The Congressional Budget Office released estimates on March 23 for how House Republicans' proposal to revise the Affordable Care Act might affect Americans. (Sarah Parnass,Bastien Inzaurralde/The Washington Post)

Republican efforts to pass an Affordable Care Act replacement took a hit Monday night with estimates emerging from the nonpartisan Congressional Budget Office that more people could eventually lose their health insurance (24 million) than gained it through Obamacare (20 million).

Democrats seized on this report as proof Republicans' replacement efforts are misguided, while House Speaker Paul D. Ryan (R-Wis.) said he found the analysis “encouraging” because it predicted the bill would also reduce the deficit and lower premiums. The White House took the approach of disparaging the report and the office that wrote it altogether.

In other words, one's politics shape one's reality. (What's new?)

To help us cut through the clutter, we called someone who knows what it's like to be in the middle of a CBO political storm: former CBO director (and Republican) Doug Holtz-Eakin, who ran the agency from 2003 to 2005. Our conversation has been edited for length and clarity.

THE FIX: Is the political tension surrounding this particular CBO report any more pitched than usual?

HOLTZ-EAKIN: I think this is pretty much business as usual. CBO is generally a nonpartisan organization. It exists in a very partisan environment, and the volume on that goes up and down over time, and at moments each side uses the CBO to support their side.

What about this particular moment in time has turned up the volume?

Health and Human Services Secretary Tom Price on March 13 said a Congressional Budget Office report on the House Republicans' health-care plan is "just not believable." (Reuters)

CBO is most important at the time when it actually knows the least, sadly. When Congress does new policy and the CBO is put in the position of evaluating the policy, becomes more important because it's new. And it's always at a time when it's the hardest to do.

CBO tries hard to put its estimates in the middle of what it thinks the relevant range is, so you're just as likely to be too high as too low.

House Minority Leader Nancy Pelosi (D-Calif.) on March 13 said the House Republicans' health-care plan "doesn't achieve anything it sets out to do." (Reuters)

The CBO's estimate that 24 million fewer people would have health insurance over the next decade is significantly higher than other outside estimates. What does that mean, if anything?

I think it tells you the range of uncertainty about the bill. CBO is honest about the fact its uncertainty is quite large. A big piece of uncertainty is: How important is the individual mandate? It's clear from these numbers the CBO thinks it's very important: The minute it goes away, they expect 14 million people to say “no thanks” to health insurance.


 

Can you give us a CBO 101 course? What are some misconceptions about the agency?

CBO does two things. It scores legislation and it tells you the impact on the federal budget.

It is nonpartisan. It is barred from making policy recommendations, so it does not tell the Congress what to do, ever. It answers Congress's questions, and everything it produces is done at the request of somebody in Congress. It is generally a congressional support agency.

It also has no power whatsoever. It is strictly advisory.

Politicians are particularly adept at exploiting uncertainty. How do CBO analysts cope with that?

You have to ignore the contest. Sometimes, someone is going to be mad at you or not. Someone is going to make a big deal of it, or not. That's outside the CBO's control. Their job is to produce the work.

When I was director, I felt my sole responsibility was to tell the truth to the best of my ability and get it on time for lawmakers to make a decision. And the rest is fate.

So the job of the CBO is to provide the most accurate report it can, then let it go?

Yeah. CBO doesn't make news; someone makes news out of CBO. That's clearly what is going on in this instance, where you've got Chuck Schumer and Nancy Pelosi standing up there and blasting the CBO's scores as much as they can. The roles were reversed at a time when the CBO scored Republicans' Affordable Care Act repeal, and it projected an economic boost, and Republicans held that up and screamed about how horrible the ACA is.

That must be frustrating to work hard on a report only to see both sides twist it to their benefit.

Uh, yup. [Laughs]. There are people who have been at the CBO for decades, and I don't know how they handle it.

I was there a relatively short time, and I convinced myself it's just business. You can't take it personally.

What advice would you give an American trying to use the CBO to make a decision about Republicans' health-care bill?

The same thing I would tell a member of Congress: It's CBO's job to keep track of the cost of pieces of legislation. It's the policymaker's job to decide if the benefits are large enough to be worth those costs.

So you're not asking the CBO, “Is this a good idea?” You're asking one half of that question: “What does it cost?” And then you have to think of what the benefits are.

How are you interpreting the CBO's report on Republicans' Obamacare replacement?

It's a good piece of work. I honestly don't think this changes the politics of this much. The politics were that Democrats hated the bill; that's not going to change by the score. And Republicans still have to bridge the gap between the Freedom Caucus and Sen. Susan Collins. That hasn't changed. They have to get 218 in the House and 51 in the Senate on the same piece of legislation. It's going to be hard.

They are now in a position where, as the governing party, they don't have the luxury of just voting on things that were absolutely perfect. They have to vote “yes” on things the party absolutely despises. Every member is going to be in that position.