In asking the Congressional Budget Office to take a longer view of Senate Republicans’ troubled health-care plan, the chamber’s Democrats maneuvered to train a spotlight on exactly what the GOP has sought to bury.
The Better Care Reconciliation Act relies on the time-honored political strategy of pressing a bill’s most profound effects years into the future — in this case, in severely constricting the main source of public health insurance for poor and vulnerable Americans.
Until Thursday, that scenario had been cloaked in arcane legislative language about per-capita caps and varying inflation adjustments. What Congress’s nonpartisan budget scorekeepers did, at the prodding of the Senate Finance Committee’s senior Democrat, is make clear that the GOP legislation would squeeze federal Medicaid spending by 35 percent by the end of two decades, compared with current law.
The extra analysis comes three days after the CBO issued an estimate of the bill’s effects on insurance coverage and federal spending. The original estimate looked forward only a decade, as such analyses almost always do. It predicted that the number of Americans covered by Medicaid in 2026 would be 15 million fewer than if the Affordable Care Act remains the law. It also estimated that the program would receive $772 billion less in federal money.
The new conclusions, barely three pages long, do not indicate how much more than $772 billion would be lost from the program in that second decade. Nor does the CBO say how many fewer people would be on Medicaid’s rolls by then. Predicting that far ahead is too uncertain, the analysts said.
Still, the budget office projects that “a large gap” between Medicaid at the moment and Medicaid under the Senate GOP leaders’ plan would continue to widen after 2026. After the coming decade, the report says, “enrollment in Medicaid would continue to fall.”
Two organizations, the consulting firm Avalere Health and the Committee for a Responsible Federal Budget, sought late Thursday afternoon to translate the CBO’s forecast into dollars. Both estimated that the slowdown in Medicaid spending would go from $158 billion in 2026 to at least $330 billion a decade later.
According to the CBO and other analysts, one ripple effect would be intense pressure on states, forcing them to make hard decisions about cutting benefits, eligibility or payments to doctors and hospitals while trying somehow to make their programs more efficient.
Since its beginning in the mid-1960s, Medicaid has been a shared responsibility of the federal government and states. Today it is generally the largest program in states’ budgets, and the CBO findings mean that “you are making a bigger than one-third cut to the states’ biggest line item,” said Elizabeth Carpenter, senior vice president at Avalere. “The level of cuts being debated for Medicaid are unprecedented.”
Senate Democrats swiftly leapt on the CBO’s new findings as if they had not expected them all along. “The Senate version of Trumpcare is even worse than we thought,” declared Senate Minority Leader Charles E. Schumer (D-N.Y.)
Sen. Chris Van Hollen (D-Md.) chimed in that “when it comes to Medicaid cuts, the Senate bill is even meaner than it looks — and the more time goes by, the meaner it gets.”
A spokeswoman for Senate Majority Leader Mitch McConnell (R-Ky.) tried to discredit the latest analysis, saying that the “CBO says the 20-year predictions are almost impossible.”
Eliciting a longer view from the budget office was part of a two-pronged strategy by the Senate’s minority party to ratchet up pressure on moderate Republicans. In both ways, the Democrats drew new attention to parts of the health-care bill that already have made many of their GOP counterparts uncomfortable.
The other prong was a report, prepared by Democrats on the Senate Health, Education, Labor and Pensions Committee, that contends the GOP measure would undermine the government’s ability to respond to the nation’s opioid epidemic.
The report includes figures on residents of four states who have gained access to opioid-addiction treatment through the Affordable Care Act’s insurance expansions. The states include Ohio and West Virginia, where GOP senators have criticized the pending legislation precisely for failing to provide enough help.