CBO Scores the AHCA: Public Health Watch Report

Updated: 5/25/2017 at 10:30 AM EST

Americans on Wednesday anxiously awaited the Congressional Budget Office’s (CBO) “score” of the American Health Care Act (AHCA).

And it didn’t disappoint. Or it did. Frankly, it depends.

When it was finally posted on the CBO’s web site at 4:30 PM EST, the findings suggested that the AHCA, as written, could reduce federal deficits by $119 billion over the next decade. However, the CBO projects that at least 14 million Americans who have received coverage under the Affordable Care Act (ACA), the legislation the AHCA is designed to replace, will lose their health insurance in 2018. Depending on how the new law affects Medicaid, this number could increase to 19 million by 2020 and to 23 million by 2026.

As compelling as these figures are on their own, the unprecedented level of attention paid to the projections of the proposed legislation’s financial impact in the days leading up to the release of the CBO report was interesting for a couple of reasons: First, senators from both major political parties had already acknowledged that the legislation would likely undergo a significant overhaul, irrespective of the non-partisan group’s findings. And second, the CBO has a history of, ahem, getting the score wrong—for an example, consider its analysis of the ACA.

To be fair, the CBO got the “big picture” of the ACA right. But, the fact that there were inaccuracies in its assessment of President Obama’s signature legislative achievement, which President Trump and Republican legislators are seeking to replace, should have served as a reminder this week that the CBO cannot predict the future. Nevertheless, various media outlets—from Fox News to The New York Times—still breathlessly presented readers with their own primers on how to interpret the group’s findings earlier during the week of the report’s release.

On Wednesday, in the hours before the CBO posted its score, pundits, politicians, and people from all backgrounds took to social media to comment—not just on the AHCA or the CBO, but on the time it took to get the score published as well. Huffington Post political correspondent Jeffrey Young, for example, referred to the quick passage of the AHCA by the House of Representatives when he quipped on Twitter:

The irony of all of us waiting for the CBO score of the House health care bill is that the House didn't. pic.twitter.com/JrRRN72YC0

— Jeffrey Young (@JeffYoung) May 24, 2017

Vox.com senior policy correspondent Sarah Kliff, meanwhile, summed up the public’s impatience when she tweeted:

Need a CBO analysis of how many hours count as “late afternoon"

— Sarah Kliff (@sarahkliff) May 24, 2017

In the end, how the CBO’s score of the House version of the AHCA will impact the future of the legislation remains to be seen. Although the score of the version that passed the House—barely—in April is a slight improvement over projections rendered on an earlier iteration of the bill proffered in March, it is hardly a ringing endorsement. Will that be enough to doom its future in the Senate? Will House Republicans, fearing for their political futures, start over on a new bill? Or, will the CBO findings simply provide Senate Republicans with a guide on what needs to change with the AHCA to make it politically viable?

Truth be told, Americans concerned about the future of healthcare in this country have more to worry about than what a few bean-counters in Washington think may happen. The CBO’s findings merely confirmed what opponents to the Trump White House already thought of the AHCA:

We don't need a CBO score to know that Trumpcare has gotten worse for sick people - which is after all the true test for a health care bill.

— Topher Spiro (@TopherSpiro) May 24, 2017

And, the bill’s supporters in the Republican Party have already indicated that they couldn’t care less about the score. Meanwhile, President Trump’s proposed budget, which also made the rounds this week, could have dire consequences for important programs such as Medicaid. Reports suggest that the administration is recommending slicing the program that provides healthcare coverage to some 70 million poor Americans by $800 billion, reducing federal funding for it by 25% between now and 2026.

Of course, the president’s budget proposal is just that: a proposal. But, it is worth noting that over the coming months members of Congress will be debating legislative actions that could impact the health—and care—of more than 100 million Americans, and who pays for it.

And, really, that’s the only score that matters.

Editor's note: A previous version of this article stated that the administration is recommending cuts of $800 million. The number is in fact, $800 billion. The sentence has since been corrected.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.