Dylan Scott is a senior correspondent and editor for Vox’s Future Perfect, covering global health. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo, and STAT before joining Vox in 2017.
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You remember all the hubbub about the House passing the American Health Care Act without having a Congressional Budget Office score? Well, next Wednesday, we’re getting one.
The new CBO score on the AHCA is going to be important for a number of reasons: politics, policy, and procedure. It will help determine the health care plan in the Senate and define the House’s legislation in the public eye.
So what should you be looking for when the CBO releases its report? These four things oughta be at the top of your list:
President Donald Trump promised universal coverage, and the initial versions of the AHCA fell well short. The CBO’s earlier findings — that 24 million more Americans would be uninsured in 2026, versus what would be expected under Obamacare — quickly became omnipresent in the debate.
We’re going to get a new number in the upcoming CBO score. You can expect that figure, which is still likely to be in the tens of millions, to be deployed against every vulnerable House Republican in 2018 — and to be used by Democrats to try to slow down the Senate’s health care debate.
This is what the whole exercise has been about, even in the eyes of many Republicans: How can we cover more Americans?
The rules for the budget process that Senate Republicans are using to pass their health care bill without any Democratic votes are hopelessly complex, but they do set the parameters for what the upper chamber can and cannot do. The CBO will tell us a couple of important things.
The first quirk: The Senate is not allowed to save any less money in its health care bill than the House did. The previous CBO report said an earlier version of the House plan saved $150 billion, but the House added some provisions and funding at the last minute that should change that.
The Senate is planning to spend more money — by beefing up the financial assistance for people to buy private insurance and by more slowly phasing out Obamacare’s Medicaid expansion — and any of those new costs will have to be offset.
The new CBO score will tell us what baseline the Senate has to meet once all its proposed changes shake out.
Washington was sent into a tizzy on Thursday night when Bloomberg reported that House leaders had not actually sent the AHCA to the Senate because they were waiting for a CBO score. The implication was that the House might have to change its bill and pass it again — or even start over.
I broke down all the back-of-the-napkin math that’s fueling this speculation. It’s still a long shot, but here’s what you should know: The House bill must save $2 billion total — $1 billion each for the two Senate committees responsible for the plan — in order to comply with Senate rules.
There is at least a chance that the House bill won’t achieve those savings after the last-minute changes that were added to the bill and never scored by the CBO before the House passed it. The new CBO report next week should tell us where things stand.
Those last-minute changes to the AHCA — so politically important to squeaking the bill through the House — have another test to pass when the new CBO score comes out.
Some budget experts are dubious that the AHCA state waivers, which allow states to opt out of key Obamacare regulations, pass muster under the Senate rules. Those rules are supposed to limit these bills to policies that directly affect government spending or revenue. Changing insurance regulations might not make the cut.
But, some experts have told me, if the CBO projects that the waivers do have a significant budget impact — more likely if the office expects a fair number of states would want them — then they become easier to justify under the Senate rules.
We’ll find out next week what the CBO expects.