Opinion: Obamacare Replacement Options — Lots of Promises, Few Facts

Republicans face a big gap between ‘possible’ and ‘feasible’

MARCH 7: Vice President Mike Pence conducts a news conference after the Senate policy luncheons in the Capitol where he made remarks on the House Republican’s new health care plan, March 7, 2017. Also appearing are, from left, Sens. Cory Gardner, R-Colo., John Barrasso, R-Wyo., John Thune, R-S.D., and Senate Majority Leader Mitch McConnell, R-Ky. (Photo By Tom Williams/CQ Roll Call)

There’s a difference between “possible” and “feasible,” and the difference comes down to one word: Money. 

“Is it possible to put a window in that wall?” I once asked a contractor friend about my darkish dining room. “Anything is possible,” he said. “But is it feasible? How much do you want to spend?” (I skipped the window.)

I kept thinking about my contractor Tuesday as House Republicans rolled out their Obamacare replacement bill (I know, my mind wanders) and then tried to defend the bill without having a Congressional Budget Office score for it in hand. Just like my great idea to knock out a wall to let natural light into a dark room, so much of the Republican bill sounds great at first glance.

It retains three of the most popular pieces of Obamacare — the requirement for insurance companies to cover people with pre-existing conditions, the prohibition on lifetime coverage limits, and letting adult children stay on their parents’ plans up to the age of 26. But it also eliminates the taxes and penalties from the individual and the employer mandates embedded in Obamacare that covered the costs of the popular parts of the bill.

All candy, no carrot

Can Republicans really do both at the same time? Without a price tag from the CBO, there is no way to know if the all-candy, no-carrots approach to health insurance is possible, let alone feasible. How much will the bill cost and who pays for it? Who will still be covered? What effect will it have on the deficit? Getting those answers wasn’t easy Tuesday afternoon.

“This is about patients, it’s not about money,” Health and Human Services Secretary Tom Price said as he discussed the bill at the White House. Actually, everything in Washington is about money, so let’s forge ahead. Asked if he could guarantee that the bill won’t increase the deficit or result in millions of people losing insurance coverage, Price said only that “the goal and the desire I know of the individuals on the Hill is to make certain that this does not increase the cost to the federal government.”

Press Secretary Sean Spicer called the bill “the Obamacare replacement plan that everyone has been asking for.” But he cautioned that no CBO score will reflect all of the future savings in subsequent “phases” of the process, including executive orders from President Donald Trump and a second round of legislation that would require Democratic votes to even become a reality. When he was asked if the president would support a bill that leaves millions of people uninsured, Spicer warned, “Let’s don’t get ahead of the CBO scoring.”

It’s all enough to make you think the CBO score might not look so good for the bill once it comes in. It definitely didn’t look great for the Price-authored reconciliation bill that Republicans passed in 2015, H.R. 3762, which Texas Rep. Kevin Brady called “the underpinning document” of the bill Republicans unveiled this week.

The bills aren’t identical, but for the portions of the bills that are the same, specifically the decision to remove the Obamacare mandates but keep its insurance coverage reforms, the CBO estimated that 18 million people would lose insurance coverage within the first year, while costs for coverage would initially increase 20-25 percent, and balloon from there. Under the Price bill, which passed the House and Senate, the CBO predicted that insurance markets would be destabilized, insurers would leave the marketplace, and eventually only a fraction of Americans would be covered in the individual markets. 

Getting real

That’s an unpleasant reality check, but unpleasant reality checks are the reason the CBO was created in 1974. Those were the Nixon days, when Congress and the president battled over federal spending. Nixon accused Congress of spending money America didn’t have and blamed them for creating enormous deficits. In turn, Congress accused Nixon of abuse of power as he refused to spend appropriated money, even after it was appropriated. The CBO was created to at least get the facts straight in the budgeting process as partisans duked it out over the rest.

Today, CBO scores are usually the first piece of data a member of Congress needs to assess a bill’s potential — what’s the CBO score? What’s its cost? Can we afford it? Is it feasible? Of all of the reasons to think the Republicans’ current health care bill is in trouble, including conservatives jumping ship before the bill was even released, the decision to unveil the bill without a CBO score is the biggest red flag of all.

GOP staff stressed that a score will be available before committee votes happen and let’s hope they’re right. If Republicans can really produce legislation that expands access, improves care, reduces costs and keeps health insurance truly affordable for those who have insurance (and a cell phone, Rep. Chaffetz) today — all without a mandate, penalties, tax hikes, and a gigantic hole in the deficit — then they probably deserve the right to write the bills on their own. But there’s no way to know what this bill really does until the CBO analyses it.

So far, Republicans are telling us that everything is possible in this legislation. But it is feasible? The CBO score will tell us that.

Roll Call columnist Patricia Murphy covers national politics for The Daily Beast. Previously, she was the Capitol Hill bureau chief for Politics Daily and founder and editor of Citizen Jane Politics. Follow her on Twitter @1PatriciaMurphy.

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