[guest post by JVW]
The Congressional Budget Office released its analysis of the GOP’s plan to “repeal and replace” ObamaCare (also known as the Affordable Care Act) with a plan they have named the “American Health Care Act.” Predictably, the major news outlets are already framing this as the end of health care in America, with the Washington Post announcing that 14 million fewer people would be uninsured and the New York Times unsurprisingly upping the ante to 24 million people who will be now be uninsured. Fox News, God bless ’em, at least balances the news about the rise in uninsured with the projection of $337 billion in budget savings over the next ten years under the proposed new bill.
So, is it really a matter of millions of Americans who are starving for health insurance suddenly finding that it is about to be denied to them? Well, not quite. Here is the CBO’s explanation for the drop in the numbers of insured (emphasis added):
CBO and JCT [the Joint Committee on Taxation] estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.
So how about that? The huge uptick in uninsured will largely be people who choose to be uninsured, not people who suddenly find that health insurance is unaffordable as we know happened when Obamacare was implemented. Yes, people who voluntarily go without healthcare can be a burden on the system as they often consume emergency medical services and never end up paying for them. But to say that mandated coverage a la the ACA or the even more fanciful single-payer plans would reduce emergency room visits actually flies in the face of the data, which shows that ER visits actually increased in Massachusetts after the implementation of Romneycare and in the rest of the country after the implementation of Obamacare.
So we are going to be hearing a great deal of noise from the left suggesting that the GOP’s plan is going to “take away” health insurance from a number of people who only have it thanks to the beneficence of the ACA. This argument is grossly overstated. No doubt there would be people who stand to lose their health insurance under AHCA, just as there were people who lost their health insurance under the ACA. But for the most part, the people who would end up uninsured under the AHCA are projected to be people who choose to be uninsured, and that’s a key difference.
It’s also worthwhile to point out that the CBO’s projections for Obamacare did not quite match the realities of that legislation, so there are limits on the ability of the CBO’s crystal ball to forecast the future. The AHCA may not be a great bill, and it may not be what opponents of Obamacare were expecting from a unified GOP government, but let’s not fall prey to the manufactured hysteria which is bound to be a hallmark of conventional news opinion over the coming days.
[Update:] Over at Powerline, Paul Mirengoff finds another interesting tidbit in the CBO report:
The report is here. This passage (at page 3) jumped out at me:
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 premiums. . . .
I was also struck by the fact that the budgetary savings posited by the CBO are weighted heavily towards the period beginning in 2020.
That is in in fact very curious if the GOP is front-loading the fiscal pain and leaving the budgetary benefits for down the road. It’s certainly the opposite of Obamacare, which was essentially “let’s promise everything up front and then implement the tax and cost-control system to pay for it down the road.” But as Mr. Mirengoff points out, it assumes that the GOP will still be running the show come 2020, and there is simply no guarantee of that. Imagine if they were to be honest enough to do the hard work up front, only to see Democrats come in and take credit for the benefits later (and of course, Democrats would very quickly “reinvest” those savings back into expanded health services).