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The risk of ignoring CBO's warnings

Republicans are heading into their next phase of health care — drafting the Senate bill — with a lot of skepticism about the Congressional Budget Office. Health and Human Services secretary Tom Price declared that CBO "was wrong when they analyzed Obamacare's effect on cost and coverage, and they are wrong again." Senate Majority Whip John Cornyn tweeted in response to a House Democrat who quoted CBO's warnings about the House bill: "Fake news."

Senate Republicans can't ignore CBO completely — they have to pay attention to the cost estimates to make sure they comply with budget rules. But they can decide how much to worry about CBO's most dire predictions about the House bill, like escalating premiums for people with pre-existing conditions and unraveling state markets.

Reality check: There's a lot of analysis out there, including from conservative experts, about how badly CBO missed the mark with its estimates of the original Affordable Care Act. So let's take a quick look at what they got right and what they got wrong.

  • Prediction: 32 million uninsured would gain coverage.
  • Reality: 20 million uninsured gained coverage.
  • Prediction: 23 million people would be enrolled in the ACA exchanges in 2017.
  • Reality: 12.2 million people are signed up for 2017.
  • Prediction: 17 million people would gain coverage through Medicaid and CHIP in 2016.
  • Reality: CBO nailed this one: 17 million gained coverage through Medicaid and CHIP in 2016.

The difference: Yes, CBO was off — but the big lesson is that the ACA "only" covered 20 million uninsured people. There were no warnings that the law would have catastrophic effects. This time, there are. So Republicans have to decide whether it's worth the risk to ignore those warnings.

Yes, but: You could argue that CBO should have issued a stronger warning about premiums with the original ACA. Its 2009 analysis only estimated that individual insurance premiums would be 10 to 13 percent higher in 2016 than they were under the old system. Instead, HHS found last week that average individual insurance premiums doubled between 2013 and 2017.