Skip to main Content

White House casts pre-emptive doubt on budget office set to rule on health bill

  • Author: Alan Rappeport, The New York Times
  • Updated: March 10, 2017
  • Published March 10, 2017

WASHINGTON — President Donald Trump showed an affinity for "working the referees" in his race to the White House, criticizing a federal judge as biased, panning polls as rigged and even questioning the aptitude of the nation's intelligence agencies.

Now, with Trump's administration aggressively pitching the House Republican plan to repeal and replace the Affordable Care Act, Capitol Hill's official scorekeeper — the Congressional Budget Office — is coming under intense fire. As it prepares to render its judgment on the cost and impact of the bill, the nonpartisan agency of economists and statisticians has become a political piñata — and the latest example of Trump's team casting doubt on benchmarks accepted as trustworthy for decades.

"If you're looking to the CBO for accuracy, you're looking in the wrong place," Sean Spicer, the White House press secretary, said Wednesday, arguing that the agency's failure to accurately project enrollment in the Affordable Care Act's online marketplaces had essentially killed its credibility.

Spicer's criticism echoed that of some House Republicans who raised questions this week about the CBO's record.

The reason for their umbrage is clear: The CBO's official judgment on the American Health Care Act, as the Republican legislation is known, is expected to be released Monday and it is more than an intellectual exercise. It could make or break the bill.

Budget rules that Republicans are using to bypass a possible Democratic filibuster in the Senate stipulate that the health care legislation must not add to deficits over the span of a decade. If the CBO predicts that it would, Senate Democrats could block the bill. More broadly, a judgment by the CBO that the Republican plan would strip health care from millions of people could have politically disastrous effects.

Analysts at the Brookings Institution said Friday that the plan could increase the ranks of the uninsured by more than 15 million — and said the CBO estimate might put that figure considerably higher.

Created by Congress in 1974, the agency provides forecasts that are the foundation of the budget process. The White House's attack has sparked a fierce backlash among economists, former CBO directors and some lawmakers who see its disparagement as a sign that long-standing legislative traditions are eroding.

The criticism comes after Trump has expressed skepticism about the validity of unemployment figures from the Bureau of Labor Statistics and amid reports that his economic team has plans to manipulate the calculation of trade data.

To critics of Trump who say he is in the business of fudging numbers to fit his economic narrative, the jabs at the CBO are particularly worrisome.

"It is a valuable resource for Congress that both parties need," said Alice M. Rivlin, the agency's founding director. "Undermining the credibility of CBO when policymakers need it most harms Congress' ability to do its job and the long-run effectiveness of both political parties."

But the CBO's mandate is not ironclad.

Douglas Holtz-Eakin, a conservative economist who led the CBO from 2003 to 2005, also defended its credibility, but he noted that Congress remained the ultimate arbiter if it so chose. While it rarely happens, the Senate Budget Committee could decide to make its own determination about the bill's economic effects.

"In the end, CBO scores are ultimately advisory," he said.

Lawmakers have not mused publicly about such a move, which would probably set off a political firestorm. According to Steve Bell, a former Senate Budget Committee staff director in the 1980s, ignoring CBO forecasts for the health bill would dampen hopes for major legislation on taxes or infrastructure because the public would no longer be able to believe government estimates about the cost of such programs.

"Down that path lies serious corruption," said Bell, who now works at the Bipartisan Policy Center.

For its part, the CBO has tried to stay above the fray.

After Newt Gingrich, the former House Speaker and an adviser to Trump, said this year that the CBO was a "left-wing, corrupt, bureaucratic defender of big government and liberalism," Keith Hall, its Republican-appointed director, defended its work.

"We try very, very hard to be independent and nonpartisan," he said at a news briefing in January.

Analysts contend that the CBO's forecasts for the Affordable Care Act were mixed and that the health law was a challenge because it was such a moving target. A 2015 report by the Commonwealth Fund, which supports health policy research, found that the CBO had overestimated insurance-marketplace enrollment and marketplace costs by about 30 percent and had underestimated Medicaid enrollment by 14 percent.

The missed mark for marketplace enrollments, the report said, stemmed largely from a miscalculation that many employers would drop employee-provided health care and send workers to Affordable Care Act exchanges. They mostly did not.

"The CBO's projections were closer to realized experience than were those of many other prominent forecasters," the report concluded.

In response to questions from Congress last week about its record as a forecaster, the CBO said the cost to the federal government of the Affordable Care Act's insurance-coverage provisions had actually proved to be lower than the agency projected. That was probably because of lower-than-expected enrollment and a slowdown in the growth of health care costs, the CBO said.

Some Senate Republicans argued that the agency's figures should be heeded.

"What matters in the long run is better, more affordable health care for Americans, not House leaders' arbitrary legislative calendar," Sen. Tom Cotton of Arkansas said in a post on Twitter in which he questioned why the House was considering the bill when the CBO had not scored it.

For their part, Democrats appeared to relish the irony of Republicans assailing an agency whose work they have embraced when it suited their political arguments. That Republicans had appointed Hall to his post did not go unnoticed.

"I have no idea what the CBO report will say, but I find it amusing that the right-wing Trump administration would try to cast doubt about the integrity of that report when it was the right-wing Republicans who hand-picked its director," said Sen. Bernie Sanders, an independent from Vermont.