March 13--WASHINGTON -- The Congressional Budget Office is a non-partisan agency, but Monday it sparked a bitter political debate by issuing a report showing that the Republicans' health care plan would increase the number of uninsured people even as it decreased the deficit.
The Affordable Care Act replacement plan would cut the deficit by $337 billion over 10 years while increasing the number of uninsured Americans by 24 million during the same period, according to the report.
"Those numbers are staggering. I don't know how anybody can not be shocked by the prospect that Republicans are going to replace the Affordable Care Act with something that's going to result in 24 million Americans losing their care," said U.S. Rep Mike Doyle, D-Forest Hills.
Democratic leaders said the report should be a "knockout blow" to the plan and that Republicans should withdraw it, while the White House questioned the credibility of the CBO's work.
The CBO was created in 1975 to offer independent assessments of legislative proposals, as well as to offer policy and economic projections for lawmakers. The director is appointed by Congress but its staff is mostly budget and policy experts who steer clear of political prognostication. On its website, CBO describes itself as "strictly nonpartisan."
Health and Human Services Secretary Tom Price told reporters the CBO report is "just not believable." He said CBO didn't consider the full picture -- including plans for new regulations and laws that he said would improve the insurance market.
Senate Democratic Leader Chuck Schumer of New York said such criticism fits a disturbing pattern for administration officials. "When they hear something they don't like, they label it a lie," he said.
U.S. Rep Tim Murphy of Upper St. Clair is among congressional Republicans questioning CBO's estimates, known as "scores." He "doesn't put much credence in CBO scoring," spokeswoman Carly Atchison said. She cited the "outlandish and wildly fluctuating" scoring of the Helping Families in Mental Health Crisis Act, Mr. Murphy's signature legislative achievement last year.
The nonpartisan Committee for a Responsible Federal Budget defended CBO as an important analytical institution with a long track record of providing credible and impartial estimates. Lawmakers should take its findings seriously, cautioned Maya MacGuineas, CRFB's president.
CBO estimates aren't infallible, especially for large, complex and far-ranging legislation such as the Affordable Care Act, often known as Obamacare. A 2009 CBO report significantly overstated the number of people who would use insurance exchanges, in part because it had assumed the individual mandate and accompanying tax penalties would be more effective at forcing people to buy insurance.
Monday's report seemed to change no opinions on Capitol Hill, where Democrats have dug in their heels while GOP leaders promised to push forward, even over objections of a few moderates in their own caucus.
"TrumpCare represents a substantial broken promise to middle class families, children in rural communities and seniors in Pennsylvania," U.S. Sen Bob Casey, D-Pa., said. "Middle class families will see their premiums go up, older Pennsylvanians will face an age tax, and fewer Pennsylvanians will be insured."
The plan would decimate Medicaid and open the door to Medicare cuts, said the senator, who promised to fight for those programs "even if President Trump won't."
U.S. Sen. Pat Toomey, R-Pa., was reviewing the report Monday evening and had no immediate comment.
The office of U.S. Rep. Mike Kelly, R-Butler, responded to questions with a brief email message.
"The congressman is encouraged by the lower premiums, the lower taxes, and the deficit reduction that will be achieved in this phase of the overall process," spokesman Tom Qualtere wrote.
House Democratic Leader Nancy Pelosi of California said Speaker Paul Ryan should pull the bill from consideration in light of the CBO report. "It's really the only decent thing to do," she told reporters.
Democrats, including Pennsylvania Gov. Tom Wolf, said the CBO report confirms their view that the Republican plan puts political promises above public good.
It's unconscionable for politicians to "throw millions of people off their insurance plans and increase costs for seniors to achieve a political victory," Mr. Wolf said Monday.
CBO estimated that under the GOB plan, 52 million Americans would be uninsured by 2026, compared with 28 million under the Affordable Care Act.
It estimated that average premiums would rise by 15 percent in 2018 because Republicans would eliminate penalties designed to induce people to buy coverage, leading to higher costs for those who remain. But by 2020, premiums would begin to fall in comparison with current law, and by 2026 average premiums would be 10 percent lower than under current law.
The CBO attributes the decrease partly to an assumption that fewer older people would buy insurance because of a provision in the plan allowing insurance companies to charge significantly higher rates to elders.
Republicans contend that insurance coverage does no good unless people can choose their providers and can afford co-pays and deductibles, which many say they can't under the Affordable Care Act. There's a difference between having an insurance card and having health care, Mr. Price said
Mr. Doyle said the Republican bill won't help. Costs will go up because they will no longer be offset by young, healthy people who no longer will be required to buy insurance. And, he said, older, sicker people won't be able to afford it because rates can increase with age.
"They do nothing in their bill to change the cost in the individual markets. The risk pool now gets riskier, seniors definitely are going to pay more and young people ... aren't going to buy insurance or they're going to game the system" by waiting until they get sick and paying a 30 percent penalty for lapsed coverage, Mr. Doyle said.
Earlier Monday, President Donald Trump and Dr. Price met with people from around the country who said Obamacare failed them. They described escalating premiums, high deductibles, difficulty finding providers in rural areas, and mandates that require them to buy coverage they don't want.
"It's really not having insurance at all," Mr. Trump told Gina Sell of Wisconsin, who described paying a $1,200 monthly premium for a plan with a $6,500 deductible.
"You don't really really have insurance because the deductibles are so high that you really don't have insurance," Mr. Trump said.
Later, Dr. Price told reporters the GOP plan would "cover more individuals at a lower cost and give them the choices that they want for the coverage that they want for themselves and their family, not that the government forces them to buy."
The plan would replace the Affordable Care Act, President Barack Obama's biggest domestic policy accomplishment and a key issue conservatives used to galvanize support for Republican candidates who pledged repeal.
The Republican plan would eliminate tax penalties the Obama law imposed on uninsured individuals and companies with over 50 employees that don't offer coverage. It also would gradually end expanded Medicaid coverage while changing the way states receive funding. It would replace income-based subsidies with age-based tax credits. It ends federal funding for Planned Parenthood and restricts the use of tax credits to purchase insurance that covers abortion.
It retains key portions of the Affordable Care Act, such as allowing young adults to stay on parents' plans until age 26. It also keeps the ACA's requirement for insurance companies to cover pre-existing conditions, but allows them to charge 30 percent more for people who allowed coverage to lapse.
The legislation is expected to pass the House but could die in the Senate, where a super majority of 60 votes are needed. The Republican caucus has 52 members including at least four who have expressed concerns about provisions in the bill affecting Medicaid expansion. The four include Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska.
Washington Bureau Chief Tracie Mauriello: firstname.lastname@example.org, 703-996-9292 or on Twitter @pgPoliTweets. The Associated Press and the Washington Post contributed.
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