The Congressional Budget Office’s official “score” of the Senate GOP’s Better Care Reconciliation Act came out this afternoon, and it contained largely bad news for the bill’s sponsors — though with some significant opportunities for improvements before the bill actually hits the Senate floor.
The big bad number most often cited in criticisms of the House-passed legislation did not get a lot better. The House’s American Health Care Act was expected to cost 23 million Americans health coverage by the end of ten years. CBO estimates that BCRA will lower than terrible number by just one million. So Republican senators like Susan Collins and Dean Heller who said they could not vote for a bill that would deny “tens of millions of Americans” health coverage have no particular reason to prefer this bill more than its “mean” House counterpart.
But there are numbers in the new CBO report that will encourage Republicans. The first involves the impact on the budget: BCRA nearly triples the deficit reduction estimates for the House bill (from $119 billion to $321 billion), mostly because of a combination of a delay in the repeal of certain Obamacare taxes and reconfigured health-insurance purchasing subsidies. Medicaid cuts were slightly reduced (from $834 billion to $770 billion), but that is misleading since the Senate bill provides for deeper long-term Medicaid cuts but “back-loads” them until 2025, which means the deepest cuts fall outside CBO’s ten-year window for making these estimates.
As a practical matter the higher deficit-reduction number is pleasing to conservatives, but also gives McConnell a slush fund to buy “moderate” votes with more generous spending provisions.
The second set of estimates in the new CBO report that will please McConnell involves another key conservative priority — individual insurance premiums. There’s one terrible number: The report suggests a first-year boost of 30 percent in premiums. But that’s because the bill as presented to CBO abolished Obamacare’s individual and employer purchasing mandates without providing any substitute provision to encourage young and healthy people to join or stay in the insurance market. This was supposedly an oversight, and earlier today McConnell announced a new provision that after a certain date would lock new health-insurance applicants out of the markets for six months, presumably encouraging them to enroll earlier.
So you can expect Senate Republicans to dismiss the 2018 premium hike in the CBO report as obsolete. But they will probably embrace CBO’s estimate that in the longer run BCRA will lower individual premiums significantly: “In 2020, average premiums for benchmark plans for single individuals would be about 30 percent lower than under current law. A combination of factors would lead to that decrease — most important, the smaller share of benefits paid for by the benchmark plans and federal funds provided to directly reduce premiums.”
The bottom line for insurance premiums is that people would pay less for less: Many states would presumably opt out of ACA’s required essential-health benefits, and would also take advantage of opportunities to let insurers require more out-of-pocket expenses. But that’s fine with many conservatives who think that’s exactly what the country needs.
So the score is not very attractive, but it does most definitely give Mitch McConnell some maneuvering room, particularly if the deficit reduction and premium estimates calm conservatives down and keep them from making too many demands. It will not be very hard to amend BCRA to reduce the number of people losing insurance. And if that’s all “moderates” demand, 50 votes could yet be within McConnell’s reach.