END OF 2018 OPEN ENROLLMENT PERIOD (42 states)

Time: D H M S

GOP once again furious with CBO for insisting on following the rules.

Last July I posted:

Several regular commenters here at ACA Signups have been wondering why the Congressional Budget Office keeps using March 2016 as the "baseline" for projecting the net impact on healthcare coverage numbers under the GOP's Trumpcare bills (the House's AHCA and the Senate's BCRAP), as opposed to the more recent January 2017 baseline. After all, according to the March 2016 baseline, the CBO was projecting that under the ACA, the total individual market would have 25 million people as of 2026 (18 million on the exchanges plus another 7 million off-exchange), whereas under the January 2017 baseline, their projections are for the individual market to only be 20 million as of 2027 (13 million on the exchanges plus 7 million off-exchange). Taken at face value, this would seem to suggest a 5 million enrollee discrepancy. This drumbeat has been taken up more recently by GOP Senators, particularly Wisconsin Senator Ron Johnson.

...Still, it's a reasonable question to ask: Why not use January 2017 estimates as your baseline if they're available? Well, according to the CBO, that's the way the GOP wanted it:

CBO acknowledges that it is using the March 2016 data. But it says it is following standard procedure in doing so.

Republicans are moving their healthcare bill through the Senate under special budget reconciliation rules that prevent Democrats from filibustering the legislation. As part of that process, they passed a budget for fiscal year 2017 in January. That budget was based on CBO’s March 2016 baseline.

CBO traditionally uses the same baseline for bills passed under reconciliation as is used for the budget. This is why it used the March 2016 data as a baseline for its score on the Senate’s healthcare bill.

Senate aides agreed that the CBO used the older data based on instruction by House GOP leaders, who did not expect the process of passing the healthcare bill to drag on for so long. At a GOP retreat in Philadelphia in January, Speaker Paul Ryan (R-Wis.) outlined a 200-day agenda that anticipated repealing and replacing ObamaCare in April.

But as the Senate continues to struggle to pass its own healthcare bill, and as centrists worry over the CBO’s findings, that is looking like a costly error.

Republican senators grilled CBO Director Keith Hall over the issue when he spoke to the GOP conference on Tuesday, the day after it issued its damning report.

...Hall, the CBO director, pushed back against GOP senators in the meeting, arguing that it could take weeks to build new models based on more recent data, setting up a contest of wills between Senate Republicans and Congress’s official scorekeeper.

In short, Paul Ryan insisted on using the March 2016 projections because it was apparently the only way they'd be able to cram the Trumpcare bill through the Senate with only 50 votes. Now that the score based on March 2016 numbers sucks, the GOP Senate is insisting on using the January 2017 projections.

OK, so what about now? It's been several months, so presumably the CBO has had plenty of time to build their new models based on the more recent data, right?

CBO has changed its model to now show that repealing indiv mandate now saves a lot less and less coverage loss, per Cassidy

— Peter Sullivan (@PeterSullivan4) November 7, 2017

Cassidy is frustrated they didn't change it before when they were scoring G-C

— Peter Sullivan (@PeterSullivan4) November 7, 2017

Because health reform was under FY17 reconciliation, and that budget was based off Mar 2016. A new bill would be measured from Jun 17

— Tyler Evilsizer (@TylerEvilsizer) November 7, 2017

More Cassidy on CBO/mandate: "They’re going to say it's significantly less effective than they originally thought."

— Peter Sullivan (@PeterSullivan4) November 7, 2017

CBO this morning:

Today CBO Will Publish an Updated Estimate of the Effects of Repealing the Individual Mandate

Posted by Keith Hall on November 8, 2017

Late this afternoon CBO will publish an updated estimate of the effects of repealing the individual mandate requiring people to have health insurance meeting specified standards and that imposes penalties on those without an exemption who do not comply.

In that document, CBO and the staff of the Joint Committee on Taxation estimate that repealing that mandate starting in 2019 would reduce federal budget deficits by $338 billion between 2018 and 2027 relative to CBO’s most recent baseline. Other information about the policy’s effects on the budget, health insurance coverage, and premiums will be included in today’s report.

The agencies are in the process of revising their methods to estimate the repeal of the individual mandate. However, because that work is not complete and significant changes to the individual mandate are now being considered as part of the budget reconciliation process, the agencies are publishing this update without incorporating major changes to their analytical methods.

The report was prepared in response to interest from Members of Congress. It updates a budget option published in December 2016 and is not based on specific legislative language.

OK, so why is this such a big deal now? Because the GOP desperately wants to cram through their massive tax cuts for the superrich. In order to do so, they have to find some way, any way of "proving" that those massive cuts would be cancelled out by enough "savings" to keep the increase in the federal deficit below the $1.5 trillion mark.

In order to do that, they're relying on killing the mandate penalty saving over $300 billion over the next decade. If it wouldn't save that much, I presume it means their massive tax cut can't go through. Of course, it seems to me that they could simply reduce the tax cut itself by a tenth of a percent or something and achieve the same outcome, but what do I know?

Put another way:

  • The GOP House wanted the CBO to say repealing the ACA would save the government a lot of money. They also needed to be able to let the bill pass via Reconciliation, which required using the 2016 baseline, and didn't care that this would also mean 22-23 million losing their coverage because they're so deeply entrenched via gerrymandered districts that they didn't think they had to worry about losing their seats.
  • The GOP Senate, however, did have to care about the "losing their coverage" number since they have to run statewide and are worried about their seats. They wanted to use the 2017 baseline because that would show "only" perhaps 15-18 million or so losing coverage (as if that's any better?), while ignoring the fact that doing so would invalidate the ability to pass the bill using Reconciliation.
  • NOW, however, the GOP Senate has gone back to wanting the CBO to keep using the 2016 numbers because it would show the government saving more money. They're no longer concerned about the "how many would lose coverage" question but instead are very focused on the "how much money would it save" question.

In short:

  • PAUL RYAN TO CBO: "You must use 2016 as your baseline!"
  • CBO: "OK, here you go."
  • GOP: "Dammit!"
  • MITCH McCONNELL: "You must use 2017 as your baseline!"
  • CBO: "That'll take awhile..." (4 months pass) "...OK, here you go."
  • GOP: "Dammit! No, no...go back to using 2016!"

It's worth noting that the CBO director, Keith Hall, is himself a Republican who was hand-picked by Republican Mitch McConnell and Republican Paul Ryan (as well as former Republican HHS Secretary Tom Price).

As I also noted in July:

Of course, it's worth noting that even if the CBO did go with the January 2017 baseline instead, they'd lkely still project a good 17 million people losing coverage by 2027, which isn't exactly anything to cheer about either. That's only "good" news relative to how horrible the prior projections were.

It's also worth noting that the GOP Senate might want to be careful what they wish for here. Remember, the CBO's primary function is to issue budget projections. If 5 million fewer people were otherwise expected to be enrolled in subsidized exchange policies, that means that the baseline budget projection could also be quite a bit lower.

Ain't economics and politics fun?

Anyway, it'll be interesting to see what the CBO has to say about the prospects of repealing the mandate without any other changes.