Less is Not More

March 14, 2017

The Congressional Budget Office’s (CBO) cost estimate of the American Health Care Act (AHCA), the proposed Republican replacement of the Affordable Care Act (ACA), is out. [1] The estimate was a joint effort of the CBO and the Joint Committee on Taxation (JCT). Unsurprisingly, the “CBO and JCT estimate that enacting the legislation would reduce federal deficits by $337 billion over the 2017-2026 period.” [2] Of course, the “largest savings would come from reductions in outlays for Medicaid and from the elimination of the Affordable Care Act’s (ACA’s) subsidies for nongroup health insurance.” In other words, the savings will come from expenditures targeted toward getting health coverage for those who would otherwise be unable to afford it.

Also as expected, the “CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law.” In this early stage, most “of that increase would stem from repealing the penalties associated with the individual mandate.” This is because some of the people now covered “would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

But the number of uninsured is expected to increase after 2018.

“Later, following additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program, the increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026. The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

Given the devastating impact that medical expenses can have on individuals and families, and given the fact that many of the uninsured will simply forego necessary medical care because of the cost, it is hard to see how this outcome is desirable.

It would have been interesting to see an analysis of how this legislation will impact the economy as a whole, and how that would impact the budget. In point of fact, CBO estimates pertaining to legislation of this kind are required to contain such an analysis under operative House rules.

But we won’t be favored with such this time around. As the CBO puts it,

“Because of the magnitude of its budgetary effects, this legislation is “major legislation,” as defined in the rules of the House of Representatives. Hence, it triggers the requirement that the cost estimate, to the greatest extent practicable, include the budgetary impact of its macroeconomic effects. However, because of the very short time available to prepare this cost estimate, quantifying and incorporating those macroeconomic effects have not been practicable.” (Footnote omitted.)

Thus, due to the haste with which this legislation is being pushed through, the CBO cannot do a full analysis. To completely assess how the law will affect the budget it is necessary to give due consideration to how it will impact the economy, the federal budget not operating in an accounting vacuum. But even though House rules require the CBO to look at the overall economic effects of major legislation like the AHCA, doing such a study would take too long to accommodate the timetable of the legislation’s congressional proponents. Simply put, they want to get the new healthcare law through before the CBO is able to do a proper analysis. It is to be wondered how they could sincerely consider themselves on the right side of the question if information is their enemy.

Incomplete as the CBO estimate is because of the constraints it was placed under, common sense informed us ahead of time that the ACHA would result in an increase in the number of Americans without health insurance. After all, the legislation’s “new tax credits would be structured differently from the current subsidies and would generally be less generous for those receiving subsidies under current law,” and it rolls back Medicaid coverage. So none of this is surprising.

What is surprising is that a political party that does this sort of thing to people can continue to advertise itself as a pro-life party. If women find their economic distress exacerbated because health coverage is less affordable, how will this not have an upward pressure on the number of abortions? It doesn’t matter that the CBO expects that “average premiums for single policyholders in the nongroup market under the legislation would be roughly 10 percent lower than under current law” by 2026 (although it expects premiums to be “15 percent to 20 percent higher” in the short term); the critical question is not price itself, but what people can afford. For someone who can’t afford the premium, it might as well be $1 million a month. And if people die because they can’t access health coverage, how pro-life is that?

Why, that’s not very pro-life at all.

Jack Quirk