Vice President for Health Policy
Congressional Republicans and the Trump Administration have repeatedly sought to discredit the Congressional Budget Office (CBO) findings that the House and Senate health bills would cause more than 20 million Americans to lose coverage. Previously, they disparaged CBO’s forecasting record, even though CBO’s estimates of coverage gains under the Affordable Care Act (ACA) were about right. Now, some Senate Republicans and Administration officials are making an even weaker argument. They claim that CBO is greatly exaggerating the number of people who would lose individual market coverage and become uninsured under the Senate health bill because its analysis starts from its March 2016 “baseline” estimates of health insurance coverage under current law, instead of its January 2017 baseline.
CBO’s 2016 baseline shows 25 million people enrolled in individual market coverage in 2026 under current law, versus 20 million people in the more recent baseline. Noting that, some Republicans argue it means CBO’s estimates of coverage losses under the Senate bill are comparably overstated. But, in fact, CBO’s estimated coverage loss from the Senate bill would be similar — and could easily be larger rather than smaller — under the January 2017 baseline. What’s more, CBO consulted the House and Senate Budget Committees in deciding which baseline to use.
How switching baselines would affect CBO’s coverage estimates. CBO’s analysis of the Senate bill notes, “if this legislation was evaluated relative to the January 2017 baseline rather than the March 2016 baseline, it is unclear how different categories of insurance would be affected and whether the budgetary effects would differ noticeably.” That’s because changes would go in both directions, and all of them would be small.
While CBO hasn’t provided estimates of the Senate bill using its 2017 baseline, estimates from a similar baseline are available from the non-partisan Urban Institute. Urban projects that about 19 million people would have individual market coverage under current law in the early 2020s, in line with CBO’s 2017 baseline. And, just like CBO, Urban estimates that more than 20 million people would lose coverage under both the House and Senate bills. In fact, Urban’s estimates of coverage losses under the Senate bill are slightly higher than CBO’s.
How CBO decided which baseline to use. CBO’s use of the 2016 baseline for estimating the House and Senate health bills is standard practice. Ordinarily, Congress would have passed the 2017 budget resolution in the spring of 2016, and all fast track “reconciliation” bills authorized under that resolution — including the House and Senate health bills — would be scored based on the March 2016 baseline.
But because Congress didn’t pass the 2017 budget resolution until this January, four months into the fiscal year, CBO apparently offered the budget committees (presumably the chairs) a chance to provide input on which baseline to use to score their health care reconciliation bills. CBO’s analysis of the Senate bill notes that it settled on the 2016 baseline “on the basis of consultation with the budget committees.” And not only did the committees apparently not object to using the 2016 baseline, Senate aides reportedly confirmed that “the CBO used the older data based on instruction by House GOP leaders.”