An obscure office within the Department of Health and Human Services could play a major role in determining the fate of the House Republican bill to repeal and replace ObamaCare.
As the healthcare world anticipates the cost estimate of the controversial legislation by the Congressional Budget Office (CBO), the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary may also be putting its own price tag on the measure.
The CBO is Congress's official scorekeeper, but if the CMS puts out a similar analysis, it could help shield the non-partisan CBO from criticism.
The CMS Office of the Actuary falls under the umbrella of Health and Human Services, but it is an independent entity.
It is unclear if a score will emerge from the CMS, though it is entirely possible.
The CMS office receives requests from policymakers to provide technical assistance on various proposals, and if policymakers make that work public, the CMS will formally publish it, according to the Office of the Actuary.
The office doesn't disclose the presence or nature of confidential requests unless they are made public, so it is unclear at this time if the CMS is even working on an estimate for the House Republicans’ bill, known as the American Health Care Act.
However, the CMS did provide estimates for the Affordable Care Act, as well as the 2003 Medicare prescription drug bill that was signed into law by President George W. Bush.
A spokesman for House Minority Leader Nancy Pelosi (D-Calif.) on Monday said Democrats have requested a score from the CMS.
The CBO is expected to release this week its analysis of the Republican bill that cleared two House panels on strict party-line votes last week. Health experts believe the CBO report could be politically damaging to the bill's chances of passing Congress.
The left-leaning Brookings Institution, for example, has indicated the legislation could increase the uninsured population by more than 15 million, speculating that the CBO figure could be even higher.
In January, the CBO issued a report, requested by Democrats, stating that 18 million people could lose insurance and premiums would rise if ObamaCare was repealed. Republicans said the analysis was meaningless because it didn't take into account a replacement plan and fixes to the program that Health and Human Services would administer.
Republican leaders on Capitol Hill and the White House have preemptively gone after the CBO, contending the non-partisan agency has been wrong on many occasions.
Last week, White House press secretary Sean Spicer said, "If you're looking at the CBO for accuracy, you're looking in the wrong place."
In an interview with The Hill on Thursday, House Majority Whip Steve Scalise (R-La.) said, "We're not gong to let some unelected bureaucrats stop us from moving forward with our agenda. ... The CBO is not the Holy Grail."
The CBO and CMS had much different views on how much the 2003 prescription drug law would cost. The price tag estimated by CBO was $395 billion over 10 years. Rick Foster, who was the CMS chief actuary at the time, put the price tag at more than $500 billion over a decade.
However, Foster's analysis didn't become public before the bill was voted on. Foster accused the Bush administration of threatening to fire him if he released his figures to Congress. Had his analysis been released, the bill probably would not have passed because conservatives, including then-Rep. Mike PenceMichael (Mike) Richard Pence'Justice for J6' organizer calls on demonstrators to respect law enforcement Ethics group files complaint against former Pence chief of staff Marc Short Pence aiming to raise M ahead of possible 2024 run: report MORE (R-Ind.), objected to the bill because it wasn't paid for and would increase the nation's debt level.
A subsequent Health and Human Services investigation concluded that Foster's job was threatened, but the Bush administration had the "authority to determine the flow of information to Congress" and Foster "had no authority to disclose information independently to Congress."
Foster has since retired.
Both the CBO and CMS were way off in their estimates of the 2003 Medicare drug benefit, which ended up being far less costly than projected. That is something Republicans could point out if they don't agree with the either agency releases.
This article was updated at 10:22 a.m. on March 13 to reflect that House Democrats have requested a cost estimate from the CMS on the Republican legislation to repeal and replace ObamaCare.