Republicans Call for Updated Obamacare Score

Published November 20, 2018

Twelve Republican members of the U.S. Senate Committee on the Budget sent a letter to CBO in October requesting the agency specify the changes it is making to its health insurance simulation model (HISIM), which is used to score health care legislation. The senators are also calling for CBO to issue a comparison of estimated costs for the Affordable Care Act (ACA) under the two models.

Costly Mistakes

CBO, the government agency tasked with producing cost estimates of proposed legislation, is implementing a new health insurance simulation model, HISIM2, to increase the accuracy of its estimates and provide better information for Congress, watchdog organizations, think tanks, and the general public about the likely costs of major pieces of health care legislation.

CBO has received much criticism for its highly inaccurate projections of ACA costs and those related to other legislation. CBO’s estimates of expected initial Obamacare enrollment were 120 percent higher than the actual 2016 figure. CBO similarly provided an overly optimistic projection of enrollment in Medicaid expansion under Obamacare.

Muddled Models

Twila Brase, a public health nurse, president and cofounder of the Citizens’ Council for Health Freedom, and a policy advisor for The Heartland Institute, which publishes Health Care News, says the new HISI model will ultimately be a matter of speculation, just like the prior model.

“Predictions are just that: predictions,” Brase said. “No one actually knows what something is going to cost or how many people will enter a program or how many practitioners will participate in a program. Predictions are simply suppositions, not facts. No one has any idea what the truth is until time has passed and the facts are in.”

Past as Prologue

Brase says the failures of past models indicate what is likely to happen with the new one.

“The CBO predicted that the Obamacare exchanges would have 22 million enrollees by 2016; however, the actual number was a little less than half that amount,” Brase said. “There were also estimates about how many people would enroll in expanded Medicaid. But in most states, the actual number far exceeded the estimate.

“Models are just models,” Brase said. “There is no reason to think that they will be accurate this time.”

Jake Grant ([email protected]) writes from Alexandria, Virginia.