The long-awaited Congressional Budget Office “score” of the House-passed version of the American Health Care Act–the score House GOP leaders were afraid to absorb before the vote–arrived today. It was not good news for Republicans looking to claim the bill had been improved since the last, very bad CBO score of an earlier version.
CBO figured the bill would cost 23 million Americans health insurance coverage over the next ten years, as compared to current law. That’s slightly under the 24 million estimate for the earlier version of the bill, but for practical purposes about the same. And this small improvement in bad coverage numbers comes at the price of a much lower deficit reduction “score:” $119 billion, as opposed to the original $337 billion.
On the other issue that many Republicans have recently staked almost everything, a reduction in individual insurance premiums, CBO found that after boosting premiums initially, Trumpcare would eventually reduce average premiums—in exchange for policies offering far fewer benefits. For older, poorer and sicker people, however, the picture is much darker. The final House bill’s provisions letting states ask for waivers to get rid of certain mandatory benefits for insurance policies and community rating—a rule that requires people of the same age pay the same price for coverage— makes it hard to know what would ultimately happen, but as Vox health policy wizard Sarah Kliff points out, CBO estimates premiums for some elderly low-income people could go up by 800 per cent.
All in all, about the only good thing in this CBO estimate for Republicans is that it does not indicate the bill failed to comply with the minimum deficit reduction requirements of the budget resolution that authorized it. So the House will not have to vote on it again–at least until (if ever) the Senate passes something and the House has to vote on a final, final version.
The timing for Republicans, moreover, is really bad. A day after the White House released a $4 trillion budget full of draconian cuts aimed particularly at poor people is not the best time to discover that its health care bill will deny health insurance to 23 million Americans in order to generate budget savings that look like sofa cushion money compared to the large deficits the administration is apparently willing to accept. Moreover, the GOP’s reactionary and politically dangerous fiscal calculus of stiffing needy people in order to finance tax cuts for the wealthy is becoming very evident in the tradeoffs Trumpcare creates. As CBO notes, AHCA would reduce federal revenues by $992 billion — in no small part by cutting taxes on wealthy people. Looking at the impact of repealing “Obamacare taxes,” James Fallows notes:
This is a political nightmare for Republicans. And while the House GOP can bid Trumpcare a not-so-fond farewell for the moment, the CBO “score” should tell Senate Republicans they’d better start all over, miles from the toxic package the House sent them.