WASHINGTON — President Donald Trump told Americans he’d do it all on health care: “insurance for everybody,” better coverage and lower consumer costs. By the reckoning of nonpartisan budget analysts at Congress, that’s not what will happen if the Republican bill he’s backing becomes law.
The Congressional Budget Office is respected for nonpartisan rigor in its estimates of the costs and impacts of legislation, but no projection is infallible — particularly when it comes to large, complex programs. For example, the agency in 2010 overstated the number of people expected to buy insurance under President Barack Obama’s health care law, misjudging how many would join because of the threat of tax penalties.
A look at how statements by Trump and his team compare with the CBO’s estimates and facts underlying the health care debate:
TRUMP: “We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” — To The Washington Post, Jan. 15.
CBO: It estimates the bill would leave 14 million fewer people insured in the first year, 24 million fewer by 2026.
In the first year, the biggest reason more people are uninsured would be repeal of penalties Barack Obama’s law imposes on those deemed able to afford insurance but who don’t buy it. Still others would decide to forgo coverage because of higher premiums or do without Medicaid.
In following years the main reason for a drop in the number of insured would be that the Republican bill scales back Medicaid for low-income Americans. Altogether, CBO estimates 52 million people would be uninsured by 2026, a vast distance from “insurance for everybody.”
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TRUMP: People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better… lower numbers, much lower deductibles.”
CBO: It says cost-sharing payments in the individual market, including deductibles, “would tend to be higher than those anticipated under current law.” Cost-sharing subsidies would be repealed in 2020, “significantly increasing out-of-pocket costs for nongroup (private) insurance for many lower-income enrollees.”
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TRUMP, at a Cabinet meeting Monday: “Obamacare, all of a sudden, the last couple of weeks, is getting a false rep that maybe it’s OK. It’s not OK, it’s a disaster and people understand that it’s failed and it’s imploding. And if we let it go for another year, it’ll totally implode.”
CBO: Not in the view of the budget experts. They described the market for individual policies under Obama’s health care law as “stable.” They said it is likely to remain stable under the proposed GOP replacement legislation, too.
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MICK MULVANEY, Trump’s budget director: “If you have coverage that doesn’t allow you to go to the doctor, what good is it in the first place? …Democrats took all of this credit for giving people coverage, but ignored the fact that they had created this large group of people that still could not go to the doctor.” — Tuesday on MSNBC’s “Morning Joe.”
THE FACTS: Republicans gloss over reality when they make this argument. While deductibles are high for the Affordable Care Act’s private insurance plans (averaging $3,000 last year for a standard silver plan), the law requires preventive care to be covered at no charge. And more than half of the people enrolled in the health law’s insurance markets get an extra subsidy when they go to seek care. It can reduce a deductible from several thousand dollars to a few hundred. The GOP bill would repeal those subsidies.
Other evidence points to tangible benefits from Obama’s coverage expansion. For example, government researchers have found fewer Americans struggling to pay medical bills. A 2015 report found that problems with medical bills had declined for the fourth year in a row. Most of the improvement was among low-income people and those with government coverage, and it coincided with the ACA’s big coverage expansion.
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TOM PRICE, health and human services secretary: “I firmly believe that nobody will be worse off financially in the process that we’re going through.” — NBC’s “Meet the Press,” Sunday.
CBO: There are losers as well as winners, the analysts found. Generally, older people are bound to face higher costs because the legislation would let insurance companies charge them up to five times more for premiums than they charge young people. They can only be charged three times more now. The bottom line, the analysts say, would be “substantially reducing premiums for young adults and substantially raising premiums for older people.”
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MULVANEY: “Actually I don’t think the costs will go up at all.” — ABC’s “This Week,” Sunday.
CBO: It estimates that some costs indeed will go up, at least for a few years. The analysts say average premiums in the private insurance market would rise in 2018 and 2019 by 15 percent to 20 percent, compared with current law, then start to come down. By 2026, average premiums could be 10 percent lower, compared with the existing law. One reason: insurers could eliminate a current requirement to offer plans that cover a set percentage of the cost of certain benefits.
