Congress Needs the CBO
Now that the American Health Care Act is under the microscope of the Congressional Budget Office, Republicans are worried about what the agency’s analysts might see. As White House spokesman Sean Spicer said on Wednesday, “If you’re looking at the CBO for accuracy, you’re looking in the wrong place.”
It was just last year that Spicer was citing the CBO approvingly, as his boss has also done. What has changed? Part of it, undoubtedly, is that Republicans know their bill will not cover as many Americans as the Affordable Care Act, and they are bracing for the CBO report next week saying that. And part of it is just the self-interest of partisans, which always colors their analysis.
That’s why the Congressional Budget Office is so vitally necessary. For more than four decades, the nonpartisan agency has applied its expertise to congressional legislation, estimating the costs of bills and resolutions, and the intended and unintended impact on spending and revenue. The agency provides short- and long-term projections on the financial status of Social Security, Medicare and other federal programs.
The agency’s leadership -- it has had nine directors since 1975 -- has effectively steered it clear of partisan shoals and hewed to a consistent analytical framework. (In 2015, at Republican direction, the CBO adopted the use of “dynamic scoring” in some cases. But it has successfully resisted the kind of partisan interference that would corrupt its work.)
Is it perfect? Of course not. The world is complex; prognostication, especially about something as complex as the Affordable Care Act, is hard. The ACA imposed far-reaching changes on a multi-trillion-dollar health-care economy. There was no way to predict every outcome, and the CBO got plenty wrong. It estimated that the legislation would reduce the number of uninsured by 32 million by 2019. That won’t happen. Likewise, it overestimated how many employers would drop coverage for employees once the ACA exchanges were up and running. In part because of that, it also overestimated the overall cost of the legislation. Lawsuits and political obstruction in Republican-led states further clouded the picture.
But as the chart below from the Commonwealth Fund suggests, the CBO also got a lot right. The CBO predicted that, by 2014, about 7 million Americans would have subsidized health insurance through the ACA exchanges. The actual number was around 6 million.
CBO also estimated -- after a Supreme Court ruling threw a monkey wrench into previous projections -- that 7 million would enroll in Medicaid expansion by 2014. About 8 million did. And of course, the CBO correctly predicted that the ACA would reduce federal deficits.
But the point is not that the CBO’s numbers always turn out to be right. It’s that, even when they don’t, the CBO retains its credibility -- because it goes about its business in a fair and transparent way. And its independence from the executive branch, which has its own budget office, is crucial to both the day-to-day work of Congress and the balance of powers on which the government rests.
In other words: If the CBO didn’t exist, members of Congress would have to invent it. Their criticism of it now is as short-sighted as it is misguided.
--Editorial: Francis Wilkinson, Michael Newman
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