The much anticipated CBO scoring of the American Health Care Act, aka "Trumpcare" is out, and it has concluded that millions of Americans would lose medical insurance under the republican proposal to dismantle Obamacare, dealing a potential setback to President Donald Trump's first major legislative initiative. In total, the CBO found that 52 million people would be uninsured by 2026 if the bill became law, compared to 28 million who would not have coverage that year if Obamacare remained unchanged.
Among the key highlights are the following:
- 14 million would lose insurance by 2018, with the number risin to 24 million by 2026.
- The budget deficit would be reduced by $337 billion over 10 years.
- Premiums would rise by 15-20% in 2018-2019, however they would then decline by 10% than under current law by 2026.
Two House committees have already approved the legislation to dismantle Obamacare, but as reported earlier, the proposal faces opposition from not only Democrats but also medical providers including doctors and hospitals and many conservatives. The CBO report's findings could make the Republican plan a harder sell in Congress.
As Reuters adds, some Republicans worry a misfire on the Republican healthcare legislation could hobble Trump's presidency and set the stage for losses for the party in the 2018 congressional elections. Ahead of the report's release, Trump tried to rally support for the bill on Monday: "The House bill to repeal and replace Obamacare will provide you and your fellow citizens with more choices - far more choices - at lower cost," the Republican president said at a White House meeting with people opposed to Obamacare.
The key sections from the report:
- CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.
- Later, following additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program, the increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026. The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.
- CBO and JCT estimate that enacting the legislation would reduce federal deficits by $337 billion over the 2017-2026 period. That total consists of $323 billion in on-budget savings and $13 billion in off-budget savings. Outlays would be reduced by $1.2 trillion over the period, and revenues would be reduced by $0.9 trillion.
- The legislation would tend to increase average premiums in the nongroup market prior to 2020 and lower average premiums thereafter, relative to projections under current law. In 2018 and 2019, according to CBO and JCT’s estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up.
But today's estimates are somewhat worse than expected, as the Brookings Institution predicted the number losing coverage would be at most 15 million over 10 years.
The plan's arhcitect, Paul Ryan, took to twitter to react to the CBO report: "CBO report confirms it → American Health Care Act will lower premiums & improve access to quality, affordable care." He highlighted 2 sentences from his statement: "Our plan is not about forcing people to buy expensive, one-size-fits-all coverage. It is about giving people more choices and better access to a plan they want and can afford. When people have more choices, costs go down."
— Paul Ryan (@SpeakerRyan) March 13, 2017
As the Hill notes, the long-awaited analysis from the agency is sure to shake up the debate over the measure, which is already facing sharp criticism from conservatives and many centrist Republicans. The GOP bill repeals ObamaCare’s subsidies to buy coverage, replacing them with smaller tax credits, as well as the law’s Medicaid expansion after 2019. Both moves were expected to lead to coverage losses.
Republicans had largely expected that the CBO would show Americans losing coverage, and preemptively went on the offensive against the agency, whose director, Keith Hall, who was appointed by the GOP. White House press secretary Sean Spicer last week argued CBO was “way off” in its ObamaCare projections. "If you're looking to the CBO for accuracy, you're looking in the wrong place,” he said. White House budget director Mick Mulvaney, meanwhile, argued Sunday on ABC’s “This Week” that the CBO shouldn’t even try to analyze the bill. “Sometimes we ask them to do stuff they’re not capable of doing, and estimating the impact of a bill of this size probably isn’t the best use of their time,” he said.
That said, as we have shown on numerous occasions in the past, the CBO's predictive track record is simply abysmal. For an indication of that recall our post from 2013: "CBO Forecasts: Then And Now"
A few hours ago, the CBO published its most recent 10 year revised outlook for US revenue and spending: The Budget and Economic Outlook for fiscal years 2013-2023. Not surprisingly it was, as anything to ever come out of the CBO, overly optimistic. Promptly, the media latched on to the revised deficit expectations according to which the CBO now sees a budget deficit declining from 845 billion to "only" $642 billion in 2013, and dropping to $560 billion the year after. This looks at the short end: the near-term revenue benefits of recent tax increase policy which take from long-term growth (just ask Europe). The fact that the CBO also forecast the deficit proceeding to once again balloon to $895 billion by 2023 at which point the deficit difference between total spending and revenues goes asymptotic once the demographic crunch truly hits, was ignored by all.
We will ignore the underlying drivers to the CBO revision: we let readers peruse these at leisure. Instead, we will simply muse at the ridiculousness of anything called a "forecast" coming out of the CBO, and present how the "independent" economic forecasts from this office change in time.
On the chart below, the dotted lines are the CBO forecasts as a % of GDP from January 2008 for the period 2008-2018. The solid lines are the just released revised forecasts for 2013-2023.
Perhaps the most notable difference is that in 2008, the CBO was predicting that the US budget deficit would turn into a surplus in 2011. Instead ended up being an $1+ trillion deficit for that year alone. Also, in the period between 2008 and 2013, the CBO then forecast a cumulative deficit of just a few hundred billion. Instead, we ended up with deficits of over $5 trillion and, sadly, still rising.
So take anything coming out of the CBO with a very big grain of salt.
But for now, with the market hitting new highs every single day just because, the CBO is surely allowed to come up with any goalseeked numbers: it's not like anyone cares when stocks are soaring in a trance that is now completely disconnected from anything and only reliant on central bank balance sheets. And of course, we can't wait to look back in five years and laugh at this specific revised "forecast."
The CBO's full scaling of Trumpcare is below (link)