On Sunday, Republicans released their package of proposals to cut federal spending on Medicaid and Obamacare. Shortly afterward, Democrats and left-leaning organizations released a torrent of news releases and social media posts, all with the same claim: that the legislation would cause 13.7 million Americans to become uninsured.
It’s a striking number — a figure almost as large as the number of Americans who would have lost coverage if Republicans had succeeded in passing their third attempt to repeal Obamacare in 2017.
But in this case, the number is an exaggeration. The real number is about 8.6 million, not 13.7 million.
Here’s where it comes from: On Sunday night, the Democrats from the Energy and Commerce Committee released a letter from the Congressional Budget Office summarizing the legislation’s effects. The analysis considered the type of scenario the budget office often measures: What would be the effects of the legislation itself, compared with what would happen if the bill did not pass? The budget office concluded that the bill would mean 8.6 million fewer Americans would have health insurance than would under current law.
But because Democratic lawmakers had asked for a second set of numbers, the budget office supplied those, too. (The budget office, which works for Congress, routinely answers questions from lawmakers like this.)
Democrats asked the analysts to add together the effects of the new provisions and the effects of another policy if it expires at the end of the year as scheduled. If you add the 8.6 million to the people expected to lose coverage when that policy expires, the budget office estimated a total of 13.7 million people would be uninsured.
It is that second analysis that resulted in the larger number many Democrats are now circulating.
Since the bill’s release, dozens of Democratic lawmakers, including Patty Murray of Washington, the top Democrat on the Senate Appropriations Committee; Diana DeGette of Colorado, the top Democrat on the health subcommittee of the House Energy and Commerce Committee; Bernie Sanders of Vermont, the ranking member on the Senate Health, Education, Labor and Pensions Committee; and Dick Durbin of Illinois, the Senate Democratic whip, have used the 13.7 million number to assail the bill.
So have liberal advocacy groups and health care lobbies including America’s Essential Hospitals, Families USA, the Center for American Progress, Justice in Aging and the National Health Law Program. And several organizations that help run and fund Democratic political campaigns — including the Democratic Congressional Campaign Committee, the Democratic Coalition and the House Majority PAC — have also used the number.
If you’re interested in how insurance coverage might look in a decade if this bill became law, both are reasonable numbers to consider. But if you’re interested in measuring the impact of the Republican proposal specifically, the larger number is misleading.
Here’s why: The expiring provision was written by Democrats; it was designed to expire after a few years. Democrats passed legislation to increase the generosity of Obamacare subsidies, first for a year as part of their Covid stimulus bill, and then for longer as part of the Inflation Reduction Act. Extending those subsidies for a longer period was expensive, and the former Democratic senator Joe Manchin of West Virginia, a fiscal conservative and a crucial vote, said he would vote for the bill only if its overall price tag were limited. As a result, the subsidies were written into law only until the end of this year.
If Congress simply went home tomorrow and never passed any big budget bill, around 4.2 million people would still be expected to lose their insurance when that expiration happened.
(If Congress did nothing, another estimated 900,000 people would be expected to lose Obamacare coverage because of a proposed regulation by the Trump administration.)
Brett Guthrie of Kentucky, the chairman of the Energy and Commerce Committee, which wrote the legislation, said in a statement that Democrats were peddling “incorrect reports that include policies that aren’t even in the bill.”
“It is reckless that my colleagues on the other side of the aisle claimed an artificially high number in alleged coverage loss just so they can fearmonger and score political points,” he said.
Mr. Guthrie may have the high ground here, but Republicans in Congress are doing something spiritually similar in trying to extend tax cuts elsewhere in the bill. They’re using a maneuver known as using the “current policy baseline,” and budget experts across the political spectrum have been extremely critical of the approach. (You can read some of their disapprovals here in the form of metaphors.)
By using a current policy baseline, Republicans are attempting to obscure just how much their tax cuts will increase the deficit over time by ignoring the fact that current laws say they will expire.
Democrats are now making a version of that argument. They’re treating the expiring health insurance subsidies as if they should continue indefinitely, even though they also have a looming expiration date.
If either set of policies expires, there will be significant consequences. Few people enjoy paying higher taxes, and the expiration of tax provisions will feel like an unwelcome tax increase. Similarly, the enhanced Obamacare subsidies have made health insurance significantly more affordable for many Americans and helped contribute to a near doubling of sign-ups in recent years. If they go away, health insurance will become more expensive for millions of people, and some of them will decide they just can’t afford it.
Democrats would like it if Republicans extended those insurance subsidies and prevented those people from losing their coverage. But that doesn’t mean the Republican bill will cause them to expire. And that means the 8.6 million estimate is a fairer way to measure the effects of the Republican plan itself.
