It was a hectic week for people who follow news about health politics. Kaiser Health News veteran reporters Mary Agnes Carey and Julie Rovner sat down to discuss some of the major developments.
MARY AGNES CAREY: Hello, and thanks for joining us. I'm Mary Agnes Carey, partnerships editor and a senior correspondent for Kaiser Health News. Julie Rovner, KHN's chief Washington correspondent, is here with me to talk about a very busy week in health care: Medicaid cuts in President [Donald] Trump's budget plan and a new Congressional Budget Office analysis of the House-passed ACA overhaul. We'll also look at what Senate Republicans have in mind for their ACA replacement bill. Julie, let's get started.
JULIE ROVNER: OK.
CAREY: First the budget. President Trump released his fiscal 2018 budget plan this week. Federal spending on Medicaid and the Children's Health Insurance Program would be cut. Can you take us through those changes?
ROVNER: Yes, these Medicaid changes would be on top of what's in the House-passed health care bill, which would be about $800 billion. What the administration says is that they're going to let the amount that Medicaid goes up every year go up by less. So that would result in even more cuts. There's a roughly 20 percent cut to the Children's Health Insurance Program.
This budget also includes big cuts to the public health infrastructure. It cuts the Centers for Disease Control and Prevention by about 17 percent. It would cut the National Institutes of Health by nearly 18 percent. It would completely eliminate the Agency for Healthcare Research and Quality and fold that into the NIH. So there's been a lot of uproar from the medical and scientific community, although we should point out that this budget is unlikely to happen. Presidents' budgets are mostly wish lists -- that goes back decades. Congress basically decides who gets how much money.
CAREY: Because they control the purse, right?
CAREY: All right. Let's move on to the ACA. The Congressional Budget Office, or the CBO as we like to call it, released a new score or analysis for the House Republicans' plan to replace the Affordable Care Act. What were the top takeaways for you?
ROVNER: Well, a lot of attention was paid to, you know, that sort of top line -- that it would result in 23 million more people not having insurance after 10 years and then, overall, it would save about $119 billion from the deficit.
But what most of us were really looking at is what would happen as a result of that last-minute compromise that actually got the bill passed in the House. That was this amendment that would let states waive some of the requirements in the bill, like having a set of benefits and not charging people with preexisting conditions more. And interestingly, the CBO said that either under the Affordable Care Act or under the original House bill the market for individual insurance would probably be stable. But in those states that decided to take those waivers, it might well become unstable.
And the CBO didn't say which states that would be, but they estimated that about one-sixth of Americans lived in states where that might happen. In those cases, people with preexisting conditions might be completely priced out of being able to get policies and even people who could get insurance might have to pay many, many thousands of dollars more because some benefits that they might need, like maternity care or mental health care, would no longer be covered. So it was not a ringing endorsement of that last-minute compromise.
CAREY: And there's also a big differential between if you're younger or older, right?
ROVNER: That's absolutely right. This is in sort of the original House bill. They would change the way tax credits are provided for people to help pay their premiums. Right now, they're basically based on your income and how much insurance costs, so it doesn't matter in different parts of the country if you're sure insurance costs more. You only have to pay a set percent of your income.
The Republicans would change that, and they would link the tax credits more to age so older people would get more. Younger people would get less, but people would get less help overall. So for older people, premiums would spike dramatically. Sometimes, you know, more than $10,000 or $12,000. Some younger people, healthy younger people, would see a decrease, but it would not be nearly as large as the increase for older people.
CAREY: So what does this CBO score mean for Senate Republicans as they try to draft their ACA replacement?
ROVNER: Well, it certainly doesn't help. The Senate had to wait for the Congressional Budget Office to deliver this score. That's one of the requirements of the budget process that they're using. But Senate Majority Leader Mitch McConnell did a couple of interviews this week where he basically said that they're working hard on health care, but he doesn't see a path to 50 votes, which is what they need to get this bill passed. That's assuming Vice President [Mike] Pence could break a tie.
What we're starting to see are conservatives saying they need to have these waivers -- the ones that the CBO just said might destabilize the insurance market. Then you've got more moderates saying, no, we want fewer or no waivers. It's hard to see where they're going to come together. We're told that staff is going to try to draft something next week while Congress is out for the Memorial Day break. But there's no real anticipated timeline for this yet.
CAREY: So, Julie, why do you think Mitch McConnell would send such a public signal that he's having a problem getting to 50 votes?
ROVNER: I really don't know. I thought it was kind of curious. One of the things that it might be is that he wants to, you know, light a fire under his caucus, who are having all this disagreement, saying you know this whole thing could, you know, just dissolve if you don't actually start coming to the table and compromising. Why else do you think he might do it?
CAREY: Well you talk about how the calendar is working against him if he wants to get to tax reform. We're at Memorial Day, and typically tax reform takes a lot of work, a heavy lift, maybe he just wants to move onto that.
ROVNER: So basically abandon the whole health reform idea?
CAREY: I mean it sounds a little nutty. And obviously it's a campaign promise they've all made. But also, as we've seen, there are problems in the marketplace. You do see insurers leaving over uncertainty. Perhaps they want to let that play out. I'm not sure.
ROVNER: Neither am I.
CAREY: All right, well there you go. Thank you, Julie Rovner of Kaiser Health News.
Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.