The Zombie Trumpcare bill that the House passed 20 days ago will finally receive a score from the Congressional Budget Office today, a score that might send the House back to rewriting the bill—and revoting on it. That's because in order to get through the Senate with just Republican votes they are using the budget reconciliation process, which takes just 50 votes but also comes with restrictions. One of them comes from a congressional resolution that instructed House and Senate committees to write the legislation to save the federal government a set amount of money. If it doesn't meet that already-prescribed amount, the Senate can't take it. Which is why normally you find out from the CBO what the spending/revenue picture is in a bill before you pass it. But what't the fun in that, huh?
So here we are today, finding all that out for the second time. Because, remember, we got a score on the original Trumpcare bill, the one that House Speaker Paul Ryan had to pull from the floor when he couldn't get enough Republican votes to pass it. That score showed 24 million people losing their insurance, leading to more people being uninsured under that bill than were before Obamacare was passed. That's an important measure, and as the Center on Budget and Policy Priorities points out, it’s the one that matters: how Zombie Trumpcare compares not to Trumpcare 1.0, but to the Affordable Care Act.
The uninsured rate remained at a historic low — 9.0 percent — last year, and states that expanded Medicaid under the ACA have cut their non-elderly uninsured rate by more than half since 2010, according to new data from the Centers for Disease Control. The latest House bill would largely or entirely reverse that progress, because it retains the key elements of the House bill’s earlier versions: deep Medicaid cuts of $839 billion over ten years that would reduce enrollment by 14 million by 2026, sharply reduced subsidies for the individual market, and immediate elimination of the ACA’s individual mandate.
The uncertainty around the bill’s coverage effects largely revolves around changes to the individual market — in particular, the impact of the MacArthur amendment, which would enable states to apply for waivers to allow insurers to charge people with pre-existing conditions more or offer plans that do not cover minimum standards known as “Essential Health Benefits.” That amendment could change not just how many people get covered, but who gets covered — potentially increasing the number of healthy people with coverage at the expense of those with more serious health needs, the very people who need coverage the most. Importantly, that means the question isn’t simply how many people are uninsured compared to the ACA, but also who these uninsured are.
And, of course, there's the budget number—whether it increases or decreases the deficit over the next 10 years and by how much. That's the core question for whether the House has to redo its work. In a way, it's not all that relevant to the Senate, regardless. There's no way that Zombie Trumpcare as is could get the requisite 50 votes so they're doing their own thing, which will be informed by the score on this one.
However, if the House is forced to redo its homework (it probably won't, but who knows? Not Ryan, because he passed the bill without the score), the Senate will be forced to approach this with a little more consideration to process. Not too much, mind you, since Senate Leader Mitch McConnell is insisting on negotiating it in secret, outside of the regular committee process.