Last week, I wrote an item that made what can only be called a highly unflattering assessment of Alabama Senator Jeff Sessions. Sessions touted a study from the General Accounting Office that, he claimed, proved that Obamacare’s fiscal assumptions were lies and that the law would increase the deficit. In the item, I argued that the report showed no such thing and was following directed assumptions that its cost containment efforts would fail. I called Sessions a “Wonk McCarthyite,” and illustrated his fallacious reasoning with a tongue-in-cheek analogy to my asking the GAO to assume that Sessions were to acquire a nuclear weapon and detonate it in Manhattan, and then touting this report as finding that Sessions was going to murder 4 million people.
Senator Sessions’s staff on the Budget Committee has contacted both me and my editor objecting to the item in the most strenuous terms. I have further explored the matter at length and determined that, in my haste, I treated Senator Sessions’s claims far too generously. Senator Sessions’s combination of ignorance and gross lack of intellectual standards turns out to be even more horrifying than I managed to initially communicate. Calling Sessions a "wonk McCarthyite" implies a level of policy understanding on his part that is wholly unsupported by the facts.
I would first like to concede one point of neglect. The Republican Senate staff objects that my item failed to include a hyperlink to a post by Aaron Carroll, on whose analysis I partly relied. I apologize for the oversight. Sessions’s office further contends that Carroll, whom it correctly if incompletely characterizes as “a pediatrician,” is not a reliable source on matters of health-care finance. I replied that I consider Carroll, who is also director of the Center for Health Policy and Professionalism Research at Indiana University, and a co-author of the respected health economics blog the Incidental Economist, a reliable source on these matters. We agreed to disagree on this point.
In my haste I also, in addition to forgetting to include the Carroll hyperlink, failed to adequately capture the staggering dishonesty in Sessions’s public claims. Sessions claimed that the GAO report demolishes the accounting assumptions of Obamacare:
“The report reveals the dramatic falsehoods that were used to push [the bill] to passage," Sessions said …
"The big taxes increases in the bill come nowhere close to covering the bill's spending. … The big-government crowd in Washington manipulated the numbers to get the financial score they wanted, to get their bill passed and to increase their power and influence."
This is grossly false. The GAO study does not find that the tax increases in Obamacare fail to cover its spending. The study, in fact, does not measure the tax increases at all. It only looks at the costs of the bill, not at the revenue it raises. (As the report says, “Increases in revenue related to PPACA did not affect the long-term assumption for revenue in the Alternative simulation, which assumes that revenues return to the historical average after 2020.”) The report assumed, at least in the set of assumptions quoted by Sessions, that all the higher tax in the law disappeared after 2020.
You may be wondering why the report did such an incredibly odd thing. Here is where the unusual dynamics of the situation require some explanation. The Government Accounting Office is a kind of in-house think-tank for Congress and has earned a sterling reputation. Because it is subordinate to Congress, members of Congress can order up reports in order to advance their chosen agenda. And while GAO’s analysis is rigorous, Congress can set the parameters of that analysis.
This is the point I was making when I wrote, “the report turns out to be following directions to assume that all of the efforts in the law to control health-care cost inflation fail or are repealed, and the portions that provide coverage are kept in place.” The GOP budget staff vigorously objects to this passage in particular. I asked them to send me their request to GAO. Instead, the budget staff sent me GAO’s letter to them agreeing to do the report. When I replied that this was GAO’s letter to Sessions, rather than Sessions’s letter to the GAO, they told me the request had been made verbally and no written record could be found.
I called Susan Irving, the lead author of the GAO report. As you might expect, given the extremely difficult position in which she finds herself, the interview was pretty strange. GAO used two different possible scenarios. The first, which assumed Obamacare is actually carried out as written, shows it would substantially reduce the long-term deficit. But the report also used a second scenario, which GAO has used in the past, making more pessimistic assumptions, such as that future Congresses would pass new laws canceling out the cost-control provisions in the law. The main point of the paper was that its success in controlling costs depended on how well Congress stuck with the cost controls in the law — which is axiomatic, obviously. “There’s not much news here,” she told me.
But part of that pessimistic scenario also assumed that tax levels would revert to their historic average. Because the law was largely financed through new taxes, this meant it assumed zero effect after 2020 from the taxes in Obamacare. Obviously, since a big part of the law’s savings come from new taxes, choosing to ignore the taxes would make it look like it increases the deficit.
Irving repeatedly told me, “This is not a projection.” And of course it’s not a projection — you can’t analyze the effect of a bill on the deficit while ignoring the impact of its biggest source of savings.
What I wanted to know was why GAO used this method — why examine only the costs of the bill and not its net effect on the deficit? GAO’s letter to the Republicans on the committee promised the report would be “a general estimate of the effects of the coverage provisions in PPACA.” But “the coverage provisions” sounded like it meant just the parts of the bill that expand health-insurance coverage — that is, GAO would measure the cost of covering uninsured people, but not the savings that help pay for it. I asked Irving if this is what “coverage provisions” meant. She told me, “We were asked to look at the coverage expansion.” Asked, that is, by the Republican staff.
This didn’t really answer the question, so I kept pressing, and she kept offering up the same answer. When I told her this didn’t seem to answer the question, she replied, “You have been a reporter long enough to know why I am repeating something verbatim.”
In any case, a few things are clear. Sessions’ request is not on record, but GAO agreed, in response, to publish a study that would measure the costs of Obamacare but not its net effect on the deficit. The GAO knew this, and then Sessions falsely claimed the study concluded something completely at odds with its actual findings.
In sum, I apologize to my readers, the citizens of Alabama, budget fans, and other concerned citizens for failing in my original post to adequately convey the full paucity of the intellectual standards of the junior senator from Alabama. I hope I have rectified my failure here.
This piece has been updated throughout.