On Monday afternoon, immediately after the Congressional Budget Office released its hotly anticipated score of the Senate’s Obamacare repeal bill (the Better Care Reconciliation Act), the mainstream media was at it again.
CNN declared the analysis “devastating” while the Daily Beast labelled it a “disaster.” Within minutes, the DC pundits were dismissing the bill’s prospects, downgrading their estimation of Senate Majority Leader Mitch McConnell from legislative mastermind to political novice in the process. I couldn’t help but wonder if they read the same CBO report that I did.
Yes, the Senate’s discussion draft can be made better, but an examination of the facts shows this bill is superior to the House-passed version and leaves McConnell the financial flexibility to sway the final few senators to hit the magic number of 50 yeas (Vice-President Mike Pence can break the tie).
The CBO report makes me feel more optimistic that this legislation can pass the Senate and that it will better Americans’ lives.
The CBO estimates that in 2020 premiums will be 30% lower than under the Affordable Care Act, and they would still be 20% lower in 2026. Importantly, by restructuring the House’s tax credits, the CBO does not forecast the same spike in premiums for Americans over 50 years old. A core promise of repealing Obamacare was reducing premiums, and the Senate bill makes good progress on this front.
The Senate bill gradually rolls back the Obamacare Medicaid expansion, gives states the ability to impose work requirements on able-bodied adults, and pegs the growth in Medicaid funding to inflation. These changes mean Medicaid spending will rise from $393 billion today to $464 billion in 2026 compared to $624 billion under Obamacare.
Much of the media says the bill forces “deep cuts” on Medicaid whereas it actually just slows the rate of growth. The Senate bill spends 18% more on Medicaid in 9 years than we do today. Media and Democrat cries of “Medicaid cuts” are half-truths at best; outright deception at worst.
All told, the Senate bill reduces the budget deficit by $321 billion, which is $202 billion better than the House bill.
The CBO also anticipates 22 million more uninsured Americans, but that isn’t surprising as the House bill saw a 23 million increase. The GOP has campaigned on eliminating the individual mandate, which forces Americans to buy insurance they often do not want. Undoubtedly, many Americans will once again exercise their personal liberty and choose not to buy insurance.
Republicans’ goal should not be to maximize coverage, but to maximize the affordability and attractiveness of insurance so that Americans choose to buy insurance that meets their needs.
Also keep in mind that the CBO estimated that 2016 exchange enrollment would be 22 million. It was 9 million. The CBO has chronically overestimated how many people would be coerced into insurance under Obamacare.
Not only does the Senate bill reduce premiums by 20%, but it leaves slightly more Americans insured and saves $200 billion relative to the House bill. That is a dramatic improvement and begins to make good on years of campaign promises. Couple this with the fact private insurers are leaving Obamacare exchanges en masse, and the Senate bill looks far superior to the status quo.
That said, several Republicans, namely Senators Dean Heller (NV), Susan Collins (ME), Ron Johnson (WI), and Rand Paul (KY) appear opposed to begin debate on it, which has sparked hope on the left that the GOP may bungle its last best opportunity to repeal Obamacare. From this view, I dissent.
Because the Senate bill need only save as much money as the House bill, McConnell has essentially $200 billion to spend to assuage the concerns of moderates, far more flexibility than anticipated. With that much firepower, one needn’t have written “The Art of the Deal” to find the last few votes.
There is room to fund a stronger response to the opioid crisis, slightly enlarge the tax credits, and perhaps peg Medicaid to medical inflation (which has historically run higher than overall inflation), which can sway reluctant moderates without breaching Senate rules. By coupling that spending with more expansive state waivers that conservatives like Mike Lee have been clamoring for, McConnell would bring the wings of his caucus back into the fold and have a very viable path to 50 votes.
The fact the CBO found such deeper savings without leading to more uninsured vs the House bill gives McConnell the room he needs to pass the bill, even if it does take a few more days than first anticipated.
From maintaining unprecedented party discipline during the Obama years to getting Neil Gorsuch confirmed to the Supreme Court, Mitch McConnell has proven a deft vote-getter. Don’t count him out now. Not when the CBO just gave him $200 billion.