White House looks to regain health care offensive, trashes CBO
President Trump and Republicans in Congress tried to regain the initiative Wednesday in the battle over health care, seeking to recover from the withering criticism of their rollout of a replacement for Obamacare.
To that end, they went after the Congressional Budget Office, which is still days away from releasing its analysis of the Republican bill.
“If you’re looking at the CBO for accuracy, you’re looking in the wrong place,” White House press secretary Sean Spicer said during Wednesday’s briefing with reporters.
Piling on, House Majority Whip Steve Scalise, R-La., dismissed the CBO as “unelected bureaucrats.”
House Speaker Paul Ryan, R-Wis., said the CBO was likely to release its report on the bill by “early next week.” The expectation among many health care experts is that the CBO’s “score” of the GOP plan, the American Health Care Act (AHCA), will forecast high costs and the loss of coverage for millions of Americans.
The comments from Spicer and Scalise were echoed in some corners of conservative media. “The CBO’s score will most likely be wildly off, [and] most Americans don’t much care what the CBO thinks,” wrote Jeffrey Anderson, a Hudson Institute scholar, for the Weekly Standard. “Those who debate and pass legislation should focus on whether it would be good policy that can be communicated to the American people on its own grounds, not on the grounds of the CBO’s generally dubious scoring.”
Spicer based his criticism of the CBO on the fact that the office estimate in 2010 that 24 million people would acquire health insurance in the exchanges created by then-President Obama’s health care law. Only 9 million people are covered in the exchanges now, however.
Grover Norquist, president of Americans for Tax Reform, said he would give more weight to a CBO analysis of a tax cut than he would to one of how many people would be insured under a bill, because the latter delves into predicting consumer behavior. Ironically, conservatives have long complained that the CBO did not take human behavior into account when scoring tax bills, and in 2015 passed a rule requiring the CBO to use what’s known as “dynamic scoring” on tax legislation.
Norquist said that if the CBO concludes that a large number of people will lose their health insurance as a result of the bill now being debated, Republicans would challenge that finding, but allowed that it might lead to some changes in the legislation. “We will say, ‘Show us your assumptions. How do you get to that?’ If they make a good point, then we could make changes,” he said.
Avik Roy, the opinion editor for Forbes and a leading conservative critic of the new health bill, wrote Tuesday that “there are flaws in the way the CBO models health reform legislation, but the AHCA itself contains enough flaws that there can be little doubt that the plan will price millions out of the health insurance market.”
Beyond the fact that a bad CBO score would present a political and public relations problem for the bill, it would also contradict Trump’s own statements that his replacement of President Barack Obama’s health care legislation would provide “insurance for everybody.”
Trump has not clarified since January whether he still wants a bill that provides universal health coverage.
Another conservative leader said privately that Trump needed to switch from an emphasis on universal coverage to what many on the right refer to as “universal access to care.” They say their approach will drive costs down and increase incentives for doctors and health care providers to enter the market.
Access to care rather than universal coverage is certainly the traditional conservative position, and it was the message Spicer delivered Tuesday. But Trump’s entire candidacy rested on upending conservative orthodoxy, and many in Washington wonder whether the president will stick to that strategy if public opinion and pressure breaks sharply against the new legislation.
The GOP’s health care bill has already endured a rougher than expected rollout. It has faced resistance from Republican governors who don’t want to see Medicaid recipients in their states lose coverage, and on Tuesday, the legislation was savaged by conservative members of Congress and a large number of right-wing organizations, such as Heritage Action and the Club for Growth.
Ryan played down the criticism as “the inevitable growing pains of being an opposition party to becoming a governing party.” And one House Republican leadership aide said that it was “sort of anticipated,” given the fact that groups like Heritage Action, FreedomWorks and the Club for Growth, not to mention media outlets like Breitbart News, have criticized and opposed Republican leadership on most issues.
“The difference is they are now trying to go against a Republican president representing districts I’d imagine Trump won overwhelmingly,” the aide said.
But another source close to House Republican leadership said that “the scope and ferocity” of the blowback, “coupled with the conservative media pushback, put the leadership on its heels.”
Norquist said that one White House aide asked him if they could have done more ahead of time to reduce the criticism from these groups on the right. “Did we do something wrong?” the Trump aide asked him, according to Norquist. Norquist said no.
“Of course people react this way. They want to be in the continuing conversation, and they would like the next month to include, ‘Is this group happy yet?’” he said. “In this case, given that Heritage action was going to say, ‘Hell, no,’ and the establishment press was going to run to them and cover them, you couldn’t get around that.”
Trump met with leaders of these groups — Heritage, Freedomworks, Club for Growth, Americans for Prosperity (backed by the Koch brothers) and Tea Party Patriots — at the White House in the late afternoon.
Norquist said that many of the objections being raised by conservative critics of the bill are over matters that cannot be dealt with in what Trump himself as referred to as the first of three phases in replacing Obamacare. Republicans in Congress are conducting the first phase of what’s known as the budget reconciliation process, which only requires a simple majority of 51 votes in the Senate, but which limits the scope of what they can do to parts of the bill that impact spending and budget matters.
He also said that the new bill had been vetted with enough senators in the weeks leading up to its rollout Monday night to give the White House enough confidence that Senate Majority Leader Mitch McConnell, R-Ky., can get the 51 votes he needs. However, that may be overly optimistic, given the concerns among some senators about how the replacement bill deals with Medicaid, and objections from conservatives like Rand Paul over refundable tax credits for lower-income Americans.
Ryan and McConnell have set out an ambitious, late April timetable for the health care bill’s passage, but numerous Republican senators have expressed misgivings in private conversations about pushing the bill through so quickly.
As one aide to a Republican senator said, “The idea that we can re-plan one sixth of the economy in just three weeks on one up or down vote is ridiculous.”
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