Grassley on health care bill: CBO has history of being wrong

July 08--RATHBUN -- To reassure a concerned hospital president Friday, U.S. Sen. Chuck Grassley said numbers from the Congressional Budget Office have a history of being wrong. He expects they could be wrong with the proposed Senate health care bill, as well.

Clint Christianson, president of Mercy Medical Center in Centerville, said he felt Grassley has always had the backs of rural Iowans, and he hoped that track record would continue. Christianson said he had faith that Grassley would "do the right thing" with health care.

Christianson

"It would be potentially devastating to our rural communities."

-- Mercy Medical Center-Centerville president Clint Christianson

The local hospital leader urged Grassley that many in Appanoose County could be affected by a loss of coverage in the Senate health care bill. In citing numbers from the CBO report on the bill, Christianson was concerned about proposed cuts to Medicaid.

Christianson said those cuts could trigger a 60 percent increase in uncompensated care -- or care provided by hospitals to low income or uninsured patients for no payment -- would be a tough pill to swallow for rural hospitals.

"It would be potentially devastating to our rural communities," Christianson said. "And we know we're part of that lifeblood in these rural communities."

Grassley said those cuts don't start until 2020, and then are phased in. He assured Christianson that there will be the ability to correct issues as they come up down the road.

Grassley also said estimates from the CBO were wrong with the Affordable Care Act, and says they could be off with the Senate Republican's health care bill.

"They were way off on Obamacare, so we're expecting they could be off now," Grassley said. "They could be off in a positive way or a negative way. ... So, in three years or any one of the next five years, if we have misjudged things we have an opportunity to change it."

There is some merit to that argument, as both original and revised CBO reports on the law incorrectly estimated some of its effects.

The amount of newly insured through the insurance exchanges was off significantly. The CBO estimated that under "Obamacare" 23 million would buy insurance through the exchanges by 2016. The Centers for Medicare and Medicaid Services said only roughly 10.5 million had done so through the first half of 2016, the latest numbers available.

The CBO estimated "Obamacare" would leave just 21 million Americans uninsured by 2016. The latest estimates from the Centers for Disease Control and Prevention put the actual figure closer to 27 million uninsured at the end of last year.

A legislative branch agency, Medicaid and CHIP Payment and Access Commission, attributes a portion of this overestimate to a 2012 Supreme Court ruling that gave states the option whether or not to implement the Medicaid expansion.

The CBO report also underestimated some effects of the law, too.

Despite that Supreme Court ruling, the CBO's revised projections issued after the Supreme Court ruling actually underestimated the amount who would be insured through the Medicaid expansion by roughly 4.4 million.

Obama's health care law also cost less than the original CBO estimate. Some initial estimates pushed the expected cost at more than $2 trillion from 2015 through 2025. That number has consistently been reduced by the CBO, expected to cost $1.2 trillion through 2025 according to the nonpartisan office as of their last estimate in 2015.

Other parts, it nearly nailed square. For instance, the number of nonelderly that would be covered by 2016. The CBO estimated 89 percent of that population would be covered, the CDC says it turned out to be 89.7 percent.

A 2015 report, based on data from 2014 by the nonpartisan Commonwealth Fund found that despite the CBO's shortcomings, they were still closer to predicting the bill's outcome than other sources. Those sources included the Obama administration as well as research organizations RAND Corporation and Urban Institute, and health industry consultant Lewin Group.

Overall, the Commonwealth Fund said in 2015 that the CBO's estimates for Obamacare were "reasonably accurate."

Several times Friday attendees requested Grassley take a stance on whether he supports the health care bill offered by Senate Republicans. He wouldn't give a definitive yes or no, saying he needs to see the final product first.

Grassley cited that he wanted to make sure the numbers used for Medicaid funding in the bill are predicted appropriately as a hold up for giving his approval on the legislation. He said the current bill uses data that could have been impacted by the state's privatization of Medicaid in Iowa when making its projections.

"These are things that are still out there," Grassley told media after the meeting. "Until we get answers to them, that's what we've got to be working on."

Kyle Ocker is the editor of the Daily Iowegian and can be reached at kocker@dailyiowegian.com or by calling (641) 856-6336. Follow him on Twitter @Kyle_Ocker

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