Updated August 2nd, 2017
On Wednesday President Trump invited 49 Senators to the White House for a GOP luncheon conference to discuss the status of the repeal and replace Obamacare initiative. The President may have called the conference in part to try to restore a clear direction to (his) the Republican Party’s present/future path on the healthcare plan after realizing the varying comments he made in the previous 2 days may have created a great deal of uncertainty within his own Party, not to mention the American people.
Trump may also have taken the luncheon as an opportunity to be more forceful in putting forth pressure as to what he expects from the GOP going forward. That he delivered his message in a passive aggressive manner is not unlike Donald Trump, President or not.
While the lunch meeting was mostly conciliatory in tone, Trump did take the Senators to task at times reminding them that they’d won the election in large part with their campaign promises to voters to repeal Obamacare and produce a new and better GOP healthcare plan.
During the luncheon, the President played “good” and “bad” cop roles, as he both lauded the “good, loyal Senators who worked hard on the healthcare bill and telling them, “We’re close. We’re very close and yet chastised them at the same time for failing to get the job done. At one point Trump told them, “We’re close. We’re very close.” But in the next breath, the President continued on to say, “Any senator who votes against starting debate is really telling America that you’re fine with Obamacare.”
This particular comment by the President may have been directed at the three Senators; Susan Collins of Maine, Shelley Capito of West Virginia, and Lisa Murkowski of Alaska who publically stated they would vote against a motion to proceed to block bringing a vote to repeal (only) the Affordable Care Act. All three Senators stated in varying degrees that they could not vote in favor of the motion to repeal (only) the ACA.
While scolding the Senators for not finding common ground to fulfill their campaign promises, he suggested that the Senators should stay in Washington, foregoing the August recess, until they produced a bill that would pass Congress.
“For seven years you promised the American people you would repeal Obamacare. People are hurting and frankly, inaction is not an option,” said President Trump. At the end of the luncheon, Trump reminded the Senators he had his pen in hand and that it was time for action, not fulfilling their promise to the American people of a better healthcare plan was not an option.
Did The President Gain Anything From This?
It’s possible the President’s words at the luncheon may have had some effect on the Senators he intended to reach if Senator Shelley Moore Capito of West Virginia is any kind of barometer. Of course, it’s too soon to know if the Trump roast worked on the defecting Senators or not, but there may be some indications to be gleaned from the comments from some of the Senators he served up.
Senator Capito was one of the three Senators who immediately spoke publicly saying she would not support Majority Leader Mitch McConnell’s intended motion to proceed on a repeal-only healthcare bill. Capito told the press just before going in to attend the luncheon that she had serious doubts that there would actually even be a Senate vote on the repeal-only bill saying, “It’s changing so quickly. I think we’re probably going to air what our differences are again. The President has taken a lot of time to try to call us all individually. I don’t think anyone’s mind is going to get changed sitting right there, but it gives us a chance to frame it where we have our differences.”
But, after the White House lunch, Capito said, “I think we all want to get to the right place,” which some say may be seen as an indicator of a softening on her earlier proclamation of intending to block the motion to proceed. Later in the day, she tweeted: “I’m glad @POTUS agrees that we cannot move to repeal Obamacare without a replacement plan that addresses the needs of West Virginians,” indicating they were going back to the drawing board.
Senator Ron Johnson of Wisconsin, who has been vocal in his opposition of the earlier healthcare bill debates among Republicans, came out from the meeting to say that he understood the message from Trump as being a push to return to McConnell’s replace and repeal drive that was withdrawn earlier in the week.
Senator Johnson said, “I think the President showed some real leadership here.” Johnson’s statement might be another possible indicator of a Republican softening on the opposition of the replace and repeal healthcare bill, or it could just be the realization of the fact that Republican voters will likely hold the GOP responsible if a better healthcare bill is not passed. Many voters feel they are stuck with the high priced (and still rising) monthly premiums and increasing out-of-pocket costs of Obamacare which they are forced to buy but can’t afford to use.
From the White House, Majority Leader Mitch McConnell said, “I think we all agree it’s better to both repeal and replace. But we could have a vote on either.” After the lunch with President Trump concluded McConnell spoke with reporters saying, Next week we’ll be voting on the motion to proceed, and I have every expectation that we’ll be able to get on the bill.”
To add more pressure or was it to reassure the GOP Senators, Leader McConnell called out some big guns stating that Vice President Mike Pence, Seema Verma, head of the Centers for Medicare and Medicaid Services, and Health and Human Services Secretary Tom Price would be on hand Wednesday night on Capitol Hill to discuss any concerns the senators may have. The clock continues to tick as far as President Trump is concerned as he becomes increasingly frustrated.
To top off the mounting pressure on the GOP to produce passable legislation, came the announcement of a recent poll conducted for a non-profit GOP political group called the American Action Network and was just published by the Washington Post which stated the following:
- 70% of respondents support repeal of Obamacare with a “modest transition period,” during which people will retain their coverage until a new law is enacted.
- 32.1% – primarily Democrats – agreed a repeal would “make America sick again;” 64.8% of independents disagreed, as well as 85.9% of Republicans.
- 54.1% are in favor of a complete repeal or to major changes in the ACA, this figure (54.1%) included 61.6% of independents and 17.6% of Democrats.
- Voters would support repeal of Obamacare by a margin of 68.9% to 25.2% – if disruptions were avoided.
- Voters across the board want Republicans to keep the pre-existing conditions prohibition of denial of coverage, as well as allowing children up to age 26 to remain on their parent’s insurance policy.
What The Non-Partisan CBO Report Said About The Bill
The nonpartisan Congressional Budget Office (CBO) also released their latest analysis of the GOP healthcare plan saying it would increase the number of uninsured Americans to 22 million people over the coming decade (by end of 2026). The CBO estimates that by 2026, 82% of all Americans under age 65 will be insured compared to 90% if the ACA remains intact.
Under the GOP plan, premium costs would increase by 20% in 2018 and an estimated 10% in 2019; increases are necessary to re-stabilize the insurance industry due to the repeal of the ACA, but that premium rates would be reduced by 30% in 2020.
The federal deficit would be reduced by $420 billion over the 2017 – 2026 time periods, according to the CBO. The CBO and JCT methodology used to estimate the reduction of the deficit in the GOP’s previous version of the bill primarily applies to this latest version as well. The reduction of the deficit is the result of the bill’s $903 billion reduction in direct spending which is offset by a $483 billion loss in revenues for a total net reduction of the deficit by $420 billion.
Senate Majority Leader Mitch McConnell added an additional $70 billion in funding slated to help stabilize the existing insurance markets in hopes of improving the long-term effects of the healthcare plan (reducing premium cost). However, McConnell also reduced by $70 billion the amount of funding for the pre-existing conditions pool.
The latest revised version of the bill does not contain any proposed changes from Senator Ted Cruz of Texas, therefore none of the Cruz provisions were analyzed by the CBO for its report at this time.
How Accurate Is The CBO?
With each CBO report on the GOP proposed healthcare plan(s) repealing Obamacare there have been rumblings from Republicans on the accuracy of the CBO historically, specifically citing errors in their predictions on the ACA.
As an example, Mick Mulvaney, director of the White House Office of Management and Budget brought up the CBO’s prediction record on Obamacare or its inability to assess large bodies of legislation such as the ACA, pointing specifically to the CBO’s prediction as to how many people would purchase health insurance through the healthcare exchanges.
Mulvaney did have a point, the CBO projected that by the end of 2016 more than 21 million people would buy healthcare insurance through the exchanges. The actual figure turned out to be a bit over 11.5 million individuals that had signed up for health insurance coverage for 2017. However, in their defense, the CBO could not have taken into account the Supreme Court’s ruling that the states would be allowed to decide for themselves whether to expand Medicaid or not, which did have a measurable impact on the ACA enrollment numbers.
What the CBO did get right was their prediction on the reduction of Americans without healthcare coverage, predicting a historically low rate and in that respect, the CBO was accurate in their prediction. Another factor the CBO hadn’t anticipated was the lack luster enrollment by employers on the exchanges. The CBO had expected employers would drop insurance plans from the private sector in favor of the plans offered through the exchanges. That didn’t happen.
What should be noted is that the CBO adjusted their projection this year of how many would purchase insurance through the exchanges from the estimated 21 million to 13 million, which is only 1.5 million off the mark. And according to independent institutional and industry peer reviews, experts say the CBO provides some of the most accurate estimates, particularly when taking into account the information they had available at the time of their assessment.
An additional factor to consider is that the CBO routinely reviews their work, learning from their errors and adjusting accordingly. It is widely believed by industry experts that the projected estimates on the GOP bill(s) will be even more accurate than those of the ACA.