The Congressional Budget Office’s analysis of the Republican health-care bill had just been made public Wednesday, and Rep. Mark Meadows was standing off the House floor, 15 minutes into a sparring session with reporters over its significance when he suddenly paused.
“Listen,” Meadows (R-N.C.) said, his voice cracking. “I lost my sister to breast cancer. I lost my dad to lung cancer. If anybody is sensitive to preexisting conditions, it’s me. And I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself. So I tell you that in the most earnest of ways that we’re going to get this right.”
The burst of emotion from the House Freedom Caucus chairman, a man who played a crucial role in shepherding the American Health Care Act to passage, was a poignant reaction to an uncomfortable fact: According to the nonpartisan CBO, the GOP bill broke a fundamental promise GOP leaders made to the public.
Repeatedly, top Republicans said, people with preexisting medical conditions would still be able to purchase affordable insurance under the AHCA. They downplayed concerns from independent analysts that the protections they included would not be sufficient to protect the sickest patients from drastic price hikes — touting a last-minute fix to beef up subsidies without waiting for the CBO to judge whether it would work.
“Preexisting conditions are in the bill,” President Trump said last month. “I mandate it. I said, ‘Has to be.’ ”
“Under this bill, no matter what, you cannot be denied coverage if you have a preexisting condition,” House Speaker Paul D. Ryan (R-Wis.) said earlier this month, after his office issued a release saying the bill “protects people with preexisting conditions.”
“We need to protect the most vulnerable people,” Rep. Tom MacArthur (R-N.J.), who worked with Meadows to craft a viable bill, told CNN. “These are people with preexisting conditions. We want to make sure they are protected.”
The CBO found that while insurers could not deny coverage to sick Americans, they would be far from being “protected.”
In states that choose to waive certain insurance coverage mandates as allowed under the GOP bill, the report stated, “people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”
The scorekeepers added: “[L]ess healthy people would face extremely high premiums, despite the additional funding that would be available under [the AHCA] to help reduce premiums. Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly.”
The analysis undermines not only the claims made by GOP leaders, but also shows that their bill could, by undoing what is perhaps the Affordable Care Act’s single most popular provision, throw consumers back into insurance markets where their ability to purchase affordable insurance would depend on their health.
The CBO report prompted a variety of explanations and evasions this week. Many House Republicans simply cast doubt on the CBO’s ability to analyze health-insurance markets.
Rep. Phil Roe (R-Tenn.), a medical doctor who played a role in the health-care debate, said “the preexisting condition issue has been put to rest” and that the CBO has been “outrageously wrong” in the past.
“Look, they’re good people,” he said. “They do the best they can with the data they have, but they’ve been wildly wrong in these predictions.”
MacArthur suggested the CBO had little sense of how the bill would play out on the state level: “I’m not a prophet, and let’s remember, neither are they,” he said. “There are some questions. Frankly, I think they’d be better off saying, ‘We don’t know.’ But that’s not the answer. The answer’s always an answer.”
And Ryan suggested Thursday that the CBO had not taken into account funds that states would spend to stabilize their insurance markets. “We will have federal resources and state resources, which taken together will improve the situation,” he told reporters.
In his extended back-and-forth with reporters Wednesday, Meadows said that he would closely examine the CBO report and that he was open to the notion that more funding would be needed to support the “high-risk pools” included in the bill to help sicker Americans.
“The president is committed to making sure preexisting conditions are covered, both in principle and in practice, which means funding has to be there to make it work,” he said.
There were plenty of indications that the House GOP plan to protect those with preexisting conditions could be inadequate. Rep. Fred Upton (R-Mich.), a key House moderate, agreed to support the bill after negotiating to add $8 billion to a $130 billion fund that would be used to subsidize high-cost patients. But GOP leaders could point to no analysis suggesting that particular amount would be sufficient.
“It’s our understanding that the $8 billion over the five years will more than cover those that might be impacted and, as a consequence, keeps our pledge for those that, in fact, would be otherwise denied because of preexisting illnesses,” Upton said.
The House voted before the CBO analysis was complete.
On Thursday, Meadows revisited the risk-pool funding issue with reporters — and joined the ranks of those questioning the CBO’s acumen.
Two different studies, he said, showed “we’re in the ballpark of where we need to be” to make the high-risk pools work. “I know the numbers, and I know the assumptions that you have to make, and some of their assumptions appear to not be backed up by real analysis,” he stated.
Meadows then reached for another frequent House GOP talking point: Pay no mind to this CBO score, because the score that really counts is still to come.
“I feel very confident where we are,” he said. “Moving it across to the Senate was certainly not a mistake, because ultimately the final CBO score that we’ll debate is going to be one that happens after the amendments get agreed to in the Senate.”