May 30 2017

The nonpartisan Congressional Budget Office (CBO) released its much-awaited analysis of the Obamacare repeal and replace bill that was passed by the U.S. House of Representatives in May, and the news wasn’t good. If the bill were enacted into law, 23 million more people would lack health insurance by 2026 than if Obamacare, as the Affordable Care Act is known, were left in place.

The CBO report found that of those 23 million people, 14 million would be without health insurance by 2026 because of a whopping $834 billion cut to Medicaid ($662 billion of that cut would be used for tax breaks that mainly benefit wealthy individuals and large corporations). California would bear the brunt of those cuts, since Medicaid funds much of the Medi-Cal program, which provides health insurance coverage to one in three Californians.

The other 9 million additional uninsured would be people who otherwise would have gotten coverage through individual marketplaces such as Covered California or through their employers. The CBO report also estimated that for those who would still have insurance, their premiums would rise 20 percent in the first year after enactment of the House bill.

But if Members of Congress already voted on the bill, before knowing the real economic and human costs, why does this CBO report matter?

The CBO report matters because Congressional leaders are trying to repeal and replace the Affordable Care Act using a streamlined process known as “budget reconciliation” to fast track their bill through the Senate, and that process requires an analysis from the CBO on the bill’s costs and savings. If the CBO had found that the bill would not decrease the deficit by at least $2 billion over ten years, then the House leadership would have been required to change their bill and vote again. It appears they cleared that hurdle, but other procedural hurdles may still exist.

The CBO report also matters because the Senate is currently working on its own bill to repeal and replace the Affordable Care Act and the House bill has been serving as the foundation for that. The CBO’s findings underscore that if the Senate wants to avoid a bill with similarly dire consequences, then they’ll need to take a radically different approach.

Until now, the Senate’s Republican majority has been trying to draft a bill the same way the House majority did–by excluding the minority party and holding as few public hearings as possible. There have been some reports that Senate Majority Leader Mitch McConnell might choose not to hold any hearings at all and instead just take a bill negotiated by 13 of his colleagues (none of whom are women) straight to the floor of the Senate. We just saw that movie this spring, and that’s one horror flick that doesn’t need a sequel.

A different approach could be for the Senate to proceed with bipartisan negotiations to reform the Affordable Care Act in a way that ensures millions won’t be left without affordable, quality health insurance. A small group of Republican and Democratic Senators have already met to explore exactly that option. The CBO’s report will strengthen their hand and weaken that of McConnell, who already admitted before the CBO report was released that he didn’t know how he was going to get the votes for a bill to repeal the Affordable Care Act.


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