The White House was forced to defend its healthcare plan on multiple fronts on Tuesday after a damning report found it would deprive millions of people of insurance, deepening divisions in the Republican party.
A nonpartisan Congressional Budget Office (CBO) study released on Monday predicted that by 2026, the number of people without insurance would increase by 24 million if House Republicans’ legislation to replace the 2010 Affordable Care Act (ACA) – also known as Obamacare – is adopted.
But during an hour-long briefing dominated by the issue, White House press secretary Sean Spicer challenged the CBO’s figures, contended that two further phases of reform should be taken into account and continued his retrospective battle with Barack Obama’s administration.
In 2013, Spicer said, the CBO estimated that 24 million people would have coverage under the ACA in 2016, only to be off by 13 million people, or more than 50%. In fact, he claimed, only 10.4m people were actually covered, and reports suggested this number had dwindled to 9 million.
“CBO coverage estimates are consistently wrong and more importantly did not take into consideration the comprehensive nature of the three-pronged plan to repeal and replace Obamacare with the American Health Care Act,” Spicer told reporters at the White House.
But he was eager to embrace the CBO’s forecast that the act would reduce the deficit by more than $330bn and bring health insurance premiums down 10%.
“When you get down to it, the Congressional Budget Office is there to measure the potential impact of programmes on the federal budget. Its attempts to estimate coverage have been historically faulty … They’re pretty good at dollars, not as good at people.”
The second and third prongs of the new plan include reforms to further drive down costs and increase coverage, he said, for example by allowing health insurance companies to sell across state lines. “It’s like building a puzzle. If you only put a third of it on the table and said, ‘Hey, look, this puzzle’s incomplete, we hid the other two-thirds’ pieces,’ it’s not explaining to people how the whole thing comes together.
“There’s no question that increased competition drives down costs. It is just an economic certainty, and allowing greater choice will do the same.”
The bill has been condemned by Democrats, some Republicans, the American Medical Association, the American Hospital Association and a swath of conservative interest groups. Jonathan Gruber, an architect of the ACA and professor of economics at the Massachusetts Institute of Technology, has denounced it as a “scam”.
Spicer said in response: “I think the plan that he helped create hasn’t done so well for Americans seeking health insurance … Respectfully, I think he should just hang out more at MIT and allow good ideas to continue to come forward so we can focus on achieving the president’s goal of what he sought out in the first place.”
‘The president’s proud of it’
Pressed more than once on whether Trump would guarantee healthcare for everyone, Spicer continued to attack the ACA, claiming that it forced people to buy plans they did not like. He said out of 30 million potential users, 6.5 million people decided they would prefer to pay a penalty, while nearly 14 million had applied for a hardship exemption.
“So you’ve almost 20 million people in America who have said that they don’t want Obamacare and they’ll either pay a penalty or have applied for a hardship.”
Retaining the ACA – seen as Obama’s signature domestic policy achievement – was not an option, he added. “If we do nothing, if we just allow this to continue, it will collapse on its own. The cost of it is unsustainable. The premiums are going sky-high in state after state and the choices keep going further and further down, and so this idea of comparing it to Obamacare is a false choice, because they have no choice.”
He was reluctant to embrace the term “Trumpcare”, however. “The Obama administration didn’t label it Obamacare. They called it the ACA. This is the American Health Care Act. The president’s proud of it, the president’s proud of the fact we’re working with Congress … I don’t think this is about labels and names.”
But the non-partisan CBO report leaves Republicans with an uphill battle to sell the plan – their first major piece of legislation under Trump – in the Senate and possibly the House. It was thought to be no coincidence that Breitbart News, a pro-Trump website, released a potentially damaging audio recording of the bill’s champion Paul Ryan, the House speaker, saying on a conference call with House Republicans on 10 October: “I am not going to defend Donald Trump – not now, not in the future.”
On Capitol Hill, Republican lawmakers from across the political spectrum criticised the plan. “It’s pretty eye-popping – 14 million people who will lose insurance in a year relative to baseline,” Republican senator Bill Cassidy, a physician from Louisiana, said, referring to the findings in the CBO report. “That’s something that folks should be a little bit concerned about.”
Cassidy, who introduced an ACA replacement plan in January, said he would like to see significant changes to the plan, especially to make insurance more affordable for low-income earners.
The vice-president, Mike Pence, and the health and human services secretary, Tom Price, joined Senate Republicans for their weekly lunch on Capitol Hill in an effort to galvanise dwindling support for the legislation.
The Senate majority leader, Mitch McConnell, a Republican from Kentucky, said after exiting the weekly lunch: “Regarding the projection of fewer people purchasing [insurance], I think that’s the inevitable result of the government not making you purchase something you may not want.
“And so we are hoping to have a more vibrant market that will attract a greater number of people to actually be able to buy, at an affordable cost, insurance that actually makes sense for them rather than one prescribed by the government.”
McConnell said he expected changes to be made in the House before the bill is delivered to the Senate, where he anticipated it would be amended further.
Conservative hardliners have balked over concerns that the bill does not go far enough to repeal the ACA, panning Ryan’s replacement plan as “Obamacare lite”. On Tuesday, members of the House Freedom Caucus, whose support Republicans need to pass the bill in the House, said they required substantial changes to the legislation in exchange for their votes.
“Obviously we’ve got some work to do still,” the Freedom Caucus chairman, Mark Meadows, a Republican from North Carolina, told a crush of reporters. He added: “I’m optimistic that we’ll [see] some good results in less than a week”.
Meadows said he had received “no assurances” from the White House on the legislation yet, but said he was having “good conversations” on “Medicaid, essential health benefits and the mandates”.
Speaking to Fox & Friends on Tuesday morning, the Ohio representative and Freedom Caucus member Jim Jordan said the current plan “doesn’t unite Republicans” and “doesn’t bring down the cost of premiums”.
But some joined the White House in seeking to discredit the budget office in an effort to undermine its findings. Senator Roy Blunt, a Republican from Missouri, said that the CBO was “notoriously bad” at anticipating what would happen in the marketplace. “They’re sometimes not even very good at adding and subtracting,” he said.
On Tuesday, Democratic leaders held a news conference with doctors who are supportive of the Affordable Care Act and patients who are insured under the current healthcare law.
Pelosi denounced Republicans for what she characterised as prioritising political ideology above millions of Americans who risk losing coverage under the GOP healthcare plan.
“They’re saving $33bn a year and they’re cutting off 26 million people from healthcare,” House minority leader Nancy Pelosi, said, adding: “This isn’t about politics, it’s about values.”
During an afternoon press conference, the Senate minority leader, Chuck Schumer, called the plan one of the president’s “biggest broken promises” and quoted a pre-inauguration promise in which Trump said his plan would provide “insurance for everybody”.
“The CBO report confirms that Trumpcare does not even remotely come close to that pledge,” the New York Democrat said. “The president was off by 24 million Americans – more than the population of my entire state.”