The next big event for the GOP health care bill is the release of the Congressional Budget Office cost and coverage estimates — which could be devastating. (The Brookings Institution predicted that CBO will estimate that 15 million people would lose coverage.) They're probably coming either today or tomorrow, so while we wait, here are the political realities:
- If the estimates are good, or even just not terrible, the repeal effort moves ahead.
- If the coverage estimates are bad, it will be a political nightmare for Republicans, but they may be willing to tough it out (see above). They've already been preparing for that in different ways: by pre-emptively discrediting CBO (noting that its estimates have been off in the past), and by insisting they're not trying to achieve the same coverage numbers as Democrats.
- If the cost estimates are bad, it could be over. Conservatives won't vote for a bill they consider too expensive.
It's also worth a review of how CBO actually works. In his book "America's Bitter Pill," Steven Brill describes how much the budget office frustrated Democrats during the writing of the Affordable Care Act. Its process was "more a game to be played than it was a precise measuring device to be read like a thermometer," Brill writes, and its estimates were "unpredictable and often maddening." Its estimates were always cautious, and if it was wrong, it wanted to guess that an initiative would cost more than it really did, or a tax change would bring in less revenue than it actually did.
The bottom line: "In short, CBO was an only-in-Washington institution—an independent body whose only virtue was its independence. Which meant not only freedom from political influence but also freedom from having to do its job the way people in the real world did."