Notice & Comment

How Secretary Price Could Get His CBO Estimate of All Three Prongs of Republican Health Care Reform, by Sam Wice

The Congressional Budget Office (CBO) would likely be able to alleviate Secretary Price’s concerns about the recent CBO of the American Health Care Act if Republicans produced their comprehensive proposal for reforming Obamacare.

In Monday’s CBO estimate of the American Health Care Act, CBO estimated that 24 million Americans would have health insurance and premiums would rise up to 750% for some users of the exchanges. Although the estimate had several favorable numbers for Republicans such as a $337 billion reduction in the deficit and overall decrease in insurance premiums on the exchanges, the Trump Administration attacked the estimate as inaccurate. Secretary Price claimed that the estimate is not accurate because Republicans plan to pass healthcare reform in three parts and this estimate only examines one part in a vacuum.

Republicans’ plan would be to 1) pass the American Health Care Act through reconciliation, 2) pass more bipartisan reforms, such as allowing insurance to be offered across state lines, through the regular legislative process (need 60 votes in the Senate), and 3) use regulations as much as possible to reform the current law. Legislatively it is not apparent that any Democrats are willing to join a Republican reform of Obamacare and regarding the regulatory changes Professor Bagley wrote a recent post in this blog about why using regulatory reform is not possible and, but because this is what Secretary Price states Republicans would actually be putting in place, I will assume that this approach would be successful.

If Secretary Price wants CBO to estimate the combined impact of his three-part plan, he could likely get CBO to do so. Secretary Price could get House or Senate Republicans to introduce a straw-man bill that includes all the legislative proposals Republicans hope to pass plus directives to promulgate the regulations that the Trump Administration plans to enact. Absent a committee mark up, CBO would not be required by law to issue an estimate, but if Speaker Ryan or Senator McConnell asked CBO to estimate the bill, it likely would.

Until Secretary Price offers an exact proposal, CBO cannot estimate this amorphous, three-pronged approach. CBO can only estimate the proposal that Republicans provide them and Congress will be voting on. If Secretary Price believes that this three-pronged approach will create the savings and increase in insurance that he claims, he could produce the other two prongs of the proposal and let CBO provide what he would consider a more accurate estimate.


Sam Wice is an attorney adviser for the U.S. Government, a former analyst at the Congressional Budget Office, and a former Council member of the American Bar Association’s Section of Administrative Law and Regulatory Practice. The views expressed herein are those of the author.

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