Op-Ed: Math is not the friend of the Republican Party

Math is not the friend of the Republican Party.

As the GOP leadership fights to find the votes from Trumpcare, the bill that just won’t die, the Congressional Budget Office issued two new scores for how Republican proposals would affect the health insurance system.

First, the government office confirmed that a bill to repeal Obamacare without replacing it — the Obamacare Repeal Reconciliation Act of 2017, or ORRA — would result in 32 million more people losing health insurance compared to the status quo, and a doubling of premiums for those lucky enough to retain insurance. That’s bad math. (Well, good math, but bad for the GOP.)

That forecast is so devastating in part because Republicans in pursuit of an Obamacare repeal have no choice but to use the reconciliation process, which requires only a simple majority rather than the usual 60 votes. (Democrats obviously won’t sign on, in any number, to destroy President Obama’s signature legislative achievement.) And because reconciliation bills can deal only with taxes and spending, the ORRA would eliminate the taxes and spending contained in the Affordable Care Act — while leaving many of its regulations intact.

The result would be the worst of both worlds for insurers and the now-insured. Obamacare’s historic expansion of Medicaid would be eliminated, and so would the subsidies that make purchasing insurance on individual exchanges more affordable. But insurers still would be required to issue insurance regardless of preexisting conditions, and this insurance still would have to provide comprehensive coverage.

Guess what would come next? An almost-immediate death spiral: Effective premiums would skyrocket, which means that only the sick and desperate would maintain insurance while healthy people fled the market in droves, causing prices to increase even more. (You may have heard that the ACA is already in a death spiral, but this is simply false — the existing exchanges have, for the most part, stabilized.)

In other words, the ORRA would devastate Medicaid and completely destroy the individual market for health insurance. Maybe the number of people who would lose coverage would be somewhat less than the CBO’s projected 32 million, and maybe it would be even more, but it’s somewhere in that ballpark, and no logical analysis would conclude otherwise.

Although repeal-without-replace is the GOP’s worst idea yet, the party’s latest affirmative replacement plan isn’t all that much better, as the CBO score issued Thursday makes clear. It would cut coverage by 22 million, raise premiums by 20% on average and cut Medicaid by $772 billion while giving the wealthy and corporations $541 billion in tax breaks. Deductibles would be an outright disaster; someone making $26,500 in 2026 would pay $13,000 — or half his income — compared with $800 under the ACA.

So it’s the same old, same old. The House bill that passed in May, as well as the Senate’s two proposals for remaking Obamacare, would all substantially cut the spending that helps people afford insurance on the individual markets. All of these schemes would lead to a huge increase in the number of uninsured. None contain any material benefit to anyone except wealthy taxpayers.

These bills were never going to be popular if scored accurately. There’s just no way to slash costs without slashing the insurance rolls. That’s simple math.

And that highlights the importance of the CBO. If Democrats and liberal commentators alone claimed that Republican legislation would lead to death spirals and all the rest, the media would cast it as a “views differ” or “on the one hand, on the other hand” issue. Reporters would repeat, without comment, ridiculous Republican assertions that massive cuts in healthcare spending wouldn’t hurt anyone because The Market Is Magic and Innovation Rules. But the CBO has the authority to get the truth out there, and this has made the resistance to Trumpcare much more effective.

At this point, the Republican Party could grow up and get a heart. It could choose not to propose policies that take away important benefits from tens of millions of people to help only a few. It seems more likely, however, that Republicans will respond by undermining the CBO and perhaps stop using its analyses altogether. One party will continue living in the world of fact, while the other will enter the realm of pure fantasy.

Math is not the friend of the Republican Party, so the Republican Party is not the friend of math. The CBO is helping kill Trumpcare, but Trumpcare ultimately could kill the CBO.

Scott Lemieux is an instructor of political science at SUNY Albany and a regular contributor to the New Republic and the Week.

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