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THERE WASN’T MUCH FOR THE GOP to cheer about when the Congressional Budget Office released its report on the updated American Health Care Act late Wednesday. That evening, Politico published a rundown of the report’s key points, many of them grim: 23 million fewer people insured within a decade, more than half within a year of the AHCA’s passage; more than $800 billion in Medicaid cuts and loss of coverage for millions reached under Medicaid expansion; selective premium increases, particularly for “poor, older Americans.”
The CBO also had bad news for those with pre-existing health problems. Although the GOP has argued their bill would protect people with medical conditions, the CBO ruled otherwise. Vox’s Sarah Kliff singled out what she called the “most devastating paragraph” in the CBO report:
“People who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all… As a result, the nongroup markets in those states would become unstable for people with higher-than-average expected health care costs.”
Here’s the bright spot for the GOP: The government would save some $119 billion over the next 10 years, and stakeholders and wealthy Americans who are now paying more taxes and fees to help subsidize insurance coverage would be relieved of that obligation.
All the Republican spin in the world shouldn’t erase the fact that, under the AHCA, America would take a giant step backward in its effort to bring health insurance to more of its citizens. Yet, in spite of the numbers, coverage of the CBO report shows a heavy layer of GOP gloss.
Health and Human Services Secretary Tom Price dismissed the credibility of the report outright. “The CBO was wrong when they analyzed Obamacare’s effect on cost and coverage, and they are wrong again,” Price said in a press release minutes after the report dropped. He then turned to a familiar GOP line of defense: “In reality Americans are paying more for fewer healthcare choices because of Obamacare.”
Other Republican elected officials took the same approach. Oklahoma Rep. James Lankford noted that the CBO previously overestimated how many would sign up for Obamacare insurance exchanges. New Jersey Rep. Tom MacArthur flatly dismissed the CBO conclusion that the GOP plan would hurt people with pre-existing conditions, according to The Hill.
“I respect the CBO’s role,” said MacArthur in The Hill, “but just because a group of auditors down the block have created a model that has a lot of ifs, ands, and maybes, looks out 10 years, doesn’t make that the gospel. That is somebody’s opinion at CBO. I have a different opinion.”
House Speaker Paul Ryan had a different opinion, too. A Congressional reporter for Fox News quoted a notably upbeat Ryan on Twitter:
#BREAKING Ryan on CBO report on health care bill: "I feel good about it. It's great." Won't say when Hse will send bill to the Senate
— Chad Pergram (@ChadPergram) May 24, 2017
Ryan also told reporters he was “actually comforted by the CBO report because it shows, yeah, we’re going to lower premiums.” But that’s not exactly the case.
Whether premiums continue to rise will depend on where someone lives, and whether his or her state opts out of certain Obamacare requirements. For example, a state could eliminate the essential benefits package, which requires insurance providers to offer high-cost coverage such as maternity care and mental health treatment. That would allow insurers to lower their premiums and make their products more palatable to families. The CBO estimates that premiums in opt-out states could drop by anywhere from 4 to 20 percent over 10 years.
COVERAGE FROM CONSERVATIVE MEDIA amplified claims against the CBO. Breitbart passed along this, from Rep. Louie Gohmert, a Texas Republican who was dismissive of the report: “I could care less about what CBO said. They should not be scoring anything.” On Fox’s “Your World,” host Neil Cavuto asked Home Depot founder and Republican donor Ken Langone whether he thought the government was cutting Medicaid or simply “slowing the rate of growth”:
CAVUTO: Well, let me ask you this. What is a cut to you? When I hear cuts and I hear people, liberals espousing this view that we’re cutting to smithereens the social safety net, I’m thinking, well, they’re wiping it out, when, in fact, I discover with Medicaid and some of these other programs, we’re slowing the rate of growth. But that’s entered the vernacular, just like the argument that if you’re anti-illegal immigration, it morphed into you’re anti-immigrant. Ken Langone, what is a cut to you?
LANGONE: A cut to me is if you’re getting $4, and now you’re getting $3.80, that’s a cut. A cut is not, when I’m getting $4, and, next year, I was going to get $4.40. Instead, I’m only going to get $4.30. That’s not a cut.
CAVUTO: They call that cut.
LANGONE: Well, guess what? That’s what politicians do. It’s all about illusion.
Langone’s opinions made slowing the rate of growth sound like a good thing, though they may have confused those viewers trying to follow the conversation. The “rate of growth” argument is at least 20 years old; Republicans used it when they first began to attack federal spending on Medicare. Cavuto’s statements minimize what amounts to a massive Medicaid cut—something Politico also pointed out:
The Trump administration’s blueprint for Medicaid goes beyond simply reinforcing conservatives’ bid to fundamentally reshape the program. It wholeheartedly embraces the roughly $839 billion in Medicaid cuts included in the House GOP repeal legislation, and then layers a whole new level of reductions on top of that.
Assailing the credibility of the CBO report doesn’t address what National Review columnist Jim Geraghty called the GOP’s “current predicament in health-care policy”: Republican officials “now have to explain the tradeoffs of a specific plan when their standard-bearer refused to do so in 2016.” Geraghty enumerated campaign statements by Trump—to “take care of everybody,” to repeal and replace the Affordable Care Act, to make “no cuts to Social Security, Medicare and Medicaid.”
Geraghty then argued, “You can’t keep all of those promises. Some of them are more or less contradictory. You can’t keep Medicaid intact AND repeal Obamacare, because Obamacare expanded Medicaid.”
The CBO story boils down to this: numbers from an agency with a reputation for gold standard reports versus the spin and opinion from Republican proponents of their health plan. In the end, context-free numbers and defiant quotes from congressional Republicans with a huge stake in the AHCA’s outcome do little to tell the electorate exactly what the Republican plan will and will not do for them.
“This is a deeply unpopular piece of legislation,” Democratic strategist Jon Vogel told Politico before the latest CBO report. “But the electorate is not fully aware of what it does and it is not at the top of people’s minds.” The CBO report can’t explain those consequences in full. It falls to journalists to explain how the health plan that will soon emerge from the Senate will actually affect ordinary people struggling to make sense of the spin.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.