Perspectives on “Repeal and Replace.”


Is it dead yet? “Repeal and Replace” has developed a life apart from reality.

Today is a good day to look at an interesting perspective as the “bill” is in the midst of some unseen resuscitation. Have you ever wondered why it is always “22 million?” The Congressional Budget Office (CBO) has issued ever so many analyses of Republican plans for “Repeal and Replace.” But despite the “plan” the CBO consistently concludes that “22 million” will loose their insurance. How is that POSSIBLE???

I have written about this in some detail previously. But Avik Roy looks at this in an interesting way. All of the estimates by the CBO have shown millions fewer people would have insurance in 2026 under the various GOP plans. In fact, different approaches to the bill haven’t seemed to make much of a difference in the CBO’s projections.

  • If we completely repeal Obamacare: CBO says 22 million fewer people would have health insurance.
  • If we replace Obamacare with a system of flat tax credits (under this plan Americans get the same amount of assistance regardless of your financial need): CBO says 23 million fewer people would have health insurance.
  • If we replace Obamacare with means-tested tax credits (the Senate bill does this): CBO says 22 million fewer people would have health insurance.
  • If we adopt the House version: CBO says 22 million fewer people would have health insurance.

How is it possible that the estimate is the SAME regardless of the planned change? And the answer is SIMPLE!

The CBO is, for all intents and purposes, only looking at ONE THING. And THAT THING is the same in every proposed bill. And what is that,  ask you? “That,” it turns out is the repeal of the hated MANDATE, answer I.

If Obamacare remains in place, the CBO assumes that Americans will abide by the “mandate.” If they do, 16 million will buy health insurance that do not currently possess health insurance. Therefore, the CBO computation necessarily shows that repealing the mandate alone would lead to 16 million fewer Americans insured by 2026. Of course the CBO did not PUBLISH THAT ESTIMATE. Therefore, nearly three-fourths of the CBO’s estimate of the coverage difference between the GOP bills and Obamacare in 2026 is accounted for by this alone.

The above graph is enlightening. Enlightenment 1: If Obamacare remains in place AS IS and doesn’t COLLAPSE, 28 million Americans will still be without health insurance 17 years after its passage!

If we eradicate the outdated CBO baseline 32 million Americans will still be without health insurance 17 years after its passage!

If you believe that the mandate is actually NOT A TAX but rather is a PENALTY (as opposed to how the Supreme Court made its final ruling via the machinations of our illustrious Chief Justice) and, thus, is unconstitutional then the “16 million” who are “not insured” but will somehow “lose” the insurance “they do not have” also disappears. (The convolution of that sentence is intentional as was the convolution of the Justice Roberts’ decision that the “penalty” was a “tax” despite President Obama assuring the nation on multiple occasions that the “mandate” WAS, IN FACT, A PENALTY AND NOT A TAX!)

Then the true IMPACT of the Senate version of Repeal and Replace is a couple million Americans. And if insurance premiums come down and more plans are offered (as the CBO also predicted) then perhaps these “couple million” Americans will simply BUY an insurance policy they actually WANT!

Roy Filly 

 

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About Roy Filly

Please read my first blog in which I describe myself and my goals.
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