Skepticism is already being expressed ahead of the Congressional Budget Office release of its score card on the Senate health care bill.
Senate leaders unveiled their plan to overhaul the Affordable Care Act last week. The measure includes deep cuts over time to Medicaid, including capping its budget, getting rid of the individual mandate and repealing tax increases imposed on wealthier people and the insurance industry.
The CBO may release its analysis this week. It has likely received parcels of information ahead of last week's publication of the draft bill, according to Doug Badger, a research fellow with Galen Institute, a free market health and tax policy research organization.
The CBO could not publish its analysis in a matter of days without having seen the language along the way, Badger told Patient Daily.
They will want to know if the Senate is moving in a completely different direction, and also what works under budget reconciliation, he said. A bill marketed as budget reconciliation can pass with a simple majority rather than 60 votes.
Republicans are continuing to negotiate over the final language of the Better Care Reconciliation Act, meaning the CBO will continue to crunch the numbers following revisions. "We’re going to make a lot of changes over the next seven days,” Sen. Tim Scott (R-SC) told reporters Thursday.
The CBO estimated the House American Health Care Act will increase the number of uninsured by as many as 23 million by 2026.
But Badger said that while he recognizes the CBO is the official score keeper, he has been critical of how it comes up with some of the numbers.
Badger said that, for example, if the plan is to "reduce payments for home health, you can find out how much is saved, and is pretty straight forward."
But, he added, if you replace the tax credits with ones that work differently, how many are on reduced coverage. "That is a much harder question," said Badger.
Further, Badger argued, the figures for those no longer eligible for Medicaid are likely also to be flawed. If there is no mandate to have insurance, and no penalties, millions will simply not apply for Medicaid.
"There has always been this issue where people are eligible (for Medicaid) but do not bother applying, Badger said. "But it that person goes to the hospital, they can receive Medicaid on the spot if they are eligible, and it is in the provider's best interest to sign them up."
Many others, particularly younger people, just paid the penalty, while there are also a large number who do not file tax returns.
The Senate bill, which Senate Majority Leader Mitch McConnell (R-KY) wants passed by July 4, faces opposition within his own party, from those who believe it does not go far enough to repeal the ACA to others fearing cuts to Medicaid and other provisions will leave millions of people without any insurance.
Sen. Ron Johnson (R-WI), one of the senators who publicly stated they will not vote for the bill in its present form because of its claimed failure to fundamentally overhaul the ACA, said a vote should not happen this week.
“There's no way we should be voting on this next week. No way,” Johnson said on "Meet the Press" on Sunday. "I have a hard time believing Wisconsin constituents or even myself will have enough time to properly evaluate this, for me to vote for a motion to proceed. So I've been encouraging leadership, the White House, anybody I can talk to for quite some time, let's not rush this process."
Crucially, the bill does not allow flexibility on community rating, the bar on insurers charging individuals different prices within a particular region. Critics of the House bill argued scrapping community rating would effectively allow insurers to charge non-affordable prices to those with pre-existing conditions..