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Health-care redo: After CBO analysis, House Republicans have much to answer for

Trump/RyanCare neither repeals nor really replaces Obamacare. It just amends it, mostly in ways that are beneficial to the rich, the healthy and the insurance industry.

Demonstrators and health-care activists rallying before the visit of Speaker Paul Ryan at the Success Academy 1 charter school in Harlem on May 9.
REUTERS/Shannon Stapleton

Right on schedule, the Congressional Budget Office Wednesday released its analysis of the version of the American Health Care Act that passed the U.S. House on May 4.

I said at the time and I still feel that there was no need for the House to rush the bill through without waiting for the CBO’s analysis of what it would cost and what it would do for whom and to whom.

The nonpartisan CBO cannot truly see the future in all its complexity, nor can anyone else. But the CBO is the best we have and there is something shady, shameful and dishonest about the House Republicans’ decision to push the bill through without benefit of the CBO analysis. The CBO works for Congress and its job is to give its members this kind of analysis.

The CBO found that this version of the AHCA (which I prefer to call Trump/RyanCare just as Republicans prefer to call the Affordable Care Act “Obamacare”) will likely cause 14 million additional Americans to become uninsured within a year and 23 million additional Americans to become uninsured over the next 10 years.

Savings offset by tax cut

Various money-saving provisions of the law will reduce the cumulative federal deficit by $119 billion over the same 10-year period, the CBO found. Actually, that’s not quite right. The money-saving provisions will cut spending by more than $1 trillion, but most of that trillion is offset by tax cuts of almost a trillion dollars, tax cuts that will disproportionately benefit wealthy Americans.

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(On that point, I’ll just pass along the statement, sent out Wednesday, by a bunch of wealthy liberals, who call themselves “The Patriotic Millionaires,” who said:

The CBO score proves what we already knew: Trumpcare is a tax cut for millionaires disguised as a health care bill.

I agree, and would add that if the Republicans who support this bill (no Democrats do) cared as much as they often claim to care about the size of the federal deficit and debt, they had a chance to prove it in this bill by leaving the high-end taxes in place and reducing the debt by more than $1 trillion over the decade ahead.)

The 23-million-person reduction in the number of Americans who are covered with insurance is a slight improvement over the previous version of the bill, the one that was pulled down because its sponsors knew it didn’t have the votes to pass the House. That one, according CBO, would have produced an increase of 24 million in the ranks of the uninsured. I would call that a very small improvement.

In fairness, I should mention a favorite Republican talking point on the increase of uninsured Americans: Many of the uninsured, the CBO projects, will choose not to be insured once the new law removes the penalty that the current law imposes on the uninsured, the so-called mandate.

The cost of premiums

Aside from the rising share of uninsured Americans, the other biggest deal is what the House health care bill might do to the cost of premiums of some of those who remain insured. As I’ve mentioned before, Trump/RyanCare neither repeals nor really replaces Obamacare. It just amends it, mostly in ways that are beneficial to the rich, the healthy and the insurance industry. The House-passed version of Trump/RyanCare offers states the right to opt out of various provisions of ObamaCare, including the way the current law tries to protect those with pre-existing conditions.

MinnPost’s Washington guy, Sam Brodey, made a heroic effort to explain this two weeks ago. I highly recommend it. But, to cut to the chase, as part of its CBO-report coverage, the Washington Post said yesterday that, depending on your age and what your state opts out of, some people (especially those aged 60-64) could see premiums that will rise from an annual out-of-pocket cost of $1,700 to a cost of $13,600 or $16,100, or a maximum increase of 850 percent. Here’s that Post piece.

There are a million — or maybe it’s a zillion — more details that could be discussed about Trump/RyanCare. I’ll just mention one of my favorites:

As a candidate, Donald Trump said that the health care plan that he would sign as president would cover “everybody,” and that for those who couldn’t afford it “the government will pay for it.”

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As you recall from the famous “Schoolhouse Rock” cartoon about how we make laws in America, the House bill awaits Senate action. Although Republicans have a 52-48 majority in the Senate, there is no handicapper who believes the Senate will pass the House bill as is.

“I don’t know how we get to 50 at the moment,” Majority Leader Mitch McConnell told Reuters on Wednesday. “But that’s the goal.”

The full 33-page CBO report (plus a few pages of tables) is available here.