When it comes to health care, there are lies, damned lies, and CBO-bashing.
Republicans are deploying all three strategies, with Mike Pence’s vile lie about the disabled – the utterly false claim that Medicaid expansion has actually hurt those most in need of help – drawing lots of justified outrage. But the really big push over the next couple of days will be the attempt to trash Congressional Budget Office estimates that are almost sure to show massive losses, even if the CBO is somehow prevented from considering the Cruz amendment.
One answer to this stuff is to notice that everyone, and I mean everyone, who knows something about insurance markets is declaring the same thing: that this proposed bill would be a disaster. We’ve got the insurance industry declaring it “simply unworkable”; the American Academy of Actuaries saying effectively the same thing; AARP up in arms; the Urban Institute forecasting disaster; and more.
But, say the usual suspects, CBO got the effects of the Affordable Care Act all wrong. Actually, it didn’t. Yes, it overestimated the number of people who would sign up for the exchanges. But this was largely because it overestimated the number of employers who would drop coverage and send their workers to the exchanges. Overall, its estimates of coverage gains and premiums weren’t that far off, especially when you consider that this was a big leap into the unknown: Aside from limited experience in Massachusetts, we didn’t have very good evidence on how an ACA-type system would work.
Which brings me to a point I haven’t seen emphasized: Whereas the creation of the ACA was a leap into the unknown, Trumpcare – or maybe we should call it Cruzcare – is a leap into the known. Before the ACA, most states allowed insurers to discriminate based on medical history. Many also restricted access to Medicaid as much as they could. So we have a very good idea what health care in America would look like if the Better Care Reconciliation Act, or BCRA, passes: It would look like health care in unregulated, low-aid states pre-ACA.
Or to not put too fine a point on it, it would look like health care in Texas circa 2010, with 26 percent of the nonelderly population uninsured.
So the burden of proof should lie completely with anyone who claims that this bill would NOT cause drastic coverage losses. It would establish a system very much like that which existed in those parts of America in which vast numbers of people lacked coverage in the past; why would this time be different?