Horowitz: New CBO Score Deals Mortal Blow to House Healthcare Bill

Tuesday, May 30, 2017


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Rob Horowitz

To no ones ‘surprise the Congressional Budger Office (CBO) score of the tweaked so-called American Healthcare Act, better known as either RyanCare of TrumpCare, which narrowly passed the House of Representatives several weeks ago, was similar to the CBO score of the original version, which died in the House without a vote.  This is because the new and supposedly improved version, contains some useful political fig leafs that worked to garner the necessary votes, but little substantive change.

The revised legislation, designed to repeal and replace Obamacare would leave 23 million more people without health insurance as opposed to the 24 million people who would lose health insurance in the original bill.  As with the original bill, these cuts in health insurance would pay for a giant tax cut for the wealthiest Americans, along with a small amount of deficit reduction.   There would also be steep premium increases for older and sicker Americans.

No wonder, Senator Majority Leader McConnell (R_KY) told Reuters, "I don't know how we get to 50 [votes] at the moment.”

If McConnell continues to work to pass Healthcare legislation with only Republican votes, he will probably never get to 50 and if he does, it will be for something so politically toxic, that he will end up wishing he didn’t succeed.

But there remains a way forward, still open to McConnell, Ryan and President Trump. As I wrote several weeks ago, it requires abandoning repeal and replace and making the goal the reform and repair of Obamacare. It means building a completely different legislative coalition that includes Democrats, along with moderate Republicans and pragmatic conservatives.

Contrary to the Republican attempts to declare Obamacare unsustainable or in Trump’s exaggerated description “dead," objective analysis demonstrates that it is by and large still working fairly well and can be  put on sound long-term footing with common sense fixes. For example, restoring more competition can be accomplished by minimizing risks for health insurance companies and increasing—not lowering-- government subsidies. This can help put the brakes on big premium increases. These common sense fixes can be combined with experimenting with allowing health insurance to be bought across state lines and permitting small businesses to join large health care purchasing pools to give them more leverage in the market.

Additionally, repairing and reforming Obamacare is a political winner for the Republicans, especially when compared to passing some version of the current Republican legislation. A majority of Americans now approve of Obamacare and strongly disapprove of the Republican alternative.

Republican Senators Bill Cassidy (R-LA) and Susan Collins(R-ME ) have proposed legislation that retains more features of Obamacare and does so by forgoing the giant tax cut. This bill could potentially serve as a starting point for a bi-partisan effort that would be good for the nation and actually good general election politics for the Republicans.  

It would mean, of course, standing up to the far right elements in the party. That will take leadership, but it is leadership of which Senator McConnell, if not the President or the Speaker, is more than capable. Let’s hope for the nation’s sake, the Senate Majority Leader chooses this all around better way. 


Rob Horowitz is a strategic and communications consultant who provides general consulting, public relations, direct mail services and polling for national and state issue organizations, various non-profits and elected officials and candidates. He is an Adjunct Professor of Political Science at the University of Rhode Island.


Related Slideshow: Trump’s Win - What Does it Mean for Rhode Island?

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Jennifer Duffy

Cook Report

"We don't really know what a Trump presidency means for the nation, never mind the smallest state.  One of the unintended consequences of last night's results is that Sen. Jack Reed won't be chairman of the Senate Armed Services Committee.  Chalk that up as a loss for RI."

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Pam Gencarella

Head of Ocean State Taxpayers' Association

"Trump’s win means that his signature issue, illegal immigration, could have a big impact on RI, hopefully reversing our course as a sanctuary state and saving the state taxpayer millions of dollars.  While we agree with his 'repeal and replace' Obamacare stance, we have no idea what that means to the RI debacle known as UHIP.  It is not a stretch to believe that federal funding for this kind of system will be off the table so, will RI be stuck with this massively expensive system that still doesn’t work and that is expected to cost another $124 million to fix?  

Trump's belief that there is significant fraud in the Food Stamp program and the policies that may come from that belief could have a negative impact on RI's local economy since there are businesses in certain cities that rely heavily on this program, fraud and all. On the upside, we may be able to ditch the UHIP program if there is significantly less need for processing welfare program requests (ie. Medicaid and food stamps) resulting from fewer illegal immigrants and less fraud.  While we are ambivalent about his touted child care policies, if enacted, it may force our legislators to revisit the ever growing state cost of subsidies in this area and possibly reduce the fraud and abuse in this system." 

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Kay Israel

Professor at Rhode Island College

"With a Republican President and Congress, Rhode Island will probably be excluded from the 'fruits of victory."  

The congressional delegation will be able to vocally make their presence felt, but in the long term it's more symbolic than substantive.  

For Rhode Island it's a matter of holding on and waiting until '18 or '20 and a surge in Democratic influence."

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Jennifer Lawless

Professor at American University

"The RI congressional delegation just became even less powerful than it was. With unified government, Trump doesn’t need to quell Democrats’ concerns or acquiesce because he’s worried about a Democratically-controlled Senate.

His appointments will reflect that. His executive orders will affect that. And the conservative policy agenda he puts forward will affect that."

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Len Lardaro

Professor at University of Rhode Island

"Well there's a few things -- because there's not going to be gridlock, that's a big difference if it had been Hillary and a GOP Congress, in which nothing would got done. We'll at least get a half a billion in infrastructure that's going to pass which will have an impact.

I think you'll see there will be reduced reliance on government nationally -- and that's where we'll stick out like sore thumb. We've relied way too much on government -- and our government is highly inefficient and ineffective.  Maybe, just maybe, in this who cycle of things we might be forced to be small and more efficient for once.

A couple of other things -- interest rates jumped. The one to follow is the ten year government bond rate -- which is tied to mortgages. It went from 1.7% to 2.05% in one day. The point is -- if the ten year stays high, mortgage rates will start going higher -- and in the short time people will run to re-finance. 

That's the short term impact -- but then if rates stay hight, that will make mortgages more out of reach. And we just passed a bond issue to limit open space -- housing has limited upside here.
The next thing -- the Fed Reserve will go ahead with tightening next month. A strong dollar will hurt manufacturing. When the dollar is strong our exports become more expensive overseas. 

Our goods production sector -- manufacturing and construction -- in the near term will do a little better, but as time goes on will be more limited. But something you won't hear, is there are lags in fiscal policy, of six months to year. So we won't really see the effects until the third our fourth quarter of 2017, going into 2018."

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Mike Stenhouse

RI Center for Freedon and Prosperity

"As the unbelievable turned into reality this morning, it struck me that the presidential election was not really all about Donald Trump and Hillary Clinton. It was about a fed-up people, revolting against a corrupt system - the "beast" - that relentlessly favors insiders. Hillary personified the beast, while Donald personified the slayer.

Sadly, based on election results in our state, Rhode Island's version of the beast lives on. I fear our political class has not learned the lessons from the Bernie Sanders and Donald Trump movements - and will continue with their government-centric, anti-family, anti-business status quo."

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Kristina Contreras Fox

VP of Young Democrats of America

"A Trump Presidency means the validation of the ugliest part of America. In RI, as with the rest of the country, the hammer of his hatred will fall hardest on minority communities. Being a blue state doesn't make us immune from this danger.

Trump won over 35% (39.5) of the vote here! We need to look in the mirror, and not lie about what the reflection shows us. No more hiding underneath a blue blanket. I expect those who claim Democratic values to be true to those values. The gulf between words and actions have turned into fertile ground for Trump's message to grow here in RI. If you call yourself a Democrat, if you claim to stand in opposition to Trump, now is the time to prove it. Show up and fight back."


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