The CBO Score, and What It Means for Health Care Reform

Ezra Klein assesses the meaning of what happened today:

The question people generally ask about the final health-care reform vote is, “Won’t it be politically difficult for many House Democrats to vote yes?” But with the release of the CBO report (pdf), I’d flip that question a bit: Won’t it be substantively difficult for many House Democrats to vote no?

If you’re a liberal House Democrat, here’s what you’d be voting against: Legislation that covers 32 million people. A world in which 95 percent of all non-elderly, legal residents have health-care coverage. An end to insurers rescinding coverage for the sick, or discriminating based on preexisting conditions, or spending 30 cents of each premium dollar on things that aren’t medical care. Exchanges where insurers who want to jack up premiums will have to publicly explain their reason, where regulators will be able to toss them out based on bad behavior, and where consumers will be able to publicly rate them. Hundreds of billions of dollars in subsidies to help lower-income Americans afford health-care insurance. The final closure of the Medicare Prescription Drug Benefit’s “doughnut hole.”

And to those whose response to the CBO’s finding that the bill will reduce the deficit by $130 billion in the first 10 years and $1.2 trillion in the 10 years after that is to question the accuracy of the CBO’s work, Ezra has this to say:

This was a hard bill to write. Pairing the largest coverage increase since the Great Society with the most aggressive cost-control effort isn’t easy. And since the cost controls are complicated, while the coverage increase is straightforward, many people don’t believe that the Democrats have done it. But to a degree unmatched in recent legislative history, they have.

The Medicare Prescription Drug Benefit didn’t try to offset its costs. It just increased the deficit. And Medicare and Medicaid were passed in the days before the Congressional Budget Office even existed. For health-care reform, Democrats have gotten the toughest scorekeeper in Washington to bless their effort, and though many don’t think that’s good enough, it’s a lot more than anyone else has ever done.