Five takeaways from the CBO score on Senate ObamaCare bill

Five takeaways from the CBO score on Senate ObamaCare bill
© Victoria Sarno Jordan

The Congressional Budget Office has released its analysis and score of the Senate GOP’s ObamaCare repeal bill.

The big finding? The Senate bill would leave 22 million more people without insurance over the next decade compared to current law.

Here are five takeaways from a report that will play a big role in the Senate’s discussions on ObamaCare.

The road to 50 just got harder

Senate Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnell32 male senators back Senate women's calls to change harassment rules Duckworth brings her baby to Senate vote, drawing a crowd FreedomWorks backs Jim Jordan for House Speaker MORE (R-Ky.) needs 50 members of his conference to back the bill in order to pass it, assuming Vice President Pence casts the tie-breaking vote. The CBO report didn’t make his job any easier.

The analysis found little difference with a House bill that came under scathing criticism from Republican senators when it came to the uninsured. The CBO said the House bill would leave 23 million without insurance over 10 years — just 1 million more than the Senate bill.

Leadership downplayed the coverage losses and focused on premiums, but the report immediately led some senators, such as centrist Sen. Susan CollinsSusan Margaret CollinsOvernight Energy: Trump NASA pick advances after drama | White House office to investigate Pruitt's soundproof booth | 170 lawmakers call for Pruitt to resign Trump's NASA nominee advances after floor drama Family, friends mourn death of Barbara Bush MORE (R-Maine), to say they would oppose a motion to proceed to the bill.

“If you were on the fence, if you were looking at this as a political vote, the CBO score didn't help you,” Sen. Lindsey GrahamLindsey Olin GrahamDems walk tightrope on Pompeo nomination Senate panel moving ahead with Mueller bill despite McConnell opposition Overnight Defense: Lawmakers worry over Syria strategy | Trump's base critical of strikes | Flake undecided on Pompeo | Coast Guard plans to keep allowing transgender members | GOP chair wants to cut B from Pentagon agencies MORE (R-S.C.) noted Monday afternoon.

“I think it's going to be harder to get to 50, not easier.”

The bill lowers premiums, but does it do so quickly enough?

Conservatives have said they won’t back a bill unless they are convinced it will lower premiums, and the CBO offered a mixed report.

It estimates premiums will increase in 2018 by 20 percent and by 10 percent in 2019. In 2020, premiums would be about 30 percent lower than under ObamaCare and 20 percent lower by 2026.

GOP Sens. Ted CruzRafael (Ted) Edward Cruz32 male senators back Senate women's calls to change harassment rules Senate confirms Trump’s pick to lead NASA DOJ denies reports judicial nominee once called illegal immigrants 'maggots' MORE (Texas), Mike LeeMichael (Mike) Shumway LeeSenate confirms Trump’s pick to lead NASA Key senators warn Trump of North Korea effort on Syria Rep. Jordan: Action in Syria ‘should be debated in Congress’ MORE (Utah) and Rand PaulRandal (Rand) Howard PaulHeitkamp becomes first Dem to back Pompeo for secretary of State Senate committee sets Monday vote even as Pompeo appears to lack support Trump checkmates Democrats in sending Pompeo to North Korea MORE (Ky.) all said they were opposed to the bill last week, before the CBO score.

It’s unclear if any of the trio will vote for a procedural motion to bring up the bill.

Asked how he’d vote, Cruz said “at this point we need improvements to drive down premiums” as the elevators doors closed behind him.

The bill will cut the deficit

The CBO estimates the Senate bill would save $321 billion over 10 years, mostly due to Medicaid cuts.

Under the budgetary rules that Republicans are using to prevent Democrats from filibustering their legislation, the measure needs to save $133 billion over a decade.

That means that Senate GOP leaders have a surplus of nearly $200 billion that they now might use to entice reluctant senators to vote for the bill.

Such new policies could include additional money to combat the opioid epidemic, which was a key concern for moderate Republican senators like Rob PortmanRobert (Rob) Jones PortmanTax rules will be subject to more OMB review under new memo Ending sex trafficking tomorrow requires preventing child abuse today Doctors bristle at push for opioid prescription limits MORE (Ohio) and Shelley Moore CapitoShelley Wellons Moore CapitoFamily, friends mourn death of Barbara Bush Lawmakers propose boosting park funding with oil money Lawmakers trade barbs, torch Trump at DC soiree MORE (W.Va.).

Medicaid takes a hit

Moderate senators have had major concerns over ending ObamaCare’s Medicaid expansion.

By 2026, the Senate bill would result in 15 million fewer people on Medicaid. That’s close to the House’s 14 million.

Additionally, the bill would put a cap on federal Medicaid reimbursement for states, resulting in a $772 billion cut over a decade.

On Friday, Heller said he wouldn’t vote for the bill in its current form, citing the its phaseout of extra federal funds for Medicaid expansion as a main concern.

This could be an issue for other moderates from expansion states, such as Portman and Capito. The pair had proposed phasing out federal funds over a seven-year period. The bill begins ending the extra funds in 2021 and would revert to pre-ObamaCare levels in 2024.

Insurance waivers are a potential problem

The Senate bill makes it easier for governors and insurance commissioners, with permission from their state legislatures, to apply for waivers allowing insurers to forego covering a list of services, such as maternity care and mental healthcare.

The CBO estimates about half of Americans would live in states that would decide to narrow the scope of “essential health benefits” that insurers must provide under ObamaCare.

The result?

“Insurance covering certain services would become more expensive—in some cases, extremely expensive—in some areas,” the CBO estimated.

The political fallout from this finding is unclear, but Sen. Bill Cassidy (La.) is the Republican to watch.

He has been bullish that the Senate’s bill must protect those with pre-existing conditions, which he dubbed the “Jimmy Kimmel test,” a reference to an opening monologue late-night host Jimmy Kimmel delivered in which he revealed his newborn son had a heart defect that, without ObamaCare, could be considered a pre-existing condition that would prevent him from purchasing affordable insurance later in life.