The Congressional Budget Office just released its much-awaited report analyzing the possible effects of the American Health Care Act, the GOP plan to replace the Affordable Care Act. The verdict is a doozy. Twenty-four million fewer Americans would have health insurance by 2026, according to the CBO, with 14 million of them losing coverage in 2018. While, yes, the report also says the GOP’s health care plan would save the government $337 billion within the decade, it underlines a potentially stark contradiction with President Trump’s prior promise that the bill would “provide insurance for everybody.”
The report spurred quick responses from all sides of the political spectrum, with Democrats decrying the results and Republicans questioning the CBO's methodology. (Health and Human Services Secretary Tom Price complained that the CBO did not take into account potential future legislation, which sounds like a financial planner not incorporating potential scratch-off lottery wins in a retirement portfolio.) What few have questioned, though, is the CBO's integrity. And given the political climate, this seems downright remarkable.
In fact, since its inception four decades ago, the CBO has occupied a rarified space in which the objectivity of data reigns. Call it wrong if you must---and sometimes, sure, CBO is wrong---but don't call it partisan. How does it ensure that entrenched neutrality? A culture designed not just to encourage it, but demand it.
It goes back to history. The Congressional Budget Office was born out of a conflict between President Richard Nixon and Congress in 1974. The Democrat-controlled legislative branch wanted a stronger voice in the budget process, but couldn’t rely on a sole source of economic information: the White House’s Office of Management and Budget (OMB). So Congress decided to create the CBO as its own unbiased and independent budget office.
Today, every bill that comes out of a congressional committee has to include what’s called a CBO score. Essentially, this is how much a proposed bill would cost or save the federal government compared to what would happen if the government didn’t pass it---a baseline, of sorts. For something like a health care policy, there’s the added (and crucial) piece of determining how many citizens would be covered by the health care system before and should the legislation pass.
“Let’s say somebody had actually done research on what happens if you change the procedures for how difficult or easy it would be for someone to sue for malpractice---an academic study---and CBO found the results to be credible,” says Philip Joyce, a professor of public policy at the University of Maryland and the author of The Congressional Budget Office: Honest Numbers, Power, and Policymaking. “CBO would take this and ask, if the federal government was looking to do this across the country, what would be the effect?”
The people who assess that score, too, exist largely outside of the political machine. "It's is very much like the academic hiring process,” says Jonathan Gruber, an MIT professor of economics and former health care consultant for the Obama administration. "CBO tries to hire the best possible PhD students in economics. There’s no politics involved in the qualifications."
That's the key difference between lawmakers and the CBO's nonpartisan team of budget wonks. “The people who propose legislation often assert that if you do what you think should be done, good things will happen,” says Joyce. “CBO doesn’t take at face value that good things will happen---its job is to assess how credible those claims actually are. That’s the thing that often frustrates supporters of legislation.”
That process doesn't always yield right answers, as critics of the CBO are quick to point out. The agency's March 2010 analysis of Obamacare estimated 21 million people would be enrolled in public marketplaces by 2016. The year ended with only 11.5 million enrollees.
Still, CBO’s original ACA projections were closer to accurate than “many other prominent forecasters," according to the Commonwealth Fund, an independent health care research group.
“CBO makes plenty of mistakes,” says Gordon Gray, director of fiscal policy at advocacy group American Action Forum, which promotes center-right public policy. “It’s a difficult thing predicting the future. But it does a good job of explaining what they screwed up if they screwed up, how, and why.” Gordon also points out that this is only the first CBO score to drop---there will be others as the bill incorporates amendments and revisions---so it's important to take the score with the dose of context it deserves.
Still, it's the agency's vaunted transparency that makes CBO estimates the gold standard, by the public at large, across party lines, and by the mainstream media.
“The media and the general public looks at CBO and says, ‘Well, CBO doesn’t really have a dog in this fight,’” says Joyce. “Not because it’s right, but because it hasn’t been tainted by bias. It’s not trying to get the legislation passed, nor is it trying to kill it.”
In fact, you needn't look much farther than the CBO's ability to consistently enrage both political parties, says Gruber. After all, it was Clinton-appointed CBO director Robert Reischauer who released the CBO report that ended up making the Democrats' 1993 health care reform bill DOA.
Could the attitude of independence change at the CBO? Sure. And yet it’s unlikely. “I can’t prove CBO is non-partisan, except for having watched the behavior of the organization,” says Joyce. “It’s the culture. It’s in the water.” Short of the administration appointing a CBO head whose express intention was to turn the organization partisan, who would then fire a bunch of people within the agency, Joyce doesn’t see CBO turning red or blue anytime soon.
“The way I put it to people who are skeptical of this is: If you’re somebody at CBO, the only thing you have is your credibility,” he says. “At the point at which CBO and its staff begins to be viewed as just another partisan organization in Washington, people will stop paying attention to them.”
It’s not that CBO’s motives are purer than the rest of us. It's that rather than following the shifting political winds, the CBO's entire purpose depends on ignoring them.
