In this circumstance with the AHCA, Congress isn’t waiting for the final score, but CBO did put out the score on the base bill a couple weeks ago, and these three amendments don’t really change that. But people would put up amendments on the floor without having any CBO score and without knowing. Holtz-Eakin: We did a lot of things with the Medicare Modernization Act, the Part D program we put a score out for that, of course. Newkirk: In your tenure, did you have any situation where Congress decided, on a final bill, to waive or bypass the CBO scoring? It gets done differently in every circumstance. Congress can waive the CBO score at any time. The Budget Act of 1974 said that if you’re going to consider language that contains a congressional authorization, there should be a CBO score that accompanies it-so that’s the basis for which this process was set up. That describes the budgetary impact of the legislation-what does it do to revenues coming in and spending going out?-and often, for health legislation, provides some supplementary information on premiums and coverage implications of the bill. Then there will be final legislation as well, and CBO will write a formal cost estimate. Then they’ll actually have to write the legislative language and send that to CBO, and there will be several iterations on that. Congress will then provide them, typically, with some sort of outline of the structure of the bill, and CBO will give some sort of estimate of the implications. Newkirk II: Can you walk us through what the traditional CBO scoring process is like for a major health-reform bill like the AHCA?ĭouglas Holtz-Eakin: As the legislation is being developed, the staff on the Hill will be in contact with CBO describing what they’re going to do, so CBO has some notion of what’s coming their way. The following interview, conducted before the House vote, has been edited for length and clarity. Bush administration and is now president of the center-right think tank American Action Forum. Perhaps more consequentially, they voted before its specs could be reappraised by the Congressional Budget Office, the agency that evaluates a law’s potential outcomes.īut what exactly does the CBO’s work entail, and why is its scoring important? In lieu of a report from the office itself, I spoke with former CBO Director Doug Holtz-Eakin on the agency’s role and his own analysis of the amended AHCA. But House Republicans were invested in moving quickly-eschewing hearings on the law and allowing limited time for analysis and consideration. A collection of amendments added after its initial drafting-including one from Representative Tom MacArthur allowing states to waive certain protections for preexisting conditions, and two amendments that set aside $23 billion total for high-risk pools in states-carry downstream consequences, like changes in employer plans or increased costs for sick people. The decision to push for a vote this week had proved controversial, as there is little consensus on what the revised law will actually do.
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