No, The CBO Did Not Say That 24M People Will 'Lose' Their Health Insurance Under Trump's Plan


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The media was predictably going to frame the CBO's report on the Republicans' ObamaCare repeal plan last night as awful, regardless of what the office actually said. There were, in fact, some encouraging numbers in there. The bill would significantly reduce the deficit and put downward pressure on insurance premiums.

There was only one meaningful statistic in the report that generated media headlines though: 24 million people will lose their health insurance under President Trump's healthcare plan!

It's a glaring number and it should cause some concern. But the word lose - like the New York Times tweeted here or the Boston Globe wrote here - suggests that 24 million Americans will have their health insurance coverage suddenly ripped out their hands by callous Republicans.

That's a scenario that Democrats would love to have you believe. They, with the media's help, are already spinning the CBO score as a “knock-out blow.” In reality, it's not accurate and oversimplifies a very complex issue in the name of slandering the GOP healthcare bill.

You don't even need to read more than the first couple pages of the CBO report to understand what the CBO actually said.

According to the CBO, the first spike in the number of uninsured Americans will come in 2018, when the number of uninsured increases by 14 million. However, as the highlighted portion from the report shows below, “most of that increase” will be prompted by the repeal of ObamaCare's mandate and penalties, which means that millions of people will voluntarily drop their insurance now that they're not forced by law to buy it.

Source: CBO

If the goal is universal coverage (and that's a debatable goal), this is obviously still a problem. Nevertheless, Republicans wouldn't be stripping it away, but rather empowering consumers to willingly opt out of an ObamaCare product they don't want.

This is not a bug but a feature of the Republican health plan, a pillar of the broader conservative commitment to having a dynamic insurance marketplace that offers more variety of choices and costs than what ObamaCare currently permits.

The next bump comes in 2020, when the number of uninsured rises from 14 million to 21 million and then to 24 million by 2026 (a net gain of 10 million). This new increase will be, in large part, a result of states no longer being able to expand Medicaid eligibility, which means that someone who might have been hypothetically enrolled in Medicaid in the future under ObamaCare will no longer receive that coverage.

Source: CBO

These are still people who will not have health insurance, so as stated above, it is still a policy problem for universal coverage. But again, a large chunk of that new round of 7 million will not “lose” their health insurance under the Republicans' plan because they don't have that coverage right now to begin with. 

This is (again) not a bug but a feature, because according to Republicans, ObamaCare's vast Medicaid expansion was a flawed solution to America's healthcare problem. Studies have repeatedly shown that coverage under Medicaid does not necessarily guarantee better health outcomes. It's costs are inflammatory. 19 states opted out of the expansion entirely over these concerns.

Reforming Medicaid to a per-capita financing system would save the government hundreds of billions of dollars which could arguably be put towards more effective healthcare programs.

So what to make of all of this? The correct way to frame the CBO's finding is that, by 2026, 24 million fewer people will have health insurance than under current law. This is not the same as 24 million people “losing their health insurance.”

But here's what the CBO cannot tell us. It cannot take into account any regulatory changes to the insurance marketplace that HHS Secretary Tom Price can push through. It cannot take into account any subsequent pieces of legislation that the Republicans will pass to supplement and improve this bill. The CBO's score is a moment-in-time snapshot of the impact of the Republicans health care bill, with lots and lots of assumptions.

It should be analyzed seriously. But it shouldn't be misinterpreted by the left and the media to bludgeon the reform plan to pieces.

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