The Congressional Budget Office (CBO) has been criticized for providing inaccurate and misleading estimates of Republican proposals to repeal and replace Obamacare. Those complaints are par for the course whenever a CBO score does not live up to the claims of a bill’s sponsors. Republican dissatisfaction has now reached a new level, with proposals to slash the CBO’s budget and eliminate the agency’s ability to produce cost estimates.
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Finding consensus among Republicans and reforming the US health care system is difficult work. Attacking the Congressional Budget Office will not make it easier. REUTERS/Kevin Lamarque
In amendments to fiscal year 2018 appropriations, House Freedom Caucus leaders would reduce the CBO’s budget by 50% and eliminate the agency’s division that produces hundreds of cost estimates for legislative proposals. That is shortsighted, opening the door to Democrats picking and choosing among estimates to advance their agenda when they return to power. More importantly, hobbling the CBO will not help Republicans enact health care reform.
There is no question the CBO cost estimates are imperfect. Economic models rely on data that are unavoidably rooted in the past. Modelers — whether they work for the CBO or other government agencies or private organizations — make assumptions about how consumers and businesses are likely to respond to changes in legislation. Plausible assumptions produce plausible results, but there are no guarantees.
CBO estimates that the latest version of the Senate’s Better Care Reconciliation Act (BCRA) would increase the number of uninsured by 22 million in 2026. That number may well be too high. It assumes that the individual mandate is highly effective in forcing people to purchase insurance or enroll in Medicaid. It assumes that most states that had not expanded Medicaid eligibility under the Affordable Care Act would do so.
An estimate that has less faith in mandates and more skepticism about states committing to Medicaid expansion given the uncertain political and fiscal outlook of such an action would produce a smaller, but still significant impact. If 22 million more uninsured is politically unacceptable to Republican senators, what reduction in coverage would be acceptable?
A better estimate will not solve the political problem, and shopping around for a better number sets a precedent that Republicans will not want to tolerate when they are in the minority.
The problem is not the estimate. It’s the policy, and the lack of consensus among Republicans about what sacrifices they are willing to make to achieve their policy goals. Republican leadership, including the White House, needs to get past the slogans that served them well when they were not in power. A slash and burn approach to the CBO is not a substitute for the hard work of reforming health care.
