23 Million Fewer Americans Will Have Health Coverage Under GOP Plan—Really?

Columnist questions new health care “mantra”

Columnist Seth Chandler, writing in Forbes, argues that the Congressional Budget Office (CBO) unfairly maligned the GOP’s American Health Care Act (AHCA) in its recent report. Chandler’s complaint centers on what he calls the CBO’s “dogged refusal” to adjust its computations to the failings of the Patient Protection and Affordable Care Act (PPACA).

“When the CBO says that 23 million fewer people will have insurance coverage under the AHCA than under the [PP]ACA––a statistic that politics have converted into a mantra––that figure is predicated on a [PP]ACA that no longer exists,” he writes. “It is based on the continuing assumption that the [PP]ACA will have 18 million people enrolled on its exchanges in 2018 and that this situation will persist until 2026. I know no one on any side of the political spectrum who believes this to be true. The [PP]ACA has about 11 million people currently enrolled on its exchanges in 2017, with premiums going up [and] some insurers withdrawing from various markets. … The consensus is that [PP]ACA enrollment will stay the same or go down, not increase 60%.”

The CBO’s use of “the wrong numbers” to compare the AHCA with the PPACA has three consequences, according to Chandler.

“First, it means the 23 million figure is too high,” he writes. “A better comparison, all else being equal, would yield a significantly lower result.

“Second, it means one has to question the objectivity of the CBO in conducting this analysis. This is not a subtle error or some sort of typo by the CBO; it is a deliberate and erroneous choice. On what other points might the CBO Report reflect bias?

“Third, it means that other legislation that may revise American health care is going to be put to too hard a test. If one really believes the [PP]ACA will leave only 28 million Americans uninsured by 2026, other legislation that might be better or cheaper (or both) will be wrongfully criticized if the methodology used by the CBO persists.”

Chandler takes sharp aim at how the CBO came up with its figures. Using March 2016 data to structure its comparison of the AHCA and PPACA, the CBO assumed that 18 million people would be enrolled on the PPACA’s insurance exchanges in 2018 and that this number would remain “roughly constant” (since the PPACA would remain basically the same) until 2026, Chandler points out. But by May 2017, he writes, it should have been obvious to the CBO that, whatever may have been the case 14 months prior, assuming that 18 million people would be enrolled on the exchanges by 2026 “no longer made any sense.”

“The whole point of CBO scoring––better decision making on new legislation––is lost if the CBO continually makes the wrong calls on the consequences of existing legislation,” Chandler writes.

Source: Forbes; May 30, 2017.