Republicans set low expectations for health bill cost study

Updated: 9:40 a.m. | Posted: 6:25 a.m.

Republicans pushing a plan to dismantle Barack Obama's health care law are bracing for a Congressional Budget Office analysis widely expected to conclude that fewer Americans will have health coverage under the proposal, despite President Trump's promise of "insurance for everybody."

House Speaker Paul Ryan said he fully expects the CBO analysis, set to be released as early as Monday, to find less coverage since the GOP plan eliminates the government requirement to be insured.

But Ryan and Trump administration officials vowed to move forward on their proposed "repeal and replace" plan, insisting they can work past GOP disagreements and casting the issue as one of "choice" in which consumers are freed of a government mandate to buy insurance.

"What we're trying to achieve here is bringing down the cost of care, bringing down the cost of insurance not through government mandates and monopolies but by having more choice and competition," Ryan, R-Wis., said on Sunday. "We're not going to make an American do what they don't want to do."

The CBO's long-awaited cost analysis of the House GOP leadership plan, including estimates on the number of people expected to be covered, will likely affect Republicans' chances of passing the proposal.

GOP opponents from the right and center are already hardening their positions against the Trump-backed legislation. House conservatives vowed to block the bill as "Obamacare Lite" unless there are more restrictions, even as a Republican, Sen. Tom Cotton, R-Ark., warned the plan would never pass as is due to opposition from moderates.

"Do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote," Cotton said. "If they vote for this bill, they're going to put the House majority at risk next year."

Trump was bullish about Republican chances of passing a health care bill, tweeting Monday, "Republicans will come together and save the day."

"ObamaCare is imploding. It is a disaster and 2017 will be the worst year yet, by far!" he tweeted.

The GOP legislation would eliminate the current mandate that nearly all people in the United States carry insurance or face fines. It would use tax credits to help consumers buy health coverage, expand health savings accounts, phase out an expansion of Medicaid and cap that program for the future, end some requirements for health plans under Obama's law, and scrap a number of taxes.

During the presidential campaign and as recently as January, Trump repeatedly stressed his support for universal health coverage, saying his plan to replace the Affordable Care Act would provide "insurance for everybody."

On Sunday, his aides took pains to explain that a CBO finding of fewer people covered would not necessarily mean that fewer people will be covered.

"If the CBO was right about Obamacare to begin with, there'd be 8 million more people on Obamacare today than there actually are," said Mick Mulvaney, director of the White House Office of Management and Budget, disputing the accuracy of CBO data. "Sometimes we ask them to do stuff they're not capable of doing, and estimating the impact of a bill of this size probably isn't the best use of their time."

Health Secretary Tom Price said he "firmly" believed that "nobody will be worse off financially" under the Republicans' health care overhaul. He said people will have choices as they select the kind of coverage they want as opposed to what the government forces them to buy. In actuality, tax credits in Republican legislation being debated in the House may not be as generous to older people as what is in the current law.

Gary Cohn, Trump's chief economic adviser, described past CBO analyses as "meaningless."

"We are offering coverage to everyone," he said. "If you are on Medicaid today, you're going to stay on Medicaid. If you are covered under an employee-sponsored plan, you're going to be continued to be covered under an employee-sponsored plan. If you fall into that middle group, we're going to provide tax credit so you can go out and buy a plan."

House conservatives weren't buying it.

Rep. Jim Jordan, R-Ohio, a co-founder of the House Freedom Caucus, criticized the plan as an unacceptable form of "Obamacare Lite." He and other caucus members want a quicker phase-out of Medicaid benefits and are opposed to proposed refundable tax credits as a new entitlement that will add to government costs.

Members of the caucus will meet with White House officials on Tuesday. They expressed hope that Trump is sincere in expressing a willingness to negotiate changes, criticizing Ryan for his "take it or leave it" stance.

"I'm not for this plan and I think there's lot of opposition to this plan in the House and Senate," Jordan said. "Either work with us or you don't end up getting the votes. That's the real choice here."

But pressuring the White House on the opposite side were moderate Republican governors and senators, who said Trump needed to allow for continuing Medicaid coverage for the poor.

"It's not like we love Obamacare. It means don't throw the baby out with the bathwater," said Ohio Gov. John Kasich, a Republican. "Don't kill Medicaid expansion. And you've got to fix the exchange, but you have to have an ability to subsidize people at lower income levels."

"We need to have Democrats involved so that what we do is going to be not only significant but will last," Kasich added.

Ryan spoke on CBS' "Face the Nation," Price and Kasich appeared on NBC's "Meet the Press," Mulvaney spoke on ABC's "This Week" and CNN's "State of the Union," Cotton was on ABC's "This Week," and Jordan and Cohn appeared on "Fox News Sunday."