Now we know why the CBO is stuck on 22 million, 22 million...

Like a broken record, the Congressional Budget Office (CBO) keeps repeating "22 million, 22 million, 22 million."  While most of us merely puzzle at the incongruity of getting the same answer from the CBO no matter the question, Avik Roy, writing at, explores why we get the same result for three "significantly different" repeal scenarios:

Thanks to information that was leaked to me by a congressional staffer, we now have the answer. 

Nearly three-fourths of the difference in coverage between Obamacare and the various GOP plans derives from a single feature of the Republican bills: their repeal of Obamacare's individual mandate.

Mr. Roy says the CBO's own estimates indicate that of the 22 million fewer insured, 16 million, or 73 percent, will "voluntarily drop out of the market because they will no longer face a financial penalty for doing so," but those "year-by-year" estimates have never been published by the CBO.

Reluctant Republicans and other opponents of Obamacare repeal can therefore tout the vaunted CBO uninsured numbers, secure in the knowledge that the CBO weeds are so deep as to be all but impenetrable.  Some would call it misleading by omission.

Mr. Roy further points out in a more detailed analysis at that the large gap between baseline CBO Obamacare enrollment projections and more realistic estimates based on actual enrollment to date accounts for much of the remainder of the CBO's coverage difference.  Referring to a summary chart in the analysis, Roy concludes:

As you can see in the above chart, two factors – repealing Obamacare's individual mandate and the CBO's outdated March 2016 baseline – explain nearly all of the CBO-scored coverage difference between GOP bills and Obamacare.

It's why the various Senate tweaks to the Better Care Reconciliation Act – repealing fewer of Obamacare's tax hikes, say, or throwing $45 billion at opioid addiction – have no impact on the CBO's coverage estimates.

Roy's estimate that repealing the individual mandate accounts for 73 percent of "the 22 million fewer people who will have health insurance in 2026 under the Senate bill" has been covered here and there, but we will not see that number in the mainstream media, as it is counter to the accepted narrative on Obamacare repeal.

One might be skeptical of Avik Roy's explanation, but Roy's numbers simply confirm what is buried in the CBO's own documents.  Page 4 of the June 26, 2017 CBO analysis of the first version of the Senate's health care bill contains this nugget:

CBO and JCT [Joint Committee on Taxation] estimate that, in 2018, 15 million more people would be uninsured under this legislation than under current law – primarily because the penalty for not having insurance would be eliminated.

A follow-up July 19, 2017 CBO analysis, covering the Senate's more recent repeal without replacement bill, states on page 8 that "[i]n 2018, by CBO and JCT's estimates, about 17 million more people would be uninsured under this legislation than under current law," and that "most of those reductions in coverage would stem from repealing the penalty associated with the individual mandate."

The July 19 CBO report on repeal without replacement – which in never-ending Washington doublespeak is really a partial repeal that "would keep key Obamacare regulations on the books" – also contains this interesting note on page 10:

The number of people without health insurance would be smaller if, in addition to the changes in this legislation, the insurance market regulations mentioned above were also repealed.  

This again sounds contrary to the accepted narrative on Obamacare repeal.

The complexity of the layers of assumptions underlying the CBO forecasts defies explanation, making it easy for repeal opponents to intimidate certain congressional Republicans into acquiescence to the status quo.  Avik Roy concludes:

GOP moderates, in particular, have been intimidated by the CBO coverage scores, expressing reluctance to vote for a plan that "takes coverage away" from so many.

If three fourths of the coverage reduction is voluntary, the "takes coverage away" narrative falls apart.

As Mr. Roy observes, "[i]t's time for those moderates to choose."  Either you support the individual mandate, in which case "no GOP replacement will ever satisfy you," or "you oppose the individual mandate, and would vote for its repeal," in which case you "should ignore at least three-fourths of the CBO's coverage score."

Roy points out that "there is no middle ground."  The so-called GOP moderates, along with certain GOP conservatives, can either stand up and be counted against Obamacare or be forever remembered for paving the way through apathy and acquiescence to single-payer health care.

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