The much-anticipated report sent the bill’s cheerleaders scrambling to defend it and prompted Republicans skeptical of the legislation to reposition themselves to potentially change it. Democrats -- who will offer Republicans no help in dismantling President Obama’s signature achievement -- meanwhile got a new round of ammo with which to take aim at the bill.
Here’s what the new numbers mean for the repeal efforts’ political dynamics:
CBO bashing will be Republicans’ first line of defense.
In anticipation of a bad score, Republicans spent the last few days planting the seeds for a delegitimization of the CBO and with Monday’s score, that delegitimization was in full bloom.
Health and Human Services Secretary Tom Price – a former House Republican whose past health care proposals provided some of the basis for the House bill –said the report was “not believable” even though he admitted he hadn’t read it yet.
“The fact of the matter is, if you look at that, it's virtually impossible to have that number occur,” Price said, in reference to the jaw-dropping number of people who it was predicted would lose coverage.
Sen. John Thune (R-SD), Republican’s No. 3 in the Senate, called the CBO’s findings a “guess-timate.”
“I think that it is highly likely that the take-up rate will be a lot higher than what they’re estimating,” Thune said, referring to the drop in coverage in the nongroup market after the individual mandate is repealed.
GOP lawmakers are also arguing that the CBO is missing the bigger picture, because its report did not take into account the regulatory changes they intend to make through the HHS, or the additional health care reform legislation they plan to introduce that will require Democratic support.
“They can only score one-third of what we’re doing,” Sen. Mike Rounds (R-SD) said Monday evening.
The CBO report gives GOP senators more cover to say they’re going to rework the House bill.
Not all Republicans were willing to brush off the CBO report. Sen. Lindsey Graham (R-SC) said there were some “fair criticisms” of the agency, but also urged his fellow Republicans to at least consider some of the its findings in order to make improvements to the bill.
“Let’s say the CBO is half right, that should be cause for concern,” Graham said. “So rather than attacking the CBO as a way of moving forward, I think the prudent thing for the party to do is to look at the CBO report and see if we can address the concerns raised.”
While a handful of GOP senators had been critical of the House bill even before the CBO report came out, most of the Republicans in the upper chamber held their fire while House leaders hashed out a bill that could pass their conference. Monday’s score gave senators more cover to indicate explicitly that they think the bill needs work.
“There are some folks within the Senate that are looking for reasons not for vote it, and then there are some of us who say, 'We’re going to get to yes, when we do it we want to make it as good as possible,'” Rounds said.
Sen. John Kennedy (R-LA) stressed that “this is the first step in a long process."
”Once it gets to the Senate my guess is a few senators’ gonna have some ideas of their own,” Kennedy.
Sen. Bill Cassidy (R-LA), who has his own Obamacare replacement plan, was a little less diplomatic and called the score “awful.”
“I would like to think [the legislation] would be corrected by amendment,” he said.
Its findings on the deficit might smooth tensions with conservatives.
Republicans got at least a little bit of good news from the CBO: Their legislation would reduce the deficit by $337 billion, a finding that was quickly highlighted by House GOP leadership.
“Well, actually, I think if you read this entire report, I'm pretty encouraged by it and it actually exceeded my expectations,” House Speaker Paul Ryan said on Fox News soon after it came out.
The savings the CBO was able to find in the Republican plan are key because how the bill affects the deficit will determine whether it can be passed in the Senate with only 50 votes, under the special process known as reconciliation. It is also an argument GOP leaders can use to appeal to conservatives who so far have been resisting the bill.
Medicaid expansion Republicans have some numbers to back up their concerns
Republicans who represent Medicaid expansion states, particularly in the Senate, have been among the most worried about the direction lawmakers were going with repeal. The CBO score did little to assuage those concerns. It found that, even with a phase-out period, the drop-off in Medicaid expansion coverage would be harsh.
“I am very worried about what the House bill would do to Arizona and especially since it expanded Medicaid,” said Sen. John McCain (R-AZ), who has largely stayed out of the fray of the repeal fight.
Part of the problem is that, due to the churn of eligibility, those who are grandfathered into Medicaid expansion under a freeze in enrollment beginning in 2020 wouldn’t stay there very long. The CBO predicted fewer than a third of enrollees would remain in the program two years after it was frozen, and only five percent of them by the end of 2024.
Democrats are now the CBO’s biggest fans
Democratic opposition to the repeal of Obamacare was reinvigorated with a CBO score that put a number on how high the stakes are.
“If this legislation is passed, and millions of people are thrown off of their health insurance, not able to get to a doctor when they must, thousands of Americans will die,” Sen. Bernie Sanders (I-VT) told reporters on Capitol Hill.
Beyond the effects on expansion the CBO found, it also predicted that premiums would go up for older people under Republicans’ plan, which would allow insurers to charge them more when compared to what they charge their younger consumers.
“If you’re older, you get hurt. If you’re [on] the expansion, it’s not there, and then the opioid addiction,” Sen. Joe Manchin (D-WV) said. “They hit me with all three.”
“Then they put on top of that the tax cuts. You have got to have a moral compass inside of you,” he added.