CBO gives Senate health care bill a toxic score

Twice now, the Congressional Budget Office has provided a clear message to Republicans rolling out health reform legislation: The "cures" the party has proposed are far worse than the Obamacare ills the bills try to fix.

Late Monday, the CBO's nonpartisan group of economists released its review of the Senate bill that has been crafted with little input from consumers, patients, medical providers or the state leaders who would be forced to grapple with the drastic cuts to Medicaid the legislation calls for. Not surprisingly, the CBO's "score" of a bill written by politicians for politicians signals that the reforms serve wealthy GOP supporters at the expense of the poor, the seriously ill, early retirees and working-class families struggling to pay for health insurance.

Compared with former President Barack Obama's reforms, 22 million fewer people would have health insurance in 2026. The Senate bill also pulls out $772 billion from the Medicaid program over the same time period, recklessly leaving states, which jointly fund the program, to deal with the fallout. Premiums for consumers buying individual health insurance would rise across the board in 2018 and 2019. After that, most — particularly those who are older or sicker — would pay considerably more to maintain the level of coverage they have under Obama reforms.

On its face, the Senate bill's score is slightly better than the CBO's assessment of the previously released House plan, which would result in 1 million more Americans lacking coverage. But the CBO score doesn't reflect the steeper cuts the Senate bill makes to Medicaid after 2026.

Minnesota experts are understandably issuing extraordinary warnings about these steep future cuts. "Nursing homes, a lot of them, will probably close because they will not be able to survive," said Lynn Blewett, a nationally respected University of Minnesota health policy expert, at a Saturday health reform forum in Burnsville.

Blewett's concern is justified. Both the House and Senate plans go far beyond rolling back the Obama law's expansion of Medicaid to needy adults. The program, which is jointly funded by the states and the federal government, provides medical care for the poor and, as part of this, pays for the bulk of long-term care for the elderly and disabled. One in two Minnesotans in a nursing home relies on Medicaid, according to the Kaiser Family Foundation.

In assessing the Senate bill's potential damage, it's also important to remember the expensive remedy the Minnesota Legislature crafted this year to stabilize the state's individual health insurance market, where consumers were hit with soaring price hikes. The solution: a $600 million "reinsurance" program to offset the cost of patients with costly, ongoing medical needs. In turn, it was hoped that this would reduce by 20 percent the premiums of the roughly 5 percent of Minnesotans who buy insurance on their own.

Many Minnesotans struggling to afford individual policies under Obamacare earned slightly too much to qualify for the financial aid the law made available to discount premiums. But the Senate bill does the opposite of what's needed by significantly lowering the financial eligibility line to qualify for premium assistance. The aid also would be skimpier for many of those who qualify. The result: more individual market consumers unable to afford coverage, leaving legislators in Minnesota and elsewhere on the hook for future rounds of reinsurance or other pricey aid. The skimpier premium aid could also affect MinnesotaCare funding, creating another legislative budget headache here.

The Senate bill's path through the chamber is far from assured, even as a vote is expected before August. The CBO has provided a factual analysis raising multiple red flags. Senators ought to heed, not ignore, these concerns.