This will be a running and updated post on the cost estimates of the AHCA by the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT)
17:20 TLDR It is about the same bill that got scored in March with marginal changes. CBO does not think MacArthur/Upton will have large net effects
16:22 The JCT estimates the bill that passed the House has a $662 billion dollar tax cut over the scoring window.
16:30 The March 23, 2017 CBO score is here. This was the managers amendment leading into the week of the first vote window which got pulled. It does not include everything that was in the bill before it got pulled.
The baseline is -24 million incrementally not insured for a total 52 million people without insurance and $150 billion in total deficit reduction.
16:33 Here it is
16:34$120 billion in deficit reduction, donut plans will be purchased, slightly more people covered
In addition, the agencies expect that some people would use the tax credits authorized by the
act to purchase policies that would not cover major medical risks and that are not counted
as insurance in this cost estimate.
1635
So basically, CBO thinks only 1-2 states would go for waivers, meaning AHCA 2.0 will *only* be about as shitty as…AHCA 1.0
— ☪️ Charles Gaba ✡️ (@charles_gaba) May 24, 2017
The MacArthur amendment is doing very little work. That surprises me. I thought that between it and Upton throwing money at states to take a waiver, that several states including medium (Wisconsin, Georgia) and large (Texas, Florida) would have been scored as very likely to go that route.
16:37
CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under H.R. 1628 than under current law. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 23 million in 2026. In 2026, an estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law. Under the legislation, a few million of those people would use tax credits to purchase policies that would not cover major medical risks.
So it looks like the CBO is mostly projecting the same loss of coverage slope between its two estimates with some uptake due to cheaper underwritten premiums.
16:42 CBO thinks MacArthur/Upton will produce structurally unstable markets in 15% of the population due to split risk pools
the agencies estimate that about one-sixth of the population resides in areas inwhich the nongroup market would start to become unstable beginning in 2020. That instability would result from market responses to decisions by some states to waive two
provisions of federal law, as would be permitted under H.R. 1628. One type of waiver would allow states to modify the requirements governing essential health benefits (EHBs), which set minimum standards for the benefits that insurance in the nongroup and
small-group markets must cover. A second type of waiver would allow insurers to set premiums on the basis of an individual’s health status if the person had not demonstrated continuous coverage; that is, the waiver would eliminate the requirement for what is termed community rating for premiums charged to such people. CBO and JCT anticipate that most healthy people applying for insurance in the nongroup market in those states would be able to choose between premiums based on their own expected health care costs (medically underwritten premiums) and premiums based on the average health care costs for people who share the same age and smoking status and who reside in the same
geographic area (community-rated premiums)
The Upton money is an incredibly underfunded high cost risk pool:
CBO and JCT expect that, as a consequence, the waivers in those states would have another effect: Community-rated premiums would rise over time, and 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—despite the additional funding that would be available under H.R. 1628 to help reduce premiums.
1645 Don’t be sick in a full MacArthur/Upton state
Finally, about one-sixth of the population resides in states that would obtain waivers involving both the EHBs and community rating and that would allow premiums to be set on the basis of an individual’s health status in a substantial portion of the nongroup market…. less healthy people would face extremely high premiums, despite the additional funding that would be available under H.R. 1628 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. As a result of the narrower scope of covered benefits and the difficulty less healthy people would face purchasing insurance, average premiums for people who did purchase insurance would generally be lower than in other states—but the variation around that average would be very large. CBO and JCT do not have an estimate of how much lower those premiums would be.
These are the states that would have unstable markets in the 16:42 update
Now time to follow the money. It is a net cut of $964 billion dollars in spending on federal health insurance funds.
16:55 This might be a big deal. I am not sure yet
BREAKING: CBO score shows AHCA violates Senate rules. The bill does not comply with reconciliation instructions. pic.twitter.com/VlDS9kxtsH
— Topher Spiro (@TopherSpiro) May 24, 2017
Both the Senate HELP and Senate Finance committees have to show at least a billion dollars in net savings per committee. I think Topher is saying this is not happening for one committee. I will find out more soon.
1657 Full MacArthur/Upton Waivers of Doom for older non-Medicare eligible buyers
CBO estimates that in states requesting AHCA waivers, premiums for low-income elderly enrollees would go up 800 percent. That is not a typo. pic.twitter.com/W7QC4z9UUS
— Sarah Kliff (@sarahkliff) May 24, 2017
1659 Being old and working poor means being the target of this bill’s pain
Although the agencies expect that the legislation would increase the number of uninsured broadly, the increase would be is proportionately larger among older people with lower income—particularly people between 50 and 64 years old with income of less than 200 percent of the federal poverty level (see Figure 2).
1701 Update on the reconciliation question —
@TopherSpiro I'm hearing that the stability fund is written into SSA, so it'll likely be counted in Finance's jurisdiction, not HELP
— Adrianna McIntyre (@onceuponA) May 24, 2017
If this is the case, then no need for another amendment and revote in the House.
1704 Premiums versus out of pocket in waiver states
half of the population—in states that obtained waivers—CBO and JCT anticipate that, on average, premiums would be lower and related out-of-pocket costs would be higher than they were in the agencies’ prior estimates. The agencies expect that premiums would be substantially higher than previously estimated for less healthy people in some states and somewhat lower for the healthier people in those states.
Lower premiums are good for people who don’t use services. Cost shift to people who use services.
So sick people in waiver states will pay far higher premiums and then much higher out of pocket costs.
1707 If you work at a co-op, polish your resume.
Effects on CO-OP or Multistate Plans. The act would exempt plans in the Consumer Operated and Oriented Plan (CO-OP) program established by the ACA, multistate plans established under the ACA, and Members of Congress and Congressional staff from the terms of any waiver approved in a state, as well as provide exemptions in a limited number of other circumstances. CBO and JCT expect that those plans would not be profitable because other insurers in the state would receive the majority of the healthier enrollees.
1710 Coverage losses
1712 Upton and MacArthur got bought for peanuts
Crucial detail: CBO says flat out that funds added to win moderates would do little to reduce premiums for those w/preexisting conditions: pic.twitter.com/EKZH1WEqsX
— Greg Sargent (@ThePlumLineGS) May 24, 2017
1715 Winners and losers — remember the case examples in the aggressive waiver states are the people who can pass underwriting
Young and well off do better to significantly better under the AHCA. Older and less well off are usually about break even or far worse off.
MomSense
662 billion dollar tax cut
Kicking 24 million people off their health insurance
Priceless
JPL
Thanks. It’s nice that we have our own expert to help us understand the implications.
smintheus
I don’t know what to make of a report from the Joint Committee on Taxation. There are some exceptionally partisan and stupid Republicans on this 10 person committee – like Devin Nunes, Kevin Brady, and Chuck Grassley.
Corner Stone
Are we thinking the CBO score will change dramatically from the March semi-baseline? If it goes from 24M to 26M is that going to be any more rage inducing?
Corner Stone
I just watched my ersatz girlfriend Nicolle Wallace have an orgasm listening to John Kasich’s 2020 stump speech.
I think I’m going to need some Obamacare, STAT.
smintheus
So the new bill saves 187 billion less than the old bill, but with the same high number of uninsured as the old bill. Great job, GOP.
Comrade Colette Collaboratrice
I assume that somewhere way, way down in the fine print of the bill, hidden behind an asterisk in 4-point font, is a clause that allows an appointed administrator to select which 24 million, individually or by voting district, will be
deprivedliberated.JPL
It’s bad. The bill also means that the Senate can pass it with 50 votes.
Morzer
@JPL:
McConnell’s saying that he doesn’t know how they get to 50, so… Looks to me like Traitor Turtle wants no part of risking his majority.
clay
Any idea on what this means vis a vis reconciliation and/or a revote in the House?
japa21
So does this mean they have to revote or not?
ETA Or what clay asked.
eric
@JPL: i do not understand this at all. why would the CBO score on a bill that the Senate has said it is not considering be relevant to reconciliation? why not the score of the bill the Senate approves, which was never going to be as bad as the House bill?
Jeffro
@MomSense:
I wonder what it’s like to be a 1%-er, see those numbers, and start thinking of everything that $662B can buy me and my buddies…while shutting the fate of those 24M people right out of my beautiful mind.
smintheus
Once again, premiums are forecast to drop by 2026, after rising sharply at first, but only because tens of millions of sick people will be priced out of insurance entirely in the first few years of the law.
It’s sort of like how a pogrom can eventually lead to less crowded streets.
smintheus
@japa21: Reconciliation is permissible with these budget numbers. Doesn’t mean that the Senate will want to touch this stinker with a barge pole, though.
sheila in nc
The waiver discussions all seem to apply either to non-group markets or small-group markets. What are the waiver implications for ESI? Is it possible for ESI to drop community rating?
Jeffro
@Corner Stone: Didn’t we tell you, she’s not worth the heartache?
Juju
@smintheus: Nicely put.
germy
Does this mean republicans will get rid of the CBO?
Jim, Foolish Literalist
@Morzer: that’s interesting, cause nobody knows better than Mitch how pliable Susan Collins is when it actually comes to voting, and he technically doesn’t need her
ETA I can’t find the tweet now, and I think it’s something that should have gotten more play, but yesterday MacArthur said, on the record, that a lot of Members just want to leave O’Care as it is. As is often the case, I’d love to see a vote by secret ballot in the Senate. Hypothetically, not Constitutionally.
SatanicPanic
@Corner Stone: well it will for two million people I suppose
rikyrah
51 MILLION VS 28 MILLION
SOCIOPATHS.
THE.ENTIRE.LOT.OF.THEM.
Belafon
@eric: I’m sure Ryan is hoping the Senate will just take up his bill just because it cuts taxes. He doesn’t seem to think there will be Republican Senators that oppose it.
smintheus
@Juju: Thank you (bows uneasily).
JPL
@eric: That I can’t answer. All I know is that they can make changes under reconciliation,
schrodingers_cat
@germy: They will sell the coastal states to Russia if they can get a tax cut.
TenguPhule
@JPL:
Of course the Financial numbers are complete bullshit. But that’s not gonna stop them.
JPL
@rikyrah: It’s only 28 million because of the states that didn’t expand medicaid.
Villago Delenda Est
So it’s every bit the disaster the Dems say it is. These people need to be destroyed.
Morzer
@Jim, Foolish Literalist:
Heller, Murkowski, Collins, maybe Sasse and Portman. I suspect the Traitor Turtle will be happy to hide behind all of them. He’s a vile creature, but he knows that destroying Obamacare and being on the record as doing so will produce intense and lasting hatred of the GOP. 24 million losing their healthcare is going to have an almighty ripple effect among their friends, colleagues, relatives etc. There’s also the issue of forcing people back into dependence on company healthcare plans, which is going to be extremely unpopular as well.
randy khan
@Belafon:
I think Ryan is happy that it’s not his problem now. I don’t know that he realizes that even voting on the bill was toxic.
BGinCHI
A bill passed by people who come from narrowly focused GOP districts now goes to people who represent entire states.
Let’s see how that goes.
rikyrah
@Villago Delenda Est:
WIPE THEM OUT.
ALL OF THEM
GregB
https://m.youtube.com/watch?v=OGnE83A1Z4U
germy
@Morzer:
Especially when companies see us as being disposable as tissue paper.
Morzer
@BGinCHI:
The GOP is going to learn that people grumble constantly about their healthcare (and benefits) while they assume that they aren’t going to lose them. Once you actually threaten to do what the people are supposedly asking, you’ll discover that grumbling is one thing, wanting to lose the things they grumble about is quite another. Obamacare is now consistently more popular than not – and even Republican voters have clearly lost the fervor they possessed for repealing it. In sum – it was a good issue for anti-Democratic propaganda, but really not safe for anything beyond that.
Corner Stone
@SatanicPanic: My point being that this horrifying number will now be treated as an “Ole” by all the media. It was shocking before but now it’s all been messaged in.
Mike in DC
Future CBO projections should include estimates of how many Congress critters will lose their jobs by voting for this.
Morzer
@germy:
A lot of people were able to leave companies they hated and set up their own businesses thanks to Obamacare. I doubt that they’ll feel much gratitude for seeing their dreams wiped out by a bunch of treasonous, greedy old swindlers led by a vicious, babbling pervert, fraudster and agent of Russian influence.
TenguPhule
@Villago Delenda Est:
Amazingly it actually seems to be actually worse then predicted.
TenguPhule
@Mike in DC:
Jobs nothing. People are gonna get violent about this if they manage to pull it off.
Morzer
@Corner Stone:
I am not convinced that you are right on that point. Sure, you’ll find the usual crazies yapping about freedom and wicked Obama, but a good chunk of the media are very clearly not aboard the Trump/GOP train.
Major Major Major Major
So no revote in the House, then? Of course, the particulars of the bill are DOA in the senate anyway; it was mostly about having passed ‘a healthcare bill’ for reconciliation purposes and getting the vehicle out there.
Morzer
@TenguPhule:
Some of the GOP tax-theft and legalized rape critters were whining about threats weeks ago. It ain’t going to get nicer for them out there.
efgoldman
@Morzer:
In a logical country, you’d think so, but in a logical country we wouldn’t be in this shit pile.
However, with the house in recess and the reps home, it’s time once again for demonstrations and calls; senatorial offices, too.
Somebody in the American Plutocrat Fascist party has got to notice that Dems won special state legislative elections (NH and NY) in districts that Amber Asswipe won by comfortable margins, and that have been represented only by Republiklowns in living memory and beyond.
phantomist
Imagine how many chicken coops doctors offices will have to buy.
Wait, I just thought of a good business opportunity.
Morzer
@efgoldman:
The thing is that the actual loss of healthcare hasn’t happened yet. If it does, you’ll see real repercussions. Even the threat of “liberation” from healthcare has already produced an obvious reaction against Trump and the GOP. It’s only going to get stronger if they actually do strike down Obamacare.
Jack the Second
Hilariously, by only managing $150 billion in deficit reduction (over, I assume, the 10-year period these things usually operate on), we could actually save more money by just killing NASA’s pittance of a budget.
? ?? Goku ? ?
@Morzer: They’re fucking with my family’s healthcare and my future career (nurse). I hope some of them get nearly beaten/killed by angry uninsured constituents just so that they can feel fear; to face some kind of lasting consequence for their sociopathy
catclub
so is the reduction of medicaid funds listed here – about $860B different from (in addition to?), or the same as, the Medicaid reductions in the recent proposed Trump budget ?
efgoldman
@TenguPhule:
At least you hope so. You must be tingling with excitement.
? ?? Goku ? ?
@efgoldman: Can you really blame him? The GOP are vile fascist fucks. They deserve to die for this.
Not just patients will be affected by this, assuming it gets enacted into law (unlikely), but also healthcare workers as well could lose their jobs. The national economy could be screwed just because Donnie and friends decided to fuck with healthcare
efgoldman
@Morzer:
It’s gonna’ be really interesting for them if they lose either or both of the special house elections in June.
mai naem mobile
Bitch all you want but the GOP is showing compassion for the wealthy taxpayer so they do too have some compassion.
Morzer
@efgoldman:
I’ll also point out that the Democrats haven’t bothered to run a candidate against Paul Ryan for a couple of cycles now – and yet his district is hardly deep red. It looks as if a local guy called Randy Bryce (https://twitter.com/ironstache) has got sick of the Democratic party sitting around with its thumb up its ass and is going for it, so maybe we will see the end of the Little Fake Policy Wonk That Couldn’t. Ryan has pretty bad favorable ratings, so 2018 looks like a good chance to put the boot in his worthless ass.
Corner Stone
@phantomist: I’m thinking about a quail ranch/farm.
Morzer
@efgoldman:
I think what’s happening, in part, is that the right wing have been very happy to use threats of violence and often actual violence with increasingly frequency and no apparent consequences – most conspicuously under Trump – and that has, effectively, given permission for people on the left to start considering the idea in ways that they usually wouldn’t. Sowing the wind and all that.
David Anderson
@catclub: Different set of Medicaid cuts. This is a 27% cut to Federal Medicaid spend. Trump’s budget adds another 20% on top of that
Raven Onthill
I think the CBO punted rather than report horrific numbers. I can see no reason that all the states that didn’t expand Medicaid won’t also go for waivers.
Have they made their model available? Can we rerun it on the assumption that all the non-Medicaid expansion states grant waivers? And (if it’s not too difficult) it might also be interesting to see what the numbers would be if the states that have bankrupted themselves with far-right policies – places like Oklahoma, Kansas, Wisconsin, Michigan – pull out. Perhaps add/remove Texas as well?
Yutsano
@Morzer: I thought they ran someone against him in 2016 but he lost handily. Not sure now.
TenguPhule
@efgoldman:
If you’re gonna input the voices in your head to my motivations, at least make the effort to try and make it funny.
LurkerNoLonger
@MomSense:
The idea that they are considering a bill that would kick even one person off their health insurance shows just how depraved these people are.
TenguPhule
@Morzer:
Sir Pratchett knew his humanity well.
Archon
What’s the percentage of people that voted for Trump believing him and the Republican party would make health care more generous?
I just think the assumption that this healthcare bill will be a disaster for Republicans is wishful.
Morzer
@TenguPhule:
David Anderson
@Raven Onthill: As I replied on Twitter, I don’t think so. Some of this may be professional affinity with the CBO folks who tried to model an extremely tough situation but I think it is reasonably grounded.
There are some states that easy. Massachusetts and New York will be non-waiver. Texas and Wisconsin will be full waiver
But what about the following states:
Virginia — no Medicaid expansion but Democratic governorship and usually a tight Senate?
Idaho — no Medicaid expansion but their own state based exchange
Utah — no Medicaid expansion but a history of fairly interesting conservative leaning health policy work that is not batshit.
?BillinGlendaleCA
@Yutsano: According to Wikipedia, you are correct sir(ZEGS won 65% to 30%, it was much closer in 2012 where ZEGS Dem opponent got 43%).
Morzer
@Archon:
There’s some evidence that a not-insubstantial number of Trump voters liked the ACA just fine but hated Obamacare, so….
I don’t think that this is about whether the mass of Trump voters turn on Donny Dumbass. What matters will be whether people who are usually neutral/non-voters decide that they are angry about seeing healthcare taken away – and then vote against the people who did it.
Baud
@?BillinGlendaleCA: Pretty red, at least for the House seat.
David Anderson
@Archon: Disagree. If Trump keeps all of his Republican supporters so what — he’ll lose some of his soft Democratic cross-over support, he’ll lose 3rd Party support that thought the two parties were the same and Trump promised to be exciting and the Democrats have a bigger base anyways. Remember, his margin of win was extraordinary thin and in most democratic societies it would be a loss. He can’t just win with Republicans.
Furthermore, the 2018 elections are fundamentally a response against Trump in general. Shitty policy that harms anti-partisans motivates pissed off people to vote. Republicans who are either harmed or fearful aren’t motivated to vote or volunteer
Anytime we’re talking policy, that depresses Republican support and increases pissed off Democratic leaning voters.
Jack the Second
@Yutsano: Paul Ryan has had an opponent every election for the last 20 years but last year. He usually gets around 60% of the vote.
You sympathize with the local party; it is really, really hard to get a credible candidate to run against an incumbent with ~10 solid victories under their belt. It eats a year of your life and costs all the money.
?BillinGlendaleCA
@? ?? Goku ? ?: Best of wishes on the nursing career, the kid got her BSN and became a RN last year and is working as a surgical nurse now.
? ?? Goku ? ?
@?BillinGlendaleCA: Thanks
rikyrah
Oh please let it have broken reconciliation rules
Adam L Silverman
The Freedom Caucus has decided to brighten everyone’s day:
Roger Moore
@phantomist:
Tyson is way ahead of you.
Tilda Swintons Bald Cap
@Adam L Silverman: Yeah baby !
debbie
I hope the 64-year-old Trump supporters are choking on their new net premium of $13,000 to $16,000. Bastards for enabling this despotism.
Another Scott
@Major Major Major Major: The GOP leadership is very good at bending the rules in Congress, so I figured that a revote was unlikely.
We need to remember that they have the votes to pass whatever they want. We just must make it extremely clear to them that it is not going to be without consequences for their political futures…
Cheers,
Scott.
rikyrah
@Adam L Silverman:
PHUCK OUTTA HERE ??
JGabriel
@eric:
Budget bills have to start in the House. Since only budget bills are eligible for reconciliation, the Senate won’t take up a bill *intended* for reconciliation until the House passes one that’s *eligible* for reconciliation – even if the Senate plans to hollow the bill out completely and substitute their own legislation.
At least that’s my understanding. I’m open to correction from any lawyers or congressional staffers who have more experience with Congressional procedure.
JGabriel
mai naem mobile:
But even that’s cruel! These poor wealthy taxpayers have so much money, they don’t know what to do with it all. The Republican plan to give them more money will just make them more confused and despairing over what to do with it all.
I think it’s heinously inconsiderate and mean for the GOP to do this to our country’s rich people. We must find some way to relieve them of this burden. If only there were a system – something like … taxation maybe? – by which the government could relieve the rich of their too much money burden and shift some of that burden to the poor …
Raven Onthill
@David Anderson: Wasn’t that what was widely believed about the Medicaid expansion in the first place?
Gretchen
So they want to make 14 million people lose their insurance right before the midterms. How do they think that’s going to help them keep their majority?
Roger Moore
@Gretchen:
What’s the point of a majority if not to achieve your policy goals? They want their tax cuts and they want to blow up Obamacare, and they’re willing to risk a lot to do it.
Jack the Second
@JGabriel: They always have the option to say “what the House did is a steaming pile of shit”, and take literally any House bill that has been sent to the Senate, amend it completely to put in their own version of a bill, and send it back to the House.
Don’t laugh; that’s how the ACA got passed.
Raven Onthill
BTW, CNN has already started the both-siderism. (Also me on Twitter.)
If a bad bill comes out of Congress with bipartisan support, Trump supporters will be able to blame it all on the Democrats. We mustn’t allow that. Question is, how much bad are Democrats willing to accept? If, say, a bipartisan bill only kills, say, 10,000 over a year instead of say, 20,000, is that acceptable?
I have coined a new word, infirmicide, to describe the Republican goal.
Raven Onthill
Can the Senate Democrats find a way to improve a Senate bill without being blamed for the bill?
TenguPhule
@Gretchen:
They’ll hire half of the poor to oppress the other half.
TenguPhule
@Raven Onthill:
No. SATSQ.
Literally, Mcconnell isn’t letting Democrats even see the thing.
TenguPhule
@Raven Onthill:
And if they sign on, the rest of us will blame the Democrats. So they’re better off not cooperating.