What to watch for in new healthcare score

The Congressional Budget Office on Wednesday is slated to release its analysis of the GOP bill to repeal and replace ObamaCare — the very analysis that House Republicans declined to wait for when pushing the bill through their chamber in early May.

The score from the nonpartisan scorekeeper could shake up the healthcare debate, particularly if the late changes made by House Republicans have significantly altered the projections.

Senators are working to rewrite the healthcare bill to address some of the issues raised by the CBO in March and will be looking to the new analysis to guide them on the path forward.

Here’s what to watch for when the CBO score is released.

 

Will the House have to vote on the bill again?

The American Health Care Act narrowly passed the House in a 217- 213 vote after weeks of arduous vote-counting.

It’s hard to imagine lawmakers would want a do-over, but it’s not out of the realm of possibility.

{mosads}The House has not sent the healthcare bill over to the Senate, just in case the new CBO score does not find that the bill saves at least $2 billion over 10 years. If that criterion is not met, the bill cannot be passed under the reconciliation procedure Senate Republicans hope to use to pass it with a simple majority.

The new CBO score will include late amendments to the House’s bill, including a provision that provides more money for an insurance stability fund. Another amendment, from Rep. Tom MacArthur (R-N.J.), would let states opt out of core ObamaCare regulations, if certain conditions are met.

If states were to get rid of the ObamaCare regulations, it could result in more people signing up for skimpier, cheaper health plans. The government would then have to spend more on tax credits to help people afford insurance premiums.

House Republicans say they haven’t sent the bill to the Senate out of an “abundance of caution.” Aides downplayed the issue.

“The bill is just being held until CBO issues its final score,” AshLee Strong, a spokeswoman for Speaker Paul Ryan (R-Wis.), told The Hill last week.

The latest CBO estimate, from March 23, showed the bill would decrease federal deficits by $150 billion over 10 years.  

 

Will Republicans attack the CBO again?

Republicans and the Trump administration attempted to discredit the CBO after the scorekeepers released the first analysis of the American Health Care Act. 

Health and Human Services Secretary Tom Price said the CBO examined only a portion of the plan — the ObamaCare reconciliation bill. The Republicans’ entire plan to repeal and replace Obama-Care, Price said, includes changing ObamaCare’s regulations and passing additional bills, which the House hadn’t voted on when the CBO first scored the legislation.

“We disagree strenuously,” Price said. “Our plan will cover more individuals at a lower cost and give them the choices that they want for the coverage that they want for themselves and their families.” 

White House press secretary Sean Spicer was more blunt.

“If you’re looking at the CBO for accuracy, you’re looking in the wrong place,” he said.

 

Are the Health Committee savings enough?

Both the Senate Finance Committee and the Senate Health Committee portions of the bill each need to save $1 billion in the CBO’s analysis.

It is “very possible” the House-passed bill doesn’t do so under the jurisdiction of the Senate Health Committee, Ed Lorenzen, a senior adviser for the Committee for a Responsible Federal Budget, wrote in an email.

He said it’s his understanding that the Senate parliamentarian — who is the ultimate decider on whether the bill meets the guidelines governing reconciliation — hasn’t made a final decision on which jurisdiction the various provisions of the American Health Care Act fit in.

One of the reasons the measure could have issues is because the House added more money to a stability fund.

“It isn’t entirely clear what the consequence would be if the House-passed bill failed to meet the instruction,” Lorenzen wrote.

Some, such as Lorenzen, believe the Senate could fix the problem itself.

The other possibility is that the lack of Health Committee savings would be a “fatal” violation. And that means 60 votes would be needed to pass the bill in the Senate.

“In other words, the Senate wouldn’t even be able to take up the House-passed bill to correct any violations,” Lorenzen wrote.

 

How many people does the bill cover?

Republicans have come under fire for passing a bill that would lead to 24 million more uninsured Americans according to the earlier projection CBO made in March.  

Democrats will be watching the new coverage number closely — and so will moderate Republican senators who fear attack ads and angry voters.

To some, the difference between the two coverage estimates isn’t what matters.

“The relevant thing is not how it changes from score to score, but how it compares to status quo, which is with the Affordable Care Act in place,” said Jacob Leibenluft, senior adviser for the Center on Budget and Policy Priorities.

 

Will insurance premiums decrease?

Under the first version of the healthcare bill, insurance premiums would rise for the first two years because the House legislation stops requiring the uninsured to pay a fee, according to the CBO’s March 13 estimate.

After the first two years, several factors would help stabilize the insurance market, leading premiums to decrease by 10 percent in 2026.

A $15 billion invisible risk-sharing program was added to the House bill after the last CBO score, and it “should lower premiums slightly, but it’s a pretty small amount of money spread over multiple years,” Larry Levitt, a Kaiser Family Foundation senior vice president, wrote in an email.

 

What is the impact of the MacArthur amendment?

A late amendment to the House bill lets states get a waiver to opt out of two ObamaCare provisions: requiring insurers to cover a range of certain services, such as maternity care and mental healthcare, and allowing carriers to charge people more based on their health.

There’s a lot for the CBO to unpack here.

Some House Republicans expressed doubt that many states would opt out of this ObamaCare provisions, but already one governor, Wisconsin’s Scott Walker (R), has indicated interest.

“I think the big question is how many states seek waivers for the essential benefits and community rating, and what effect that has on premiums, the number of uninsured, and federal costs,” Levitt wrote.

“My guess is that CBO will assume at least some states submit waivers, which will lower premiums for healthy people and raise them significantly for people with pre-existing conditions, and that the result will be a slightly smaller number of uninsured and higher federal costs than previously estimated.”