You might think of it as the legislative equivalent of flying into a storm without instruments.
Two committees in the Republican-led House have begun drafting sweeping health legislation without the benefit of an objective estimate of its impact from the Congressional Budget Office (CBO) — a reckless move, critics say, considering that they are dealing with the well-being of tens of millions of Americans and an industry that accounts for close to one-fifth of the economy.
“Health care is too important, it impacts too many lives, to have a health-care bill jammed though in the same manner as President Trump’s immigration order,” said Rep. Lloyd Doggett (D-Tex.). “What this bill needs is some extreme vetting.” Doggett offered an unsuccessful motion for a week’s delay in action by the Ways and Means Committee.
Meanwhile, even before CBO’s estimates are out, the White House has launched a preemptive attack on the agency’s credibility, saying its estimates of the effects of the Affordable Care Act were off the mark.
The bills being written by the Energy and Commerce Committee and Ways and Means will proceed to a third panel, the Budget Committee, where they will be consolidated into a major piece of fiscal legislation known as a reconciliation bill.
Republican leaders say that they expect to receive a CBO “score” of the health-care legislation early next week, before it reaches the Budget Committee and certainly before it comes up for a vote by the full House.
“We all know it’s going to score positive to helping out the deficit, to spending less money,” White House budget director Mick Mulvaney said Wednesday on MSNBC’s “Morning Joe” show. “I hear all the talk about the CBO score. The only question about the CBO: Is it going to be really good or is it going to be great when that number finally comes out?”
But the CBO’s analysis goes far beyond the question of how the legislation will affect the deficit.
It will delve into how many — and which — people would gain or lose coverage under the legislation that House Republicans are offering as a replacement for the Affordable Care Act, popularly known as Obamacare.
The CBO is also likely to weigh in on whether the bill would prolong or shorten the life of the Medicare trust fund, how its changes in the Medicaid program would affect the burden on states, and a host of other effects of changing the existing law.
The CBO has long been held in high respect for both the quality of its analysis and the independence of its conclusions. At the same time, it has sometimes frustrated policymakers, who often argue that the CBO’s methods are too cautious and overly rooted in historical precedent.
While it is not uncommon for congressional committees to consider legislation without the CBO first weighing in, at least with preliminary estimates, veterans of the process say that doing so on bills as far-reaching as the health-care overhaul is rare — and ill-advised.
“What’s different here is the scale and the scope. This thing is vast. It’s enormous,” said Keith Fontenot, who was associate director for health at the Office of Management and Budget during the Obama administration, and who also worked in health policy at the CBO.
“On something of this magnitude, it strikes me that there is not as much information being circulated on this proposal as there has been in the past,” Fontenot said.
The Republicans’ clipped timeline is part of a GOP effort to swiftly deliver on its promise to repeal and replace Obamacare.
But it also marks a sharp contrast from Congress’s last big health-care battle, the 2009-2010 debate over Obamacare, in which both parties continually cited the office’s reports to make their case.
“When we were writing the ACA, we didn’t say ‘Boo’ without thinking about what the CBO would say,” said Jonathan Gruber, a senior health-care adviser to the Obama administration.
Republicans, however, maintain that the experience of the Affordable Care Act did not exactly enhance the CBO’s credibility.
“Let’s be honest. The irony of the score is that the CBO was way off the last time,” White House press secretary Sean Spicer said Wednesday in his daily briefing. “If you’re looking at the CBO for accuracy, you’re looking in the wrong place. I mean, they were way, way off the last time in every aspect of how they scored and projected Obamacare.”
The office indeed had some misses in its assessment, predicting the measure would cost more than its eventual price tag and estimating that it would expand access to health insurance to more people that it eventually did.
Among its more serious mistakes was overestimating the number of Americans who would receive insurance for the first time under Obama’s overhaul.
During the debate over the law, the office projected that just 21 million Americans would be uninsured by last year. In fact, there were still about 27 million without insurance, according to preliminary data from the federal Centers for Disease Control and Prevention.
The CBO projected that eventually as many as 32 million more people could obtain coverage. So far, only about 13 million more have done so, according to the nonpartisan Kaiser Family Foundation, and the CBO has repeatedly revised its forecast downward.
Jeff Guo contributed to this report.