slogan and soundbites with gasbag theories, why not restore the KNOWN OUTCOMES of a free market in healthcare?. 100% treatment? Because they have no clue. And they pander to goobers.

    Yes, Repeal and Replace, but replace with a transition back to free market OUTCOMES. (Uhhh, WE DON’T NEED NO FREE-MARKET OUTCOMES.)

    So the progressives will continue kicking their ass. Trump’s approval on healthcare is now less than 35% and falling. Support for Obamacare is at record highs and INCREASING. A strategy worthy of George Custer!

    It’s conservatives who babble, self-righteously, that Americans are the most humanitarian people on earth,
    Which is WHY progressives are kicking their ass … because conservatives have NO better way to provide what people have been willing to pay for … since the Middle Ages … and ridicule anyone who tries.

    The Authoritarian Mind is the greatest obstacle to liberty, and it now dominates BOTH competing primitive tribes.

    1. Michael Hihn|3.23.17 @ 8:43PM|#
      “Healthcare remains the dumbfuck failure for fiscal conservatives, including the entire libertarian establishment — who for two decades or so have been TOTALLY clueless on the dynamics of free markets.”

      Reason: Hihnfected with dumbfuckism.

      1. Sevo REFUSES to accept that the poor and elderly were ALL treated … before LBJ.
        Sevo RIDICULES private charity.
        Sevo DENIES the unique humanitarian achievement of Americans.
        Sevo REFUSES to accept that humans have NEVER knowlngly allowed humans to suffer — since fhe 1500s.

        SEVO — AN EVER-WITLESS TOOL OF THE ANTI-GUMMINT AUTHORITARIAN MIND — INSISTS THAT VOLUNTARY ACTION BY HUMANS IS IMPOSSIBLE — THE CRITICS OF AYN RAND ARE CORRECT …. THUS, ANYONE WHO WANTS TO CONTINUE THOUSANDS OF YEARS OF HUMANITARIAN AID — BY HUMANS — MUST CHOOSE GOVERNMENT TO DO SO! (THAT is Authoritarian Mind, empowered by NAP)

        Rarely is it so clearly shown — the ABSOLUTE moral and intellectual bankruptcy of anti-gummint-goober libertarians.

        The pro-libery position: Americans have always chosen to pay for health care to all who sought it,
        Create a smooth and seamless transition back to the free market that provided it.
        (the difference between hating government and loving liberty)

  10. “The manager’s amendment, in other words, made no difference in the CBO’s estimates of the law’s performance, except to make it worse for the budget. ”

    Reason did a good article at the time of O-care’s proposal which showed how the CBO’s numbers had been gamed to show some fanciful amount.
    Peter, once you drag that up and compare, I’ll get concerned about the CBO’s estimate here.
    In no means is this a defense of the R-care replacement for O-care, just a statement that the CBO’s numbers need a connection to reality.

    1. I assume you MUST have a link that you checked before citing CBO estimates from so many years ago,
      Simply paste it in.

      Suderman REPORTED that the White House showed CBO was off on loss of coverage.
      The Trumpsters said MORE Americans would be thrown to the wolves. oooopsie

      https://reason.com/blog/2017/03…..ouse-gop-h

      Umm, why should ANY lose existing coverage when
      a) Trump promised MORE would be covered.
      b) EVERYONE was treated, regardless of income or age, before LBJ.

      Why are conservatives — and libertarians — so TOTALLY incapable of restoring the OUTCOMES of a free market? Americans have ALWAYS wanted care for the needy … and been willing to pay for.
      If you refuse to even TRY, then the progressives will keep kicking your asses.

  11. Republicans discover that their hard-working, patriotic, independent constituents want free shit just like Democrats; Trump gets mad, takes ball and goes to Palm Beach.

    1. And the libertarians who are easily suckered by free tax cuts.

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