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Make no mistake: Monday's Congressional Budget Office score of the GOP House health-care plan — which projects 14 million fewer Americans would have health insurance by next year, and 24 million fewer would have it by 2026 — was bad, though not necessarily fatal, news for Republicans. It was the equivalent in football of being called for holding after a previous illegal motion call, and Republicans are now facing 2nd and 25 from their own 5-yard line. So it's not over, but it's far, far from ideal.
Yet beyond the CBO topline numbers, perhaps the most fascinating storyline was the GOP reaction to them. On the one hand, the Trump administration criticized the CBO. "The CBO report's coverage numbers defy logic," HHS Secretary Tom Price said in a statement. "The CBO report also does not incorporate two-thirds of the healthcare reform plan President Trump has called for" (though it's a bit unusual to ask the CBO to score something that doesn't exist yet, right?).
On the other hand, the House Republicans who wrote the bill accepted the CBO numbers, and argued that insuring more Americans isn't their goal. "Our plan is not about forcing people to buy expensive, one-size-fits-all coverage," House Speaker Paul Ryan said. Added House Majority Leader Kevin McCarthy: "Unlike Obamacare, our plan does not force people to buy insurance plans they may not want or even need."
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So there you have it: A Trump administration that has promised health-insurance coverage vs. House Republicans who believe freedom means that you shouldn't be forced to have it. Populism vs. Tea Party. Trumpism vs. Ryanism.
Here's the reason why the Trump administration decided to criticize — instead of embrace — the CBO numbers: As NBC's Benjy Sarlin writes, they show Trump and his team breaking their health-care promises.
The promise: "We're going to have insurance for everybody" — Donald Trump, Washington Post interview, Jan. 15, 2017
The reality: "By the agency's estimate, 14 million fewer people would be insured in 2018 versus current law and a whopping 24 million fewer people would have insurance in 2026," Sarlin writes. "The coverage losses would be 'disproportionately larger among older people with lower income,' according to the CBO, who would face higher premiums under the House GOP bill and less federal aid to pay for them.'"
The promise: "I firmly believe that nobody will be worse off financially in the process that we're going through" — Health and Human Services Secretary Tom Price, NBC's "Meet The Press," March 12, 2017
The reality: "While CBO projects the average 21-year-old could expect a 20-25% decrease in their premiums, a 64-year-old would see their premiums go up 20-25%. This is because of a change in the law that would allow insurers to charge older customers more than they can under Obamacare," Sarlin says. "For a 64-year-old making $26,500 a year, the effects would be devastating: They would pay, on average, $1,700 total for health insurance under Obamacare in 2026, but $14,600 under the House bill."
The promise: "I'm not going to cut Social Security like every other Republican and I'm not going to cut Medicare or Medicaid" — Donald Trump, Daily Signal interview, May 21, 2015
The reality: "Obamacare expanded Medicaid to cover about 11 million more people, but the House bill would reduce Medicaid spending by $880 billion by 2026, at which point it would spend a full 25% less than under current law. This would leave many people without coverage: 14 million Medicaid patients would fall off the rolls, according to the CBO projection."
Meanwhile, over in the Senate, this was the reaction from moderate Republican Susan Collins (R-ME), per NBC's Frank Thorp: "The CBO estimate that millions of Americans could lose their health insurance coverage if the House bill were to become law is cause for alarm. It should prompt the House to slow down and reconsider certain provisions of the bill," she said in a statement.
Speaking of Trumpism vs. Ryanism, the fact that Breitbart News published this piece after the CBO score is VERY telling: "Exclusive — Audio Emerges of When Paul Ryan Abandoned Donald Trump: 'I Am Not Going to Defend Donald Trump — Not Now, Not in the Future.'" Now, we knew this conference call, from back in October 2016, had taken place. And Trump himself reacted back then : "Our very weak and ineffective leader, Paul Ryan, had a bad conference call where his members went wild at his disloyalty." But that this story is being recycled now is certainly noteworthy. And guess what: Trump speaks with Ryan and House Majority Leader McCarthy by phone at 4:00 pm ET, per the White House's schedule. But as the New York Times' Glenn Thrush quips, does this audio expose Ryan's disloyalty? Or does it remind folks about Trump's statement about groping women?
The Wall Street Journal: "President Donald Trump has given the Central Intelligence Agency secret new authority to conduct drone strikes against suspected terrorists, U.S. officials said, changing the Obama administration's policy of limiting the spy agency's paramilitary role and reopening a turf war between the agency and the Pentagon."