A key Republican senator, who is likely to decide the fate of her party’s latest effort to repeal the Affordable Care Act and phase-out Medicaid, says she will rely on a Trump administration office with a history of producing cooked figures in order to determine whether to back the bill.
Earlier this week, the Congressional Budget Office announced that, due to the rushed process Senate Republicans are using to try to pass the latest version of Trumpcare, it will not be able to fully evaluate the bill until after a vote is expected next week. That leaves senators flying blind, without the office’s guidance on crucial questions like how many people will lose coverage under the bill, or how the legislation will impact insurance premiums.
Outside estimates show that at least 32 million people will lose health insurance by 2027 if the latest Trumpcare bill becomes law.
But lawmakers in both parties typically rely on the nonpartisan CBO because it exists to provide neutral analysis of legislation that is not shaped by a desire to see a particular bill pass or fail.
Without CBO to assist her, Sen. Lisa Murkowski (R-AK) says that she will rely on other sources, including numbers from Donald Trump’s Department of Health and Human Services — which, unlike the CBO, very much has an interest in skewing the numbers to encourage lawmakers to vote for the bill.
With no CBO, Murkowski says she’s relying on data from Trump’s HHS, CMS and her state to decide whether to back health bill, per @ryanobles
— Manu Raju (@mkraju) September 20, 2017
Last July, during a different failed effort to pass a Trumpcare bill, Sen. Ted Cruz (R-TX) proposed an amendment that would have permitted bare-bones health plans to be sold at discounted rates. Among health economists and other policy experts, Cruz’s proposal was widely viewed as a recipe for disaster.
Had it become law, healthy individuals would have largely relied on the bare-bones plans permitted by the Cruz amendment. Meanwhile, as the Kaiser Family Foundation explained, more generous plans would “effectively become a high-risk pool, attracting enrollees when they need costly health benefits – such as maternity care, or drugs to treat cancer or HIV, or therapies to treat mental health and substance abuse disorders.”
The result would have been sky-high premiums for the more generous plans, as those plans’ expensive-to-insure customers drained more and more money out of them, and possibly even a death spiral, where the market for these plans collapses entirely. Both the insurance industry and the American Academy of Actuaries predicted much higher premiums for Obamacare-compliant plans.
Nevertheless, Trump’s HHS released an analysis claiming that the Cruz Amendment would result in much lower premiums even for people who buy more generous Obamacare-compliant plans. When independent experts asked questions about HHS’s methodology, they were told that the methods were “proprietary.”
Trump’s HHS, in other words, reached a widely panned conclusion that disagreed with the widespread consensus both among independent experts and within the health industry. And then, when it was asked to show their work, it refused.
Now, however, the rushed effort to pass the latest Trumpcare bill leaves senators like Murkowski in a bind. They want to know how the bill will impact their state — an analysis by the health consulting firm Avalere indicates that funding for Alaska drops modestly at first and then falls off a cliff in 2027 — but can’t turn to the most trusted source for this information. Stuck in that bind, they risk relying on sources that cannot be trusted, including the Trump administration.