Category Archives: health care

We Don’t Need No Stinkin’ CBO Score

The House leadership, that is. According to The Hill:

The House will vote without waiting for a new Congressional Budget Office (CBO) analysis of Upton’s changes or the amendment from Rep. Tom MacArthur (R-N.J.) that won over the House Freedom Caucus. That analysis will eventually provide insight into the bill’s effects on coverage and its cost.

What’s the difference between what went down in flames earlier, and what is coming now? The text is not accessible to me yet (I searched here), but my understanding is it allows to waivers so states can drop the pre-existing conditions… and adds $8 billion over ten years to fund high risk pools.

Here’s some illustration of the sheer insufficiency of $8 billion. From CBPP:

The details behind this additional $8 billion are unclear; some accounts suggest it would go to fund state high-risk pools, while others suggest it would go for other purposes. But either way, the additional funding wouldn’t come remotely close to addressing the severe problems that the bill creates for people with pre-existing conditions. Notably, the $8 billion would restore less than 1 percent of the nearly $1 trillion the House bill cuts from programs that help people afford coverage.

This seems in some ways even worse for coverage than the first plan, which CBO assessed thusly:

CBO and JCT estimate that enacting [H.R. 3762, the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, which would repeal portions of the Affordable Care Act (ACA) eliminating, in two steps, the law’s mandate penalties and subsidies but leaving the ACA’s insurance market reforms in place] would affect insurance coverage and premiums primarily in these ways:


  • The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill. Later, after the elimination of the ACA’s expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million, and then to 32 million in 2026.
  • Premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by 20 percent to 25 percent—relative to projections under current law—in the first new plan year following enactment. The increase would reach about 50 percent in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026.

Well, I can’t be sure it’ll be worse. For certain, the representatives voting tomorrow won’t know for sure because the House leadership is heck-bent on a vote without knowing. For them, it is clear, more knowledge is not helpful.

So much for the party of fiscal responsibility. Or expertise, for that matter.

Update, 6:10PM Pacific:
Vox assesses.
CRFB says the deficit will be increased by the bill.

CBO Projections of Coverage under the ACA

We all know that the CBO has been under assault over the recent scoring of the AHCA (14 million reduction in coverage by 2018, 26 million by 2026; relatively unchanged by recent amendments), with allegations that their previous projections have been “wrong”. I document in this post that CBO macro projections have been comparable to Blue Chip averages, in terms of accuracy (mean bias, RMSE’s). In terms of the issue at hand, here is a graph depicting various vintages of CBO projections of reduction in uninsured.

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From October 2013: “The Obamacare implosion is worse than you think”

That’s a title from an oped by former GW Bush speechwriter and current AEI scholar Marc Thiessen nearly a year ago. We can now evaluate whether in fact the implementation of individual insurance mandate component of the ACA did implode. From “New Data Show Early Progress in Expanding Coverage, with More Gains to Come,” White House blog today:

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