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 McConnellTrump: McConnell 'helpless' to stop Biden from packing court Senate GOP opens door to earmarks McConnell sidesteps Trump calling him 'dumb son of a b----' 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 CollinsAgainst mounting odds, Biden seeks GOP support for infrastructure plan Trump's early endorsements reveal GOP rift The Hill's Morning Report - Biden assails 'epidemic' of gun violence amid SC, Texas shootings 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 GrahamMSNBC's Joy Reid pans Manchin, Sinema as the 'no progress caucus' Overnight Defense: Biden proposes 3B defense budget | Criticism comes in from left and right | Pentagon moves toward new screening for extremists Biden defense budget criticized by Republicans, progressives alike 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 CruzBoehner: 'There's a lot of leaders in the Republican Party' Biden picks vocal Trump critics to lead immigration agencies Boehner: Trump 'stepped all over their loyalty' by lying to followers MORE (Texas), Mike LeeMichael (Mike) Shumway LeeHillicon Valley: Biden nominates former NSA deputy director to serve as cyber czar | Apple to send witness to Senate hearing after all | Biden pressed on semiconductor production amid shortage Apple to send witness to Senate hearing after pushback from Klobuchar, Lee Biden picks vocal Trump critics to lead immigration agencies MORE (Utah) and Rand PaulRandal (Rand) Howard PaulCharles Booker launches exploratory committee to consider challenge to Rand Paul Rand Paul calls Fauci a 'petty tyrant' Biden picks vocal Trump critics to lead immigration agencies 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 PortmanHillicon Valley: Biden nominates former NSA deputy director to serve as cyber czar | Apple to send witness to Senate hearing after all | Biden pressed on semiconductor production amid shortage Bipartisan lawmakers signal support for Biden cybersecurity picks GOP Ohio Senate candidate asked to leave RNC retreat MORE (Ohio) and Shelley Moore CapitoShelley Wellons Moore CapitoBiden-GOP infrastructure talks off to rocky start Moderate GOP senators and Biden clash at start of infrastructure debate America's infrastructure: You get what you pay for 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.