If Republicans in the House of Representatives press forward with a plan to vote today on an yet another amended version of the American Health Care Act, the proposal for repealing and replacing Obamacare, they are likely going to do it without an analysis of the bill by the Congressional Budget Office. However, given the kinds of changes to the bill that are reportedly being considered as House leadership and the White House try to wrangle the votes they need, they probably don’t want one anyway.
With the bill in danger of failing because of opposition from the most conservative Republicans in the House, the Trump administration and top Republican lawmakers in the House are reportedly entertaining the possibility of granting the holdouts a huge victory: the elimination of what the ACA calls “essential health benefits” that every insurance plan must cover.
Current law requires that all major medical health care plans cover ten different types of “essential” care, including hospitalization, outpatient services, maternity and newborn care, mental health and addiction services and more.
Opponents of the law have long objected to the requirement, claiming that it forces consumers to purchase coverage that they may neither need nor want and drives up premium prices, making care unaffordable for some.
Late Wednesday, Politico reported that the White House and members of the House Freedom Caucus, the right-wing lawmakers who are threatening to scuttle the bill because they don’t believe it goes far enough in undoing the Affordable Care Act’s changes to insurance markets, had agreed in principle to add language ending the essential care requirements in the bill.
Lawmakers were already facing the real possibility of having to vote on the AHCA without a CBO score of the final version of the bill. The budget agency’s analysis of the initial version of the proposal released last week was brutal. It found that the proposed changes would result in 24 million fewer Americans with health insurance within a decade -- by choice or by design -- even as costs rose and benefits dwindled for the poor and elderly.
After House leadership released amended language Monday night, though, including changes to tax credits for older Americans, tweaking the repeal of ACA’s Medicaid expansion and more, the old CBO score became inoperative. There were reports that the agency was racing to prepare a new estimate of the amended bill in advance of Thursday’s expected vote. But if major changes like the elimination of the essential care requirements are shoehorned in at the last moment, the odds of seeing a CBO score of the final bill on Thursday are very slim.
For the bill’s supporters, that’s probably just as well. That’s because if conservatives are indeed successful in gutting the essential care requirement, CBO will likely project that even more Americans will be without health insurance under the AHCA.
The CBO itself warned Congress of this last year, trying to wave lawmakers off of efforts to allow the reintroduction of bare-bones insurance coverage by signaling that it would not consider people who are not protected from the serious financial risk of unexpected health crises as actually insured.
CBO and the the staff of the congressional Joint Committee on Taxation found that absent the essential care requirements, some policies offered to people receiving the AHCA’s tax credits “would probably not provide enough financial protection against high medical costs to meet the broad definition of coverage that CBO and JCT have typically used in the past—that is, a comprehensive major medical policy that, at a minimum, covers high-cost medical events and various services, including those provided by physicians and hospitals.”
The agency continued, “If there were no clear definition of what type of insurance product people could use their tax credit to purchase, everyone who received the tax credit would have access to some limited set of health care services, at a minimum, but not everyone would have insurance coverage that offered financial protection against a high-cost or catastrophic medical event; CBO and JCT would not count those people with limited health benefits as having coverage.”
What that means is that a successful move to eliminate essential benefits would invite an even more damning analysis of the bill from the Congressional budget watchdog agency -- something that GOP leaders, struggling to hold together a coalition of lawmakers willing to pass the AHCA can ill afford.
So it will be no surprise if GOP leaders who normally preach fiscal responsibility and a commitment to budget discipline are happy to move forward on a vote before the agency charged with assessing the fiscal consequences of the ACHA has a chance to render a verdict.