On July 21, all eight former directors of the Congressional Budget Office sent a letter to Congress defending the integrity and professionalism of CBO. But even institutions with integrity can occasionally be wrong. CBO’s score of the House and Senate healthcare bills is a case in point.

The former directors did not comment on, much less defend, those specific CBO scores. They merely objected “to recent attacks on the integrity and professionalism of the agency and on the agency’s role in the legislative process.” They could not defend the scores of the Republican plans, because they, like all other Americans, cannot see the underlying models and assumptions.

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President Trump on Monday made a late-hour appeal to senators – targeting members of his own party – to move forward with debate over faltering Republican legislation to overhaul the Affordable Care Act. “Any senator who votes against starting debate is telling America that you are fine with the Obamacare nightmare, which is what it is,” Trump said in an afternoon address from the White House on the eve of an anticipated Senate vote that could spell defeat of the long-sought legislation.

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The latest version of the Senate GOP’s bill to partially repeal and replace Obamacare was pronounced dead the evening of Monday, July 17, when Utah senator Mike Lee and Kansas senator Jerry Moran announced their opposition, bringing the number of “no” votes to at least four. Where do things go from here on health care? No one knows. Here are five possibilities:

2. “Repeal-and-delay.”
3. A small bill.
4. Bipartisan bailout.
5. Nothing.

Thirty years before Republican lawmakers imperilled President Donald Trump’s hopes of uprooting Obamacare, the property mogul penned some negotiating tips in The Art of The Deal. “The worst thing you can possibly do in a deal is seem desperate to make it,” he wrote.

In a week when his party’s inability to repeal and replace his predecessor’s health programme bordered on farce, Mr Trump has appeared to be following that tip. “Let Obamacare fail, it will be a lot easier,” he said, suggesting that if there was to be no deal on an orderly overhaul of the system, it should be left to collapse on its own.

With disarray over healthcare ranking among the ignominies of the president’s first six months in office, the let-it-fail mantra injected a fresh dose of chaos and confusion and drew accusations of callousness. Next week the Senate may attempt another vote on Obamacare, also known as the Affordable Care Act, but whether it will be repeal-only, repeal-and-replace or something else remains undecided.

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The federal share of national health spending grew by about one-eighth between 2008 and 2016 and by the year 2025 is projected to have increased by nearly one-fifth. By 2025, federal, state and local taxpayers will be financing fully two-thirds of American health care . Some might say “not bad for government work.”

Careful readers might also note that the state and local government share of national health spending shrank slightly during the same period–a reflection of President Obama’s vision to give Uncle Sam a bigger role in health care, displacing decisions formerly made by stat and local governments and the private sector in the process.

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If President Trump is serious about repealing ObamaCare—about delivering a better policy with more choice and lower costs—there’s a simple move he could make that wouldn’t require congressional approval. It would align the interests of lawmakers and their staffers with the interests of voters.

Congress is essentially unaffected by the high costs of the ObamaCare exchanges because of a special exemption crafted under the Obama administration. The Affordable Care Act required members of Congress and their employees to participate in the health-insurance exchanges it established. They should have lost the generous coverage they had in the Federal Employees Health Benefit Program and instead bought one of the government-mandated options offered on the ACA exchanges.

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Recriminations are already underway – at the White House, on Capitol Hill, in the news media. They are debating whose fault it is that Senate Republicans can’t pass a health care bill. Was it the fault of Mitch McConnell? Or Mike Lee?  Or the half dozen other senators who balked?

In order to successfully pass a health reform bill, Republicans must do something they so far haven’t done. They must go on TV and explain how reform of Obamacare is going to solve real problems real people face. If they can’t do that, they will never have the support of the general public. Without that, Congress will never have the courage to enact major reforms.

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Arguably the most significant data point in the entire debate about the Senate health care bill has been the CBO’s claim that in 2026, 22 million fewer people would have health insurance under the Senate bill than under Obamacare.

Democrats have seized on this number to stoke fears about the bill’s impact; moderate Republicans, intimidated by the negative headlines, have been reluctant to support the bill.

But buried within the CBO’s reports is a key fact: the vast majority of those coverage “losses” occur because the GOP bills repeal Obamacare’s individual mandate. In its July 20 estimate of the most recent version of the Senate’s Better Care Reconciliation Act, or BCRA, CBO says that in 2018, 15 million fewer Americans will have health insurance under the bill, two years before its repeal of Obamacare’s insurance subsidies takes effect.

Why? It’s “primarily because the penalty for not having insurance would be eliminated.”

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The most recent version of the Senate Republican bill to repeal and replace ObamaCare would result in 22 million additional people without insurance over the next decade, the Congressional Budget Office (CBO) reported Thursday.

The number of uninsured is essentially unchanged from the original draft of the legislation released last month.

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A Health and Human Services analysis of Sen. Ted Cruz’s proposal to let insurers sell plans that don’t comply with Obamacare regulations appears to back up the Texas Republican’s claim that the idea would lower premiums across the individual insurance market. The analysis purports that the amendment offered to the Senate’s Obamacare repeal bill would slash premiums for certain Obamacare enrollees by 2020, and save even more for consumers who opt for cheaper, no frills products. HHS also found the amendment would boost enrollment by as much as as 16.1 million people by 2024, more than the nearly 14 million topline projected under Obamacare.

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