Wait A Minute

We are in a series outlining the big ideas that would serve as the foundation for Tim’s proposed healthcare reform plan.  Click here to find the prior posts.

The Republican Party’s circular firing squad continues, so our strategy of ignoring Washington antics seems to be a good formula for enjoying our summer. But I have to interrupt this little stroll through the fantasy world of what Tim would do and step back to reality for a minute because my head is about to explode.

We’ve  got to talk about the CBO.  Sorry.

Yep, the Congressional Budget Office scoring report is garnering a lot of political heat from both sides.

The President is paranoid (whaaat?) that Bernie Sanders has hacked the spreadsheets (were the Russians helping?).  The Democrats are having Moses carve the latest headlines into stone tablets that read ‘TrumpCare will have people eating armadillo in the streets by next Tuesday.’

It is a clear sign that Major League Baseball needs to speed up the pace of the game, because here in the dog-days of summer, we are bored enough to be talking about an actuarial forecast.  Loser that I am, I not only read the report to the Honorable Mike Enzi, Chairman of the Committee on the Budget, I downloaded a couple Excel spreadsheets from the CBO and went back to their March 2016 baseline. 

While it seems to me the good folks at the CBO are trying hard to do their job, the simple facts suggest we should stop hanging so much on these scoring reports when we think about the good or bad of a new law.

The headline from their scoring of v.27 of the Republican plan is that it would leave 22 million more people without insurance in 2026 than would ObamaCare (50 million uninsured vs. 28 million under the current law). 

Big numbers, big headlines.

There’ s lots of extrapolation to get to 2016, so who knows? Let’s ignore the 10 year out projection and look at 2018, not only because that is about five months away (close in projections should be a little more accurate, right?), but also because that is where most of the spread between the two laws happens.

In March 2016 (pre-election, mind you), the CBO said we’d have 26 million uninsured in 2018.  Now they are forecasting 41 million uninsured under the Senate plan.  A 15 million swing is about 5% of the population – that’s material.

They get to 15 million by adding three numbers: 4 million fewer on Medicaid, 7 million fewer through the market place exchanges, and 4 million fewer from employer-based coverage.  Nerds can click here and go to Table 5.

Sorry for the Monday math, but here is the summary – the new law will result in 22 million fewer people having insurance in 10 years; 15 million of that comes in the first year and comes from these three causes. 

Just ponder that for a couple of days and see what you think. Hint:  Sniff…you smell fish?  We’ll talk Wednesday.


thirteen + 13 =


Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

Yes, I'd like to get Tim's blog.