When Independent Analysis Is Attacked

I normally don’t like to mix my personal with my professional life, but as I sit in a hospital while my wife is recovering from the birth of our daughter, I cannot help but wonder what millions of Americans are thinking about in the shadow of the vote today to pass the American Health Care Act Redux.

I don’t worry about my or my family’s healthcare. I’m sitting in a world class facility, with top-notch medical care and I don’t think twice about what it costs because I get comprehensive affordable health insurance through my employer — the state of New York. My wife and daughter are getting the care they need without any fear of lack of access or cost. However, for millions of other individuals and families in this country, access to healthcare and a way to pay for it is front and center on their minds. In some cases, it literally can be life and death. In other cases, a major health issue could create significant financial strain on families.

President Obama made access to quality affordable healthcare, which had been previously out of reach to millions of people, a centerpiece of his presidential legacy with the Affordable Care Act (ACA or Obamacare). Calling the ACA a disaster, President Trump made repealing and replacing it a centerpiece of his presidential campaign and now his administration. In March, the president and some House Republicans forwarded the American Health Care Act (AHCA) — their replacement to the ACA.

Like many programs, there are things that have worked and things that have not worked so well with the Affordable Care Act. At the nonpartisan Rockefeller Institute, where our mission is to offer policymakers evidence-based policy, we’ve created a 40-state network — with our partner, the Brookings Institution. The network of professional researchers has examined how Obamacare has been implemented at the ground level since late 2013. Using data and objective research, we’ve seen success and growing stability in the program, but there are problems with the current law that should be addressed — specifically in higher insurance premiums and costs where there’s been little or no competition, higher costs because more sick people have signed up than projected, and still unmet needs for more consumer education and assistance.

Here at the Rockefeller Institute, we’ve also been working with stakeholders to learn how the AHCA would affect federal, state, and local governments — and, most importantly, individuals and families. The nonpartisan Congressional Budget Office (CBO), similarly, analyzed the AHCA’s replacement. It found that (a) the AHCA would result in 24 million people losing their health insurance and (b) premium costs would increase 15-20 percent for certain groups.

In response to this independent analysis, the Trump administration attacked the CBO. First, Health and Human Services Secretary Tom Price said, “We disagree strenuously with the report that was put out. It’s just not believable is what we would suggest.” Office of Management and Budget Director Mick Mulvaney said, “This is exactly what we thought the CBO would come forth with.…They’re terrible at counting coverage.” Finally, Trump Press Secretary Sean Spicer said, “If you’re looking at the CBO for accuracy, you’re looking in the wrong place.”

Attacking the person or institution — as opposed to factually countering the analysis — has been the hallmark of the Trump administration’s short tenure. It’s policy analysis by personal attacks, not directly addressing the issues themselves. This case is no different. The administration acted as if the CBO’s analysis was political or motivated by politics. It’s the “numbers lie” argument.

This week, the House Republicans and the Trump administration aren’t even waiting for independent CBO analysis to score the revised AHCA — calling for a vote on the bill today before anyone truly knows the effects of the bill. In this case, this is the numbers can’t lie approach, because they’re eschewing the independent analysis altogether. The CBO is a politically neutral institution, typically led and staffed by highly qualified applied economists, that has in the past been relied upon by both parties to stipulate facts even in the midst of highly controversial debates. Unfortunately, there’s little taste for any stipulations here.

But, as Rockefeller Institute Director Tom Gais aptly says, in this day and age, complex modern public policy (like healthcare policy) is not, nor should not, be static — it’s something that needs to evolve and adapt. Groups like the Rockefeller Institute or the CBO aren’t telling policymakers what they should or shouldn’t do. We are simply providing valuable, independent analysis to drive the policymaking process in an objective and transparent manner.

Whether you agree with Obamacare, Trumpcare, think more people should be insured at an increased cost, or think we should reduce the scope of coverage and the cost of the program is not the objective we’re interested in as institutions. People are entitled to their political and ideological views, especially the role of government in health and other policy.

However, what is dangerous is when policymakers and, by extension, the public don’t know what the facts are or the impact of a major potential policy change, like overhauling healthcare. It is simply too important an issue to people all across this country not to get the independent facts first. To some, a “win” in healthcare is an important political notch on the belt regardless of what it is and what it does. But with healthcare access, a life and death issue, more important than if you win, is what you win.

There are lots of lessons learned — and objective expert analysis — from the ACA’s implementation. We need the same with the newly developed law in the aftermath of AHCA’s initial failure. Even though the House voted on the bill today, there is still a lengthy process with the Senate, and reconciliation between the chambers. Only time will tell whether federal lawmakers listen to that objective analysis when casting votes on issues of such significance to their constituents.