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You are here: Home / Anderson On Health Insurance / CBO score on the BCHA

CBO score on the BCHA

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The Congressional Budget Office (CBO) released their budget and coverage score for the Better Care Reconciliation Act (BCRA), the Senate’s tax cut and Medicaid slashing bill.

I was out at the playground with my kids as the score was released so I had no instant reaction.

However here are some of the important points:

It’s a tax cut bill with Medicaid pay-fors.

The CBO does not think a 58% actuarial value plan with a $7,000 or more deductible is a near substitute for a Medicaid plan with no or minimal deductibles.

Compared to the House, the Senate bill is slightly less atrocious on Medicaid and takes more money out of the individual market.

The all out assault on the 1332 waiver will destroy the individual market in states that push the BCRA’s 1332 process to the outer limits.

The cynical take is that Mitch McConnell has $200 billion that he can throw around to buy votes. If Senator Capito and Portman want $30 billion for opioids, they can get it. If Senator Murkowski wants $5 billion for super large, low density state subsidy top-ups, she gets it for Wyoming and Alaska. If Senator Cassidy thinks that throwing $20 billion at NICU’s to protect himself from “Kimmel Rule” attacks, he can get it. This pot of money defines the possibility space of the arm twisting.

Reader Interactions

45Comments

  1. 1.

    Villago Delenda Est

    So what did we learn today, children?

    That tax cuts for the obscenely wealthy top 400 families are much more important than health insurance for 22 million Americans.

    Some priorities are very, very warped.

    You know my proposals for remedying this situation.

  3. 3.

    dr. bloor

    Saw a tweet of a tweet from someone who knows Ferris Bueller’s second cousin that said the CBO est. 4 million with employer-sponsored insurance are going to lose their coverage. Anything to this?

    Also, any estimates re: employer sponsored plans that will be allowed to/bite on elimination of lifetime caps?

  5. 5.

    eric

    Allow me to tell you how this will play: “There is nothing in the bill that says that it affects the health care of ‘John Smith,’ and since I, John Smith, am not explicitly affected by the bill, then it cannot be totally evil. So chill.”

  6. 6.

    Ruckus

    Reposting my comments from this mornings post

    That’s exactly how you can buy a plan with tax credits rather than subsidies.
    You fucking can’t. Which of course is their point exactly.
    Wealth determines your value as a human. You have less wealth, you are less worthy of living. Ergo if you don’t have enough wealth to use tax credits you don’t deserve to live.
    This is the entire course in Conservatism 101-101,000,000. It covers all years, from 0-2017.
    Everything else is fluff to get people without wealth to vote for them.

    It isn’t the absolute amount of wealth, it’s the pecking order of who has more. Once you are comfortable, well fed, have your own planes, houses in multiple states/countries, servants, etc it’s all a pissing contest. Which of course is where the term Tinkle Down Economics™ originates.

  7. 7.

    Baud

    I was out at the playground with my kids as the score was released so I had no instant reaction.

    Slacker.

  11. 11.

    Jim, Foolish Literalist

    Valdivia @ T heCorollary
    Fact that CBO takeaway for many pundits is there’s money to play with to soften bill enough to get votes is why GOP gets away w this shit.

    Pretty sure it was Avik Roy I heard on MSNBC– I was in the car– talking about all the ways McConnell can bribe Collins with Medicaid guarantees for Maine, subsidies for Murkowski and Kennedy. Cause it’s all about fiscal responsibility and cutting spending and smaller gov’t and shit. Jonathan Chait goaded Roy into admitting he’s advising McConnell while punting. ETA: Punditing

  12. 12.

    smintheus

    @Ruckus: From the CBO report:

    Under this legislation, starting in 2020, the premium for a silver plan would typically be a relatively high percentage of income for low-income people. The deductible for a plan with an actuarial value of 58 percent would be a significantly higher percentage of income—also making such a plan unattractive, but for a different reason. As a result, despite being eligible for premium tax credits, few low-income people would purchase any plan, CBO and JCT estimate.

  13. 13.

    JPL

    It appears that a few republicans are going to deny the vote to proceed. hmmm I think the dems should vote to proceed in order to put republicans on record.

  16. 16.

    smintheus

    @dr. bloor: I haven’t seen quite that level of detail in the CBO report, but there is this from the summary:

    Out-of-pocket spending would also be affected for the people—close to half the population, CBO and JCT expect—living in states modifying the EHBs using waivers. People who used services or benefits no longer included in the EHBs would experience substantial increases in supplemental premiums or out-of-pocket spending on health care, or would choose to forgo the services. Moreover, the ACA’s ban on annual and lifetime limits on covered benefits would no longer apply to health benefits not defined as essential in a state. As a result, for some benefits that might be removed from a state’s definition of EHBs but that might not be excluded from insurance coverage altogether, some enrollees could see large increases in out-of-pocket spending because annual or lifetime limits would be allowed.

  17. 17.

    J R in WV

    So just adding up in my head (using fingers too) it looks like about 1.2 Trillion dollars worth of DEATH to give rich folks some tax cuts.

    I know some folks have resisted framing this as similar to AB-Aktion or other mass murder campaigns of the Nazis during the last European war, but I don’t know what else is comparable. People dying as a result of other people’s direct actions, what is that most like in our history?

    How many people dead equals a Trillion Dollars of lost health care?

  18. 18.

    Ruckus

    @smintheus:
    I was going to say, read the CBO report.
    But first.
    Be sitting down, remove all large objects that can be thrown out of reach, remove any excess alcoholic beverage within reach, banish children who you don’t want to hear lots of swear words.

  19. 19.

    grandpa john

    As I approach my eightieth birthday, Looking back over politics since the 50’s. I am amazed at how all the self proclaimed Christians on the right no longer make any attempts to hide the pure evil that is within them. the total lack of compassion or charity that they have let greed,anger and spite take away leaving them as amoral lumps of clay with no soul, or no redeeming characteristics of humanity

  20. 20.

    Ruckus

    @J R in WV:

    How many people dead equals a Trillion Dollars of lost health care?

    Not to mention all the lost employment time/productivity, which will probably more than offset any tax fucking cuts these assholes get.

  21. 21.

    eric

    @grandpa john: they are warriors for Christ, with Christ himself in war garb as in the Book of Revelation. That is their takeaway from the New Testament. The other stuff, about softening the Hebrew God and revisiting harsh societal norms, not so much.

  24. 24.

    FDRLincoln

    This bill is a declaration of war against the American people. Hundreds of thousands will die if this or something like it becomes law.

  25. 25.

    J R in WV

    @Baud:

    @HeleninEire: Be thorough. Leave no beer unturned.

    Remember that after an exhaustive and exhausting search in Tuscany we found NO Wine that wasn’t good. So Helen in Eire has her work cut out!

  27. 27.

    grandpa john

    @eric: but evidently they neglect to read any of the red letter segments of the new testament the parts about being your brothers keeper or that you are to care for the poor ,lame ,sick, and needy

  28. 28.

    Lurking Canadian

    @J R in WV: When we add up the death tolls of the great butchers of the 20th century, we don’t just count the people who were shot, gassed, worked to death in camps, etc. We also count those who died of starvation and disease as a result of man-made famine and disaster.

    As such, I think the comparison is quite apt. If Stalin saying “Collectivize or starve” is murder, McConnell saying “Pay up or die of cancer” should also be murder.

    This is a monstrous act of killing in the service of greed. It has no other justification than the avarice of the already wealthy.

  29. 29.

    J R in WV

    @FDRLincoln:

    This bill is a declaration of war against the American people. Hundreds of thousands Millions of people will die if this or something like it becomes law.

    Fix’d that for ya.

  33. 33.

    Le Comte de Monte Cristo, fka Edmund Dantes

    @J R in WV:

    I wish I’d have known to turn you on to the 2010 Chianti and 2010 Brunello bottles.

    I can’t find them locally anymore, and only have about 8 bottles of the 2010 Brunello we had shipped still in my basement.

  34. 34.

    Valdivia

    Thanks for front paging my tweet. I am so incandescently angry about this, still, and the whole let’s see how McConnell wins coverage of it ain’t helping.

  35. 35.

    Brachiator

    The cynical take is that Mitch McConnell has $200 billion that he can throw around to buy votes. If Senator Capito and Portman want $30 billion for opioids, they can get it.

    Good return on the investment for the wealthy. How much are the wealthy saving by having the net investment income tax and the additional payroll tax repealed? About $800 million? So throwing around $200 million is chump change. And the American people are the chumps.

  36. 36.

    Major Major Major Major

    @Valdivia: Reminds me of the instant new classic from McSweeney’s.

    WINNERS AND LOSERS OF THE RECENT NUCLEAR HOLOCAUST

    The nation was recently rocked by retaliatory nuclear blasts that have turned much of America into a barren wasteland, decimating the population, triggering the rise of firestorms and supervolcanoes, and generally bringing civilization to the brink of collapse. Let’s take a look at the political fallout.

    Winners
    –Congressional Republicans. Widespread destruction aside, this was a kumbaya moment for a caucus that has had its share of family spats of late. For the first time since coming together to narrowly pass the American Health Care Act in May, Speaker Paul Ryan wonkily persuaded the House GOP’s version of the Hatfields and McCoys — the principled hardliners of the Freedom Caucus on one hand, and the reasonable moderates of the Tuesday Group on the other — to set their bickering aside just long enough to squeak through a resolution in support of President Trump’s plan, tweeted out at 3:29 a.m. on Thursday morning, to “FRANCE IS LOOKING FOR TROUBLE. Sick country that won’t solve its own problems. Maybe nucluar?” Concerns that a more deliberative Senate would splash cold water on a rare show of Republican unity proved unfounded when Senator Susan Collins (R-ME), the human fulcrum perched stoically at the precise center of American politics, revealed in a nationally televised special that she would vote to authorize nuclear war to balance out the fact that she had recently broken ranks with her party on an agriculture appropriations bill.

  38. 38.

    The Fat Kate Middletion

    I left my blood pressure meds (acquired courtesy of Medicare, but for how long?) yesterday at our acreage 200 miles away. I should not be reading this right now.

  40. 40.

    Villago Delenda Est

    @Major Major Major Major:

    Senator Susan Collins (R-ME), the human fulcrum perched stoically at the precise center of American politics, revealed in a nationally televised special that she would vote to authorize nuclear war to balance out the fact that she had recently broken ranks with her party on an agriculture appropriations bill.

    This sounds just like the vile harridan.

  42. 42.

    Shana

    I don’t know if this thread is dead or not but I have a question:

    My mother-in-law lives in suburban Cincinnati. She’ll be 90 this November and is in a nursing facility/retirement home. She is no longer very mobile and has to use a motorized wheelchair, has great difficulty transitioning from the wheelchair to her bed. She’s outlived her money and is now on Medicaid. What happens to her now?

  44. 44.

    Betty

    The collateral damage to hospitals and nursing homes and their employees does not get enough attention. Rural areas will be hit hard.

  45. 45.

    Raphael Kearns

    @Betty:

    Your comment is the one that really has me confused. Why in the world is the American Hospital Association and the Rural Hospital groups not screaming right now? This law is going to destroy many of them.

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