The Congressional Budget Office (CBO) has weighed in with its analysis of various health care bills making their way through Congress. In its most recent estimate, the CBO has calculated that some 16 million Americans would lose insurance if the so-called “Skinny Repeal” bill is passed into law. The role of the CBO itself has come under fire by some Congressional Republicans, who claim that the Office has often miscalculated critical numbers. Dean Douglas Elmendorf, a former director of the CBO, discusses these critiques in an interview with New York Magazine’s Daily Intelligencer. Professor Thomas Patterson also offers his thoughts on how CBO scoring affects media coverage of the issue. Other faculty members discussing the health care debate include Professor Jeffrey Frankel, who opines as to why the ACA still survives; and Professor Robert Blendon, who talks about the challenges facing Republican lawmakers who hope to reduce Medicaid coverage.
Dean Douglas Elmendorf, Don K. Price Professor of Public Policy, is interviewed by New York Magazine’s Daily Intelligencer. Office of Management and Budget director Mick Mulvaney characterized CBO’s previous analysis of Trumpcare as “almost … not a fair analysis.”
ELMENDORF: Director Mulvaney’s attacks on CBO are well beyond previous sorts of criticism. They are unfounded, in my view, and destructive for the country. Remember, he’s the OMB director who criticized the Bureau of Labor Statistics for not calculating the unemployment rate honestly. He has a very unfortunate tendency to undermine facts that are inconvenient for the administration’s purposes. I think that is very damaging for policy discussions in this country.
That does not mean that CBO analysis is beyond criticism. But one has to bring evidence and explain why that evidence contradicts or undermines what the CBO has done. Mick Mulvaney has emphatically not provided evidence of that sort. If you go back to our estimates with the Affordable Care Act, we did not get everything right. There’s no doubt about that. But our estimates were much more accurate than most of the wild guesses by both opponents and proponents of the Affordable Care Act at the time.
The question is, do you want imperfect estimates from knowledgeable, independent people, or do you want to rely on totally partisan guesses by people without the same level of expertise? I think the answer to that question is obvious.
Thomas Patterson, Bradlee Professor of Government and the Press, is quoted in The New York Times discussing media coverage of the health care debate.
Coverage rose after Mitch McConnell, the Senate majority leader, unveiled the Senate’s version of the bill late last month and when the Congressional Budget Office released its analysis of the proposal a few days later. But it dropped rapidly soon after.
The count includes national sources like The New York Times and The Washington Post, as well as regional and online news sources.
Analysts say coverage was abundant before the Affordable Care Act was passed in 2010, partly because of the public process through which the bill was constructed, including a series of hearings, markups and committee meetings. In contrast, Mr. McConnell created the G.O.P. Senate bill behind closed doors with a group of 13 lawmakers, keeping others in the dark about the contents until shortly before it was released.
“One reason to go behind the door is if you’re trying to deflect all the pressure from the various groups,” said Thomas Patterson, Bradlee Professor of Government and the Press at Harvard’s Kennedy School of Government. “And one way that pressure materializes is through news stories.”
Jeffrey Frankel, James W. Harpel Professor of Capital Formation and Growth, writes in Project Syndicate about ‘Why Obamacare Survived.’
Since the United States’ Affordable Care Act (ACA)—or “Obamacare”—was enacted in 2010, Republicans have been promising to “repeal and replace” it. When the 2016 presidential and congressional elections delivered all three branches of the US government to the party, the time to fulfill that promise seemed to have arrived. Yet the anti-Obamacare crusade has just been dealt a crushing blow, owing to the refusal of some Republican senators to vote for the replacement legislation.
Republicans blame their failure on the Democrats’ refusal to cooperate. But why should the Democrats help to dismantle their biggest legislative achievement of the last decade (if not longer)? The major flaws in Obamacare are not, as has been argued, unintended consequences of a poorly designed policy, which thus must be replaced; instead, they stem from Republican demands.
In any case, Republicans have majorities in both houses of Congress, so they don’t actually need the Democrats’ support to pass legislation. Likewise, President Donald Trump’s unprecedented lack of experience and general incompetence cannot be at fault, as he isn’t indispensible to the repeal and replace process….
Robert Blendon, Richard L. Menschel Professor of Public Health, argues in an article in the National Journal, that Republican hopes to trim back on Medicaid coverage, is politically problematic.
Unlike House members, who may not be tied to a district with many Medicaid recipients, senators have to answer to entire states. Handling the implications of the Medicaid changes can put lawmakers in a tough spot between sticking to a campaign promise but not wanting to throw so many people off the rolls.
“If you go back three years, they didn’t realize the [Congressional Budget Office] would describe millions losing coverage and the impact that would have,” said Robert Blendon, professor of health policy and political analysis at Harvard University.
The CBO estimated that under the most recent iteration of the repeal-and-replace legislation, 15 million fewer people will be receiving Medicaid coverage by 2026.
But Blendon added that it will be harder for lawmakers to roll back Medicaid coverage over time. “Whatever they can’t get today, they will not get four years from now,” he said.