Today in shambolic health policy: CBO skewers the American Health Care Act

Even if the American Health Care Act never passes, today’s House Republicans will bear the stigma of having proposed it.

Especially in our polarized time, the Congressional Budget Office (CBO) is an essential nonpartisan authority, ready to advise Congress and the American public of the likely economic impact of major legislation. CBO’s current director was selected by Speaker Ryan, now-HHS Secretary Price, and other Republicans in consultation with Democrats. CBO isn’t perfect, of course. But it continues a proud nonpartisan tradition that couldn’t be more important.

Two days ago, CBO released its official score the American Health Care Act, House Republicans’ proposed bill to repeal and replace the Affordable Care Act. CBO’s assessment was….brutal. If AHCA is enacted, CBO estimates that fourteen million more Americans will be uninsured by the end of next year, twenty-four million more uninsured by 2026.

That’s not the worst of it. Table 4 below is drawn from the CBO report. Health insurance premiums for low-income older workers would skyrocket under AHCA. By how much?  The numbers are almost unbelievable.

On the nongroup market, annual net insurance premiums for a 64-year-old with an income of $26,500 would rise from $1,700 to $14,600. Yup, that an annual increase of $12,900, to buy a significantly less generous policy than is now available under ACA. For proponents of AHCA, that’s politically self-immolating.

AHCA also includes a huge tax cut for the wealthiest Americans. under which the top 400 wealthiest households alone receive tax cuts worth more than the premium tax credits provided in the twenty smallest states and the District of Columbia. Since this is the one thing Republicans agree on, I wish they would simply enact these on a party-line vote, add to the deficit, and call it a day.

In all my years of studying health policy, I have never seen a less professional, more shambolic performance than I have seen among Republicans seeking to pass AHCA. Even if this bill never passes, House Republicans will remain the people who proposed it. I just don’t understand their gameplan.

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Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

7 thoughts on “Today in shambolic health policy: CBO skewers the American Health Care Act”

  1. The staff of the CBO who worked nights and weekends to produce this crucial and professional report were, let's remember, civil servants, regular employees of the US government. But the government can't do anything properly and on time, amirite?

  2. Two stories on NPR this morning were worth listening to. The first involved a Nebraska congressman who went to a town hall in person and seems to have paid attention to his constituents. Importantly, he read two letters he had received, one from a corn farmer who was being priced out of the premium market under the current law, and the other from a woman with a pre-existing condition who felt that her life had been saved by the same law. He then asked, “Who is right?” and answered, “Both are right.” This should be recommended as a model for more politicians, whatever their placement on the ideological spectrum.

    The second story involved two Texas congressmen of opposite parties who were driving back to DC together on a long road trip, during which they were conversing with one another about the merits of their respective positions on the legislative issues of the day. This also should be a model for others to follow, especially if they also took time to talk about their grandchildren. More of this also, please.

  3. You almost have to admire these guys for having the guts to propose something that would obviously be so unpopular with older people. That doesn't happen often in our politics, which seems intent on beggaring the young and struggling to pay off the old and well off.

  4. Harold, your first sentence (the one in italics) is probably wishful thinking.

    What stigmas (of which there are certainly many) can you think of that have stuck?

    1. Take a four-cell matrix on policy initiatives: "virtuous" and "sleazy", and "effective" and "flops". Politicians can often get away with effective sleaze, and virtuous fails. The sleazy flops get remembered, like Munich, the Second Iraq War and the Bay of Pigs.

      BTW, Simon Schama has a nice jibe: the GOP plans to replace Obamacare with Trumpcroak.

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