In the wake of a report by the Congressional Budget Office, Republicans and Democrats alike have expressed concern about the Trump administration’s health care proposal.
According to the CBO’s analysis, the Republican-backed American Health Care bill, which passed in the House earlier this month along party lines, would lead to a loss in coverage for up to 23 million Americans and a spike in the cost of health care.
Defenders of the GOP effort to repeal and replace Obamacare, however, put little stock in the findings of the federal agency, which according to its website has “produced independent analyses of budgetary and economic issues to support the Congressional budget process” since 1975.
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Critics point to a record of inaccurate predictions regarding the implications of a litany of budget proposals, as with reports dating back to 2009 regarding the Affordable Care Act, commonly known as Obamacare.
In anticipation of the CBO’s March report on an earlier version of the AHCA, several prominent Republicans called into question the accuracy and impartiality of an agency that prominently bills itself as nonpartisan.
White House press secretary Sean Spicer told reporters in March:
“If you’re looking at the CBO for accuracy, you’re looking in the wrong place. They were way, way off last time in every aspect of how they scored and projected Obamacare in terms of … the number of people that they projected would be on Obamacare. They were off by millions.”
House Majority Whip Steve Scalise was similarly critical prior to the report’s publication.
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“The CBO, and [Obama], talked about how [Obamacare] was going to reduce the deficit,” he said. “Remember, that promise was broken. When the CBO comes up with a score, that’s great; but in the meantime, we’re not going to wait for some unelected bureaucrats to provide relief from Obamacare to the American people.”
Following a report based on the revised bill that passed this month, U.S. Rep. Tom MacArthur, R-N.J., who helped author the legislation, shared his thoughts on the CBO’s analysis.
“They’re trying to answer questions that I think it would be better where they say, ‘I don’t know,'” he said.
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A controversial record
The CBO is known primarily for the score it assigns to an array of bills based on how the federal budget could change should they become law. These scores have frequently been a factor for lawmakers when considering whether to support a piece of legislation.
Nevertheless, there is substantial anecdotal evidence cited by critics to support their skepticism of the CBO’s report on the Republican health care proposal.
A common example involves the number of Americans expected to enroll in Obamacare in the agency’s forecast.
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The 2010 study foresaw 21 million Americans signing up for coverage in the Obamacare exchanges last year, which was more than double the actual number of enrollees.
The CBO analyzed other aspects of the health care law in subsequent years, including its prediction in 2014 that the risk corridor program, which protected insurers against losses, would generate $8 billion in profits over three years. Instead, the result thus far has been a $2.5 billion deficit in 2014 and a nearly $6 billion deficit the following year.
Former CBO Director Douglas Elmendorf recently put a positive spin on the agency’s Obamacare predictions during his tenure, but acknowledged it was “not as accurate as we would have liked.”
Elmendorf and supporters of the CBO point to several factors as the root of its inaccuracies and focus on the fact its reports were closer to reality than some other projections.
Obamacare, however, was far from the first perceived flub in the agency’s scoring record.
As an example, predictions for the 2003 budget varied by more than $800 billion between 1993, when the CBO projected a $653 billion deficit, to 2001’s forecast of a $172 billion surplus.
“Little of that $825 billion revision can be explained by legislation or bad luck,” wrote the Cato Institute’s Alan Reynolds in 2001. “Nearly all of it reflects the magnitude of past forecasting blunders.”
Reynolds went on to identify what he saw as a consistent theme.
“Errors are unavoidable, but perpetual bias is another matter,” he wrote at the time. “CBO errors always tilt in a specific direction. Aside from the first year of recessions, the CBO always exaggerates future budget deficits and underestimates surpluses.”
Critics on both sides of the aisle have also argued the agency has shown political bias, depending on the nature of a particular report.
Democrats have relied heavily on the CBO report to support their opposition to the GOP health care bill. When the same agency scored Obamacare beginning in the first year of the Obama administration, on the other hand, many sung a different tune.
Despite GOP backlash over what some saw as an overly sympathetic analysis of Obama’s health care plan, many Democratic lawmakers and Obama administration officials expressed doubt about the CBO’s reports over the past eight years.
House Minority Leader Nancy Pelosi cited the agency’s estimates in her proclamation that the GOP health care plan is “immoral.” In 2009, though, she expressed serious disagreement with the methods used by the CBO to assess Obamacare’s budgetary impact.
Sen. Mark Warner, D-Va., used the CBO report as the basis to label the AHCA “irresponsible” in a March press release.
“Today’s estimates from the Congressional Budget Office show that Trumpcare will raise costs for consumers, particularly seniors, and leave millions of Americans without coverage,” he wrote.
Like Pelosi, when its analysis was applied to Obamacare, Warner argued CBO scores did not take into account certain important factors.
In 2014, Jason Furman, then director of Obama’s Council of Economic Advisers, was discussing a CBO report when he told reporters:
“The final thing I’d like to say is that CBO themselves stress that their analysis is not complete — it doesn’t reflect the full set of factors — and that there’s substantial uncertainty around their analysis. In particular, I think there’s three very important ways that the Affordable Care Act is and will continue to improve labor markets that weren’t reflected here.”
What the CBO really means
Regardless of the persistent dispute surrounding many of the CBO’s scores and predictions, the agency still holds a place of high esteem among many involved in the federal budget process.
Stan Collender, who has served as a top congressional budget committee staffer on both sides of the aisle, said the CBO offers “the closet thing you’re going to get to facts in Washington.”
Many of the legislators ostensibly meant to use its scoring to gain insight into the ramifications of proposed legislation, however, have made it clear they do not have much faith in its ability to produce accurate and unbiased forecasts.
Among the general population, one political consultant has found the agency holds even less sway.
Richard Holt told Western Journalism that “when we start knocking on doors in a few months, there won’t be a single voter that even mentions the report — if they even know about it.”
He said such reports “sound great on TV for a day or two but have little real effect when we’re engaging with voters.”
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