Didn’t work in “A Few Good Men,” probably not going to work now. Tom Price gives it his best shot, though, noting that 14 million uninsured by 2018 is an odd number for CBO to project given that fewer than 14 million are currently enrolled in ObamaCare and the GOP’s Medicaid rollback wouldn’t begin until 2020. How does that add up? I believe it’s a combination of people who already have coverage but will drop it next year once the mandate is gone plus the number who aren’t already covered but were expected to enroll if the mandate was still in place.
Conservatives are pointing out on Twitter that CBO’s uninsured figure is tantamount to admitting that currently many millions of people “are stuck paying for something they don’t want to be paying for.” True, but that’s not the whole story. While some people have insurance now only because they’re trying to avoid the mandate penalty, others have it (or are about to get it) because they want it and will soon find themselves priced out of the market. Premiums under the new GOP plan should cost 10 percent less than they do under current law by 2026, according to CBO, but things are different in the near term. And Americans aren’t known for being patient:
In 2018 and 2019, according to CBO and JCT’s estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up.
Starting in 2020, the increase in average premiums from repealing the individual mandate penalties would be more than offset by the combination of several factors that would decrease those premiums: grants to states from the Patient and State Stability Fund (which CBO and JCT expect to largely be used by states to limit the costs to insurers of enrollees with very high claims); the elimination of the requirement for insurers to offer plans covering certain percentages of the cost of covered benefits; and a younger mix of enrollees. By 2026, average premiums for single policyholders in the nongroup market under the legislation would be roughly 10 percent lower than under current law, CBO and JCT estimate.
Trump himself warned today that costs will shrink under the GOP bill — but not immediately. These things take time. And in the meantime, some people, especially older people, just won’t be able to cover the rising cost of insurance over the next few years as healthy people flee the mandate-less risk pool: “Under the legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people.”
The GOP’s best hope here may be to remind voters that CBO’s projections on health care have proved to be hot garbage in the past and probably will again this time, although whether that means they’re overestimating the virtues of the GOP’s proposal or underestimating them remains to be seen. Note, by the way, how Price scolds the agency in the clip below for scoring the Republican plan even though it’s just one of a three-pronged approach; Price, in his capacity as HHS chief, plans to waive various regulations associated with ObamaCare once the GOP bill is signed into law and then Republicans plan to offer a second bill allowing plans to be sold across state lines. That’ll require 60 votes, though, which is dicey. Republicans are counting on red-state Democrats to panic in the face of public support and join them to pass that bill, but the hotter the politics of reform get, the less likely that is. I wouldn’t go scolding CBO for not taking into account a bill that not only hasn’t been presented yet but whose chances of passage are dubious.
Exit question via Philip Klein: Do the CBO numbers on the uninsured present the GOP with an opportunity to improve the bill? Quote: “Conservatives should argue, why not go further in repealing Obamacare and replacing it with a purer market-freindly bill, if with all of the GOP’s compromising, they’re still covering 24 million fewer people than Obamacare. In fact, a free market plan that offered more choices and had fewer regulations would make premiums lower (see below), and thus could potentially cover more people.”