A wide gulf continues to separate Republican senators as they furiously negotiate the fate of their health care bill after canceling a vote last week when it became evident it would go down in flames. While GOP senators cannot even agree on the basic questions of health care policy—whether people with pre-existing conditions should be protected from discrimination, whether or not to scrap Obamacare’s taxes on the wealthy, whether Obamacare should be repealed without a replacement ready—they have coalesced around a strategy of working the refs.
GOP senators want the Congressional Budget Office to produce new scores of the bill following the CBO’s brutal assessment that their original version would cause 22 million people to lose their health insurance over 10 years and drastically raise out-of-pocket costs for millions more.
Former CBO Director Douglas Holtz-Eakin, who helmed the office during the George W. Bush administration, told TPM this request is “extremely unusual, unprecedented probably.”
Holtz-Eakin, now the president of the conservative think tank American Action Forum, blasted the calls for the CBO to change its metrics midway through a multi-month health care repeal effort making its way through the House and Senate. He noted that when scoring the Affordable Care Act itself over nearly two years, the CBO kept using the same baseline even when it became out of date.
“The whole point of scoring is to make apples to apples comparisons,” he said. “If you tweak the methodology in the middle of the process of passing a bill, it defeats the purpose of having a scorekeeper.”
These criticisms of the CBO and demand for changes are the latest example of the GOP long-time strategy of attacking and working to undermine the office tasked with assessing the impact of their policies. Some Trump administration officials have even called for the office to be abolished, despite the fact that its current leader is a staunch conservative appointed by Republican leaders in Congress.
Now, Republicans are demanding specifically that the non-partisan office use the health care marketplace as of January 2017 as their “baseline” for assessing future coverage losses. Currently, the CBO has been using March 2016 as its baseline. They are also challenging the CBO’s assumption that some new states will join the 31 that have already expanded Medicaid under Obamacare, and are demanding the office detail in a new report how many people would choose to go without insurance once the individual mandate is lifted versus how many would lose their insurance because they could not afford it.
Sen. John Barrasso (R-WY), the fourth-highest ranking Republican in the Senate, told reporters that after grilling the CBO’s leaders at the weekly GOP luncheon, he wants them to produce a report that shows “that the preponderance of the people who would not be insured were not actually losing insurance.”
“Because it’s a free country, they would choose, because we eliminate the individual mandate, to not buy insurance,” he said.
Another key Republican, Sen. Ron Johnson (R-WI), gushed last week about the prospect of a more favorable report being released in the weeks ahead. “I think we’ll get a lot more elements to help us vote for this bill,” he said. “I’m hoping people realize the significance of the newer CBO baseline on enrollment. It really shows real doubt on how the CBO projected the loss of coverage.”
Lawmakers insisted to TPM that these changes will make the assessment of the controversial health care bill more accurate. But Stan Collender, a former top staffer on the House and Senate budget committees, sees another purpose.
“You can assume that any changes in the methodology they’re demanding are to make their bill look better,” he said bluntly. “Not to be factually correct, but politically salient.”
According to Holtz-Eakin, the CBO can’t change its legislative scoring methods unless both the Democratic and Republican leaders of both the House and Senate budget committees reach a consensus and direct them to do so. Such a bipartisan agreement in the current environment is essential impossible. What Republicans can do, however, is give the CBO various hypotheticals to score separately from the bill.
“They can ask them to make certain assumptions. They can give them hypothetical situations,” Collender explained. “They could ask, ‘If X was the case, what would that do to the scoring? What would the impact be?’ It’s unusual but not unprecedented.”
Collender warned, however, that the CBO is not likely to simply hand Republicans the favorable number they’re seeking.
“I don’t think it’s going to work,” he said. “CBO could present it as just one alternative, saying, “You’ve asked us to analyze X, but we don’t think X is correct. We think it’s not realistic. If we did it the way we normally do it, it’d be Y.'”
Republicans’ intense focus on changing the bill’s score, Collender added, is an “act of desperation,” designed to distract from the fact that “they’re having trouble agreeing on everything.”