The Congressional Budget Office on Wednesday is set to release
its latest score for the American Health Care Act, the GOP’s
healthcare bill, in a move that has been highly anticipated for
The score will measure the AHCA’s potential effects on the total
number of people with insurance coverage, how the federal deficit
would increase or decrease because of the bill, and other
measures over the next decade.
The bill has been scored twice before. But two amendments that
were added to the bill just before it passed through the House of
Representatives have changed the game significantly for the CBO
While Republicans have sought to downplay the score ahead of its
release, it could have serious implications for the future of the
The technical test
The most important aspect of the bill for Republicans will come
in how the CBO scores the AHCA’s potential effect on the federal
The GOP introduced the AHCA using a process known as budget
reconciliation. The procedure allows Republicans to need only a
simple majority in the Senate to pass the bill and avoid a
To use this procedure, however, Senate rules mandate the bill
must save at least $2 billion.
One of the
two amendments House Republicans added to the bill would
allow states to opt out of two Affordable Care Act regulations
with a waiver from the federal government, and the other calls
for an additional $8 billion in funding to protect people with
Those two factors could shave off some of
the $151 billion in deficit savings estimated in the previous
scoring of the bill, and it could affect the bill’s future.
Given the uncertainty, House Republicans have
not yet sent the bill to the Senate. A GOP aide, however,
told Business Insider that the delay was simply “an abundance of
caution” on the part of leadership.
The public-relations test
All versions of the American Health Care Act have been
unpopular with the American public. The new CBO score could
make it even worse.
The previous score estimated that 24 million fewer Americans
would have health coverage by 2026 than under the current
baseline. Democrats have seized on that number to attack the
Any change to that statistic could be the headline-grabbing
feature of the new score.
Margot Sanger-Katz at The New York Times polled six
healthcare experts ahead of the new CBO score, and their
estimates ranged from 20 million more uninsured to 25 million.
Cynthia Cox, the associate director at the nonpartisan Kaiser
Family Foundation, said the new amendments could bring down the
number of people without coverage.
“I think we could still see substantial coverage losses but maybe
not to the same degree as the previous CBO score,” Cox told
Business Insider. “The reason for that would be that the waivers
that states would take up could mean more healthy people are able
to purchase insurance. Sick people would be more likely to be
priced out of the market in states that take up the waiver,
meaning those exchanges would be more affordable for healthy
people to get in.”
Put another way, if states take up waivers and insurers are able
to price some sicker people out of the market, premiums could
fall, incentivizing more healthy people to enter the individual
exchanges established by the ACA. But this would assume that a
fairly large number of people with preexisting conditions would
This also plays into the budget dynamic, according to Cox,
because as more people are covered, more people will use the tax
credit, which will cost the federal government more.
Matthew Fiedler, a fellow at the Brookings Institution’s Center
for Health Policy, said that while there may be a lower number of
people without coverage, the changes would most likely be at the
margins and still leave millions without coverage.
“It’s important not to get too focused on the change between the
last score and this score, because what we know for sure is the
CBO is going to show a very large coverage loss under this bill,
and all we’ll learn from the score is just how large,” Fiedler
told Business Insider.