One of the best looks at Barack Obama’s post-presidency so far was published over the weekend courtesy of New York’s Gabriel Debenedetti. The story touches on everything from Obama’s decision to largely stay out of the political fray, his lucrative post-presidential business opportunities, writing his presidential memoir, and his behind-the-scenes efforts to save Obamacare. The whole thing is well worth reading.
Congressional Republicans and the Trump Administration had 24 million reasons to be unhappy on Monday: that’s the number of Americans who would lose their health insurance under the Republican-crafted American Health Care Act by 2026, according to a cost estimate from the Congressional Budget Office. The major findings of the CBO estimate:
- The AHCA would reduce federal deficits by $337 billion from 2017-2026.
- The biggest savings would come from reductions in Medicaid and the elimination of subsidies provided by the Affordable Care Act.
- The biggest costs would come from repealing changes to the Internal Revenue Code caused by the ACA.
- In 2018, there would be 14 million more uninsured people than under the current ACA law.
- This figure will continue to increase by 21 million in 2020 and 24 million in 2026.
- By 2026, an estimated 52 million people would be without health insurance, compared to 28 million people for current projections under the ACA.
- The reduction in insurance coverage between 2018-2026 would be in large part from states discontinuing the Medicaid expansion program offered under the ACA.
- In 2018 and 2019, average premiums for single policyholders would be 15-20 percent higher than under the current law. Average premiums would start to decrease in 2020.
- By 2026, average premiums for single policy holders would be 10 percent lower than under the current law.
- However, the savings on premiums (or lack thereof) vary by age:
- For a 21-year-old: 20-25 percent less
- For a 40-year-old: 8-10 percent less
- For a 64-year-old: 20-25 percent higher
- Medicaid spending would decrease by $880 billion from 2017-2026.
- By 2026, Medicaid spending would be 25 percent less than what the CBO estimates currently under the ACA.
Republicans – who had previously cited CBO estimates as evidence to attack the ACA – had been preemptively attacking or trying to question the credibility of the agency in the days leading up to the estimate’s release. Gary Cohn, director of the White House National Economic Council, told Fox News, “We will see what the score is, in fact in the past, the CBO score has really been meaningless.” Health and Human Services Secretary Tom Price told reporters, “We disagree strenuously,” with the CBO’s findings.
Not all Republicans were optimistic about the proposed law, even before the CBO estimate was released. Sen. Tom Cotton (R-Ark.) warned House Republicans that they would be risking their majority if they voted for the AHCA, and told them, “Do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote.”
Opposition to the bill is not limited to Democrats. A variety of organizations ranging from the left, right and center have all publicly come out against the AHCA. They include the AARP, the American Hospital Association, the Federation of American Hospitals, the American Medical Association, the American Nurses Association, Heritage Action, Americans for Prosperity, the Club for Growth, Moveon.org, and the Center for American Progress.
Democrats attacked the AHCA almost immediately after its unveiling last week, because it finally gave them a concrete Republican policy proposal to target after nearly seven years of a vague and undefined “repeal and replace” pledge Republicans offered as an alternative to the ACA. The CBO estimate will provide them with quantifiable data for campaign ads and talking points to target Republicans running for election or reelection in the 2017 and 2018 cycles.
In a statement, Democratic National Committee Chairman Tom Perez said, “Donald Trump’s ‘insurance for everybody’ pledge was a big fat lie.”
“The CBO, which is headed by a Republican-appointed director, just made it clear that Trump’s health care plan will cause up to 24 million Americans to lose their health insurance. At the same time, the plan slashes Medicaid, drives up the cost of care for older Americans, and defunds life-saving services provided by Planned Parenthood. The only winners here are Trump, and the corporations and rich people who get to pocket new tax breaks.”
“Of course, instead of admitting that the bill would leave millions without health insurance, Republicans are desperately trying to discredit the CBO with more ‘alternative facts.’ The American people are smarter than that.”
Tyler Law, spokesman for the Democratic Congressional Campaign Committee, issued a statement saying, “Every single House Republican owns this catastrophic bill and should be prepared for backlash at the ballot box, particularly given the anticipated loss of coverage for 14 million people as early as next year.”
UPDATE: Politico viewed a White House assessment of the AHCA which estimated 26 million Americans would lose their health insurance by 2026 – two million more than the CBO estimate. The explanation for the document from White House Communications Director Michael Dubke was, “This is OMB trying to project what CBO’s score will be using CBO’s methodology.”
She hasn’t entered the race for Democratic National Committee chair yet, but NARAL Pro-Choice America president Ilyse Hogue is showing she is not afraid to use her organization’s muscle to keep Democrats in line. In response to reports that some Senate Democrats are considering agreeing with the Republican plan to dismantle Obamacare, Hogue issued this press release:
“NARAL has a clear message for Democratic lawmakers: If you support Republicans in their effort to dismantle the Affordable Care Act, NARAL, our one million member activists, and our PAC will not support you in 2018 or beyond.
“Republican leaders have made clear their only intention is to repeal the law. They do not have now, nor are they likely to ever have, a meaningful plan to ‘replace’ this historic expansion of Americans’ health care. Democrats should not play this game with them. Democrats fought hard to pass the law, and now millions of Americans are benefiting from those efforts. The law has expanded healthcare coverage for millions of people for the first time ever and guaranteed coverage of vital reproductive healthcare services like contraception, maternity care, and well-woman visits. That’s why most Americans want to fully implement or even expand the ACA and the benefits it has brought to families across the country.
“Democrats should not learn the wrong lessons from 2016. If they do, they will be without our support in 2018.”
The statement doesn’t mention any names, but the likely culprits are red state Senate Democrats who are up for reelection in 2018. It will be interesting to see what kind of pressure this puts on the declared DNC chair candidates to take this position. All of them – with the possible exception of Keith Ellison in case he is not elected to the job and remains in the House – have the privilege of not having to vote for any Obamacare repeal or replacement proposals. It will also be interesting to see what kind of party discipline a threat like this can impose (or not).