President Trump, with House Majority Whip Steve Scalise, left, speaks during a meeting with the House deputy whip team in the East Room of the White House in Washington on March 7. (Jabin Botsford/The Washington Post)

In the era of President Trump, massive fights break out in Washington without being telegraphed at all. Trump tweets or says something, and the media erupts into paroxysms that no one saw coming. But there are still some fights that can be seen coming from miles away, Washington politics tied to the tracks as the train builds up steam on the horizon.

One of those predictable fights is the soon-to-be-released estimate from the Congressional Budget Office of how many people would lose health-care coverage if the House’s Obamacare alternative is passed and signed into law. The CBO is the nonpartisan analysis arm of Congress and is tasked, among other things, with estimating how legislation will affect the federal budget.

The fight over the House bill’s effects has been coming long enough that White House press secretary Sean Spicer already preemptively disparaged the CBO’s work.

“If you’re looking at the CBO for accuracy, you’re looking in the wrong place,” he said Wednesday. “The idea that that’s any kind of authority based on the track record of what happened last time is a little far-fetched.”

The “last time” to which Spicer was referring is the CBO’s initial estimate of the effects of the Affordable Care Act (better known as Obamacare). As our colleagues at Wonkblog noted Thursday, initial estimates from the CBO overestimated how many people would gain coverage under the law. As years passed, the estimates were revised downward. (The discrepancy was largely because the CBO overestimated how many people would enroll in Obamacare through the public exchanges.)


(Washington Post/Wonkblog)

That particular subject aside, the CBO’s analysis is generally accepted as sound. Its own assessment of its record at forecasting economic trends found that its estimates have generally been in line with administration estimates and the estimates of an average of 50 private-sector groups. The CBO’s analysis is considered sound enough that both Spicer and Trump have, in the past, cited its projections for political points.

What the CBO says matters — so much so that at least one House Republican, Tom Reed (R-N.Y.), told Vox that a big drop in the number of insured would necessitate revisiting the bill.

We don’t know yet what the CBO will say, but it seems fairly clear that their forecast will show a significant drop in the number of people with insurance coverage if Obamacare is repealed and/or the Republican American Health Care Act were to become law.

How many could lose coverage?

At least 15 million over the next 10 years if the AHCA passes. This analysis, from Brookings, estimates that, at a minimum, 6 million would lose coverage from the public exchange, 2 million from employer coverage and 7 million who are currently covered under Medicaid.

6 to 10 million people by 2024 if the AHCA passes. This assessment comes from Standard & Poors, with an estimate of 2 million to 4 million losing coverage from the exchange and 4 million to 6 million losing coverage under Medicaid.

24 million people by 2021 if Obamacare is repealed. The Robert Wood Johnson Foundation looked at the effects of a repeal last June. It predicted most of those who lost coverage would lose it because of the rescinding of the expansion of Medicaid. An estimated 8.8 million, per the foundation, would lose their private coverage.

18 million in the first year if a previous House bill were passed. That was the CBO’s assessment of the Restoring Americans’ Healthcare Freedom Reconciliation Act, which was vetoed by President Barack Obama at the beginning of last year. That bill differed from the AHCA, but it was introduced by Tom Price, then a member of the House and now secretary of health and human services.

Why does a loss of coverage matter? It matters practically for those who might face steeper medical costs or poorer health care as a result. From a political standpoint, it rescinds a benefit from potential voters. The recent outcry at congressional town hall meetings was a function of people frustrated at the prospect of losing coverage. If the CBO officially estimates that millions will lose their coverage, that could cause many legislators, like Tom Reed, to balk.

House Speaker Paul D. Ryan (R-Wis.), though, isn’t worried. His goal, he said in an interview with radio host Hugh Hewitt, was to create a patient-centered health-care system that lowers costs.

“That’s our goal,” he said, “and it’s not to win some coverage beauty contest.”

If the CBO estimates that millions will lose coverage and its estimates are anywhere close to accurate, the next few years of Republican politics could be defined by Ryan and his allies trying to explain why people who lost their coverage shouldn’t be focused on that particular “beauty contest.”

That fight can be seen from miles away, too.