The New York Times calls it “Capitol Hill’s official scorekeeper.” NPR says it’s made up of a group of “supernerds” who give Congress information. If you’ve been following news about the Senate’s struggle to pass a health care bill, you’ve likely heard its acronym: CBO. But what is the Congressional Budget Office? And how credible are its forecasts? Read on to learn the basics about the government’s nonpartisan group of go-to experts.

The Congressional Budget Office Origins

The Congressional Budget Office was established under President Richard Nixon, as one part of the Congressional Budget and Impoundment Control Act of 1974. Upset with Nixon’s practice of impounding, or not spending, funds that had been allocated for specific projects, Congress drafted the bill to increase congressional power of the purse and regulate the budget process.

Aside from setting up the CBO as an independent agency, the rest of the bill revamped the government’s budget process and established the House and Senate Budget Committees. Alice Rivlin, appointed by Democrats, was the first director of the office, and is credited with solidifying its culture of nonpartisanship.

“Free From Partisan Tinge”

The body was set up to be nonpartisan, to “provide the Budget Committees and the Congress with objective, impartial information about budgetary and economic issues,” according to the agency’s website. In practice, this emphasis on objectivity means that the CBO’s data is either revered or loathed by either party when politically convenient.

Since its inception, objectivity has remained an integral part of the CBO’s mission. In a 1976 memo to staff, Rivlin wrote that the work of the CBO must be “free from partisan tinge,” adding that any appearance of taking sides in a legislative battle would put the trustworthiness of its information in jeopardy.

“We are not to be advocates,” the memo reads. “We are not to make recommendations or to characterize, even by implication, particular policy positions as good or bad, wise or unwise.”

To ensure objectivity and provide information that politicians will respect, the CBO goes through a multi-step process. Staff analysts begin by reading relevant research and literature on related topics and analyzing data from government agencies and committees. They then consult experts from universities, think tanks, and industry groups, as well as federal, state, and local government representatives to get outside perspectives from different backgrounds. The research and reports are then reviewed internally, by employees and analysts of different levels, and externally by more experts.

As a rule, the CBO makes no policy recommendations. Its findings are facts-only reports on data and relevant research, condensed into reports that representatives and the public can read and understand before drawing their own conclusions. The agency also has a set of strict policies to prevent employees from incurring any potential financial conflicts of interest and to limit their partisan political activities.

“Alice Rivlin” Courtesy of New America: License (CC BY 2.0)

What Exactly Does the CBO Do?

Throughout the year, the CBO puts out a series of products–predictions, reports, analyses–that provide information about the economic impact of proposed or enacted legislation. This is the “between the lines” information that sponsors of a bill might not reveal, or even know themselves. It helps the general public understand the effects of policy, and helps politicians make decisions on whether or not to support certain policies.

The agency makes the news most often for its cost estimates, which it creates for “virtually every bill approved by Congressional committees.” A recent cost estimate of the American Health Care Act found that the act would result in 23 million more Americans uninsured over the next decade. All of the cost estimates can be found on the agency’s website.

The office’s budget projections, which cover time periods of 10 and 25 years, show how changing population demographics and economic trends would affect the federal budget and spending, provided laws remain stable. The outlooks also show the economic impact of possible alternative policies.

In addition to these, the CBO publishes analyses of the president’s budget, a monthly budget review, analyses of federal mandates, scorekeeping for legislation, and various other analytic reports and data compilations.

Who’s in Charge?

The head of CBO is appointed by Congress to a four-year term. The current head, Keith Hall, was nominated in 2015 by House Republicans and is the ninth director of the office. All staff are appointed by the director without regard for political affiliation.

Currently, the agency has about 235 employees, including economists, lawyers, analysts, and policy wonks of all sorts. Staff are divided into eight divisions, each of which focuses on a particular aspect of government budget issues.

How Much Power Does the CBO Have?

The nonpartisan aspect of the CBO is what makes its predictions and reports so influential in Washington. The CBO is widely respected by politicians from both parties, as well as the mainstream media and the public. Though the reports avoid making value judgements on legislation, CBO scores can often be key in shaping policy. Sometimes, politicians or other parties to legislation will wait until the CBO analysis is released before committing to a bill.

CBO researchers also make it their mission to avoid too much jargon so that their work is transparent and can be understood by politicians and the general public. The reports and publications do not stand alone–the CBO makes sure to include descriptions of methodology and contextual information.

“Although much of the work that CBO does is extremely technical, the agency devotes substantial time and energy to presenting the work as clearly and non-technically as possible,” according to an agency document.

Cost estimates of proposed legislation are dependent upon the CBO’s baseline budget and economic projections, which show how the economy will fare under existing laws. The office acknowledges that the changing nature of laws and other economic and technical factors can affect the accuracy of this benchmark.

“Actual budget and economic outcomes are almost certain to differ from CBO’s projections even if the projections are a perfectly accurate forecast conditional on existing laws,” the same document reads. “The differences between projections and outcomes can be misleading measures of the quality of the projections unless adjustments are made for changes in laws.”

How Trusted are CBO Forecasts?

In general, politicians and experts from varying political backgrounds say the CBO is a trustworthy and important source of information, but the difference between projections and outcomes make some question the validity of CBO research­–especially when doing so is in line with their agenda.

The recent CBO report on “Trumpcare” prompted fiery critiques from members of the administration and congressional supporters of the bill. Tom Price, the secretary of health and human services, told reporters that the CBO’s projections were “not believable.” “We strenuously disagree with the report,” said Price, who was previously one of the House Republicans who nominated Keith Hall to be director of CBO.

“Trumpcare NO Healthcare for 42000 LOCAL Residents” Courtesy of John Flores: License (CC BY-SA 2.0)

White House Press Secretary Sean Spicer said the CBO was inaccurate, citing its incorrect predictions of how many enrollees Obamacare would have. “If you’re looking to get a bull’s-eye accurate prediction to where it’s going, the CBO was off by more than half last time,” Spicer said. “The last time they did this, they were wildly off.”

Newt Gingrich also criticized the CBO in an interview with a Fox News host, calling the agency “corrupt” and “dishonest.” “They should abolish the Congressional Budget Office,” Gingrich said. “It was totally wrong on Obamacare by huge, huge margins. I don’t trust a single word they have published, and I don’t believe them.”

Given these criticisms, it is important to note again that the CBO insists on nonpartisanship. Hall, the current head, was nominated by Republicans. The agency also has a long history of leaders breaking with assumed party lines to publish information. Rivlin, the first director, was a known Democrat, but CBO reports under President Jimmy Carter were just as critical as they had been during the Ford Administration. Health care under President Bill Clinton was slowed due to CBO reports under agency head Robert Reischauer, a Democrat. An early version of Obamacare was also critiqued heavily after CBO scores were released. “Notably, most (but not all) prominent flash points in CBO history occurred during a period of partisan alignment,” writes legislative politics expert Sarah Binder in The Washington Post.

“Doug Elmendorf, former head of CBO” Courtesy of Gerald R. Ford School of Public Policy: License (CC BY-ND 2.0)

Conclusion

The CBO’s credibility and influence as a nonpartisan “scorekeeper” is vital to the legislative process. As the fight for healthcare reform continues in Congress, the CBO’s role and influence in Washington will become even more obvious. Learning the background of the agency and how to interpret its work will help anyone interested in politics better understand the complicated inner workings of Congress.

Avery Anapol

Avery Anapol is a blogger and freelancer for Law Street Media. She holds a BA in journalism and mass communication from the George Washington University. When she’s not writing, Avery enjoys traveling, reading fiction, cooking, and waking up early. Contact Avery at Staff@LawStreetMedia.com.

The post Keeping Score in Washington: What You Need to Know About the CBO appeared first on Law Street.

Now that Republicans have made progress in their efforts to repeal and replace the Affordable Care Act, health insurance regulations are back in the forefront of public debate. A notable component of the Affordable Care Act (ACA) was the creation of essential health benefits, the law’s primary insurance regulation mandating what all policies must cover. This rule has been hotly debated and is something that the Republican replacement bill, the American Health Care Act, would allow states to seek waivers to define at the state level. While there are reasonable arguments on both sides of the debate when it comes to mandating high standards for health insurance plans, it may be helpful to look at how certain standards work in practice, and in certain cases, how their benefits can spill over into other public good.

The Role of Regulations

A new working paper by three economists, Ioana Popovici, Johanna Maclean, and Michael French, illustrate how state-level insurance regulations can have interesting spillover effects. They find that state laws that mandate insurance coverage for substance abuse treatment may have actually had a measurable effect on traffic deaths, decreasing fatalities by 4.1 to 5.4 percent. This is particularly important given that nearly 10,000 people die in alcohol-involved car accidents each year. While their research is designed to focus on the effects of state laws passed before the Affordable Care Act, their findings help show how improving access to services like substance abuse treatment can have larger societal benefits beyond those who are directly affected.

The researchers looked at what are known as state parity laws, which involve requiring insurance plans to cover substance abuse treatment like they cover medical and surgical services in terms of the costs to consumers. Between 1988 and 2010–before the ACA started mandating this parity for all insurance plans sold on exchanges–27 states passed their own parity laws requiring substance abuse treatment to be covered to some degree. The researchers look at states that passed these laws to see what their effects on traffic deaths might be. In the process, they identified and controlled for a range of variables that would otherwise affect traffic fatalities–from alcohol tax rates to population demographics–in order to find the direct consequences of parity laws.

While the study does have some limitations–data on the use of drugs that impair driving as well as data on accidents that didn’t result in death are unavailable–they build on a considerable body of research showing both that health parity laws increase use of substance abuse treatment and that such increase is associated with fewer traffic deaths. They also find that these laws correspond with a decrease in fatal weekend crashes–which is when alcohol-related accidents are particularly likely–and that the decrease was particularly large, 8.7 percent, in states that mandated full parity. They also find that parity laws are associated with a small decline in both heavy and binge drinking; however, that is based on self-reported survey responses, not clinical diagnoses of alcohol dependence.

This study isn’t necessarily groundbreaking–it does make sense to think that expanding access to substance abuse would lower substance-related traffic fatalities–but it provides an interesting look at the consequences of health insurance regulations in general. The study looks specifically at spillover effects, setting aside the direct and obvious benefits to individuals who gain access to addiction treatment, to show that high-quality insurance can have meaningful consequences beyond those who directly benefit. While it’s important not to overstate these findings, identifying additional benefits to regulations should be a part of the discussion as we evaluate new policies.

The Current Health Insurance Debate

The Affordable Care Act did a number of things to increase people’s access to health care–including expanding Medicaid to nearly 15 million people and providing subsidies to individuals below 400 percent of the federal poverty line–but it also included a number of regulations to make sure people’s insurance covered important services. These 10 essential benefits include things like prescription drugs, emergency care, maternity care, and, notably, substance abuse treatment. While it’s fair to say that requiring these services, and rules that prevent insurance companies from capping annual or lifetime spending on them, have increased the cost of health insurance for everyone, they are also the services that most people expect their health insurance to cover in the first place.

While the Republican bill largely focuses on health care access for low-income families and those who buy their insurance individually, allowing states to set their own essential health benefits could actually have ripple effects for the entire country, including the majority of Americans who get their health care from their employer. While employer plans are not required to cover the essential health benefits in the same way that individual plans sold on the federal and state exchanges are, they do apply to bans on annual and lifetime limits as well as yearly caps for out-of-pocket costs. And large employer plans are able to use any state’s definition of essential health benefits to determine those caps. If one state were to decide that substance abuse treatment is no longer an essential benefit, there could be an erosion in coverage for residents of that state and people across the country.

There are always trade-offs involved in setting health care regulations, but it’s important to understand the potential benefits involved as we debate major policy changes. Substance abuse treatment has proven to be an important and effective way to dramatically improve people’s lives, and based on recent research, mandating it can have additional societal benefits as well.

Kevin Rizzo

Kevin Rizzo is the Crime in America Editor at Law Street Media. An Ohio Native, the George Washington University graduate is a founding member of the company. Contact Kevin at krizzo@LawStreetMedia.com.

The post How Did Health Insurance Regulations Reduce Traffic Deaths? appeared first on Law Street.

After seven years of stiff opposition to Obamacare, Republicans failed in their efforts to produce a successful health care replacement on Friday afternoon. After days of negotiating–both with the White House and with other House Republicans–House Speaker Paul Ryan decided to stall a vote on the bill, the American Health Care Act, after he told President Donald Trump the bill would not secure enough votes to pass.

Friday’s bizarre events were ripe material for Twitter’s finest to strut their stuff. Using #KillTheBill, people took to Twitter throughout the day to send shots at Ryan, Trump, and more. Some used photos and GIFs of a man who succeeded in passing a health care bill to convey their emotions:

Who’s tired of winning? Not me! #killthebill pic.twitter.com/Ylp0LpMAQu

— Peregrine (@Lies_Are_Chains) March 24, 2017

I guess Obama is just better at the art of the deal. #KillTheBill pic.twitter.com/ZnwiqJ9X5s

— Adriel L. Algiene (@AdrielLAlgiene) March 24, 2017

Others riffed on Republicans who do not support contraception to express their thoughts on the health care failure:

house republicans couldn’t agree on contraceptive coverage so they just pulled out instead. #killthebill pic.twitter.com/VWKOrXtCRv

— joe malunda™ (@maloonds) March 24, 2017

Lol when you pull out cause you don’t have a plan B pic.twitter.com/vMCSahyPtr

— Jessica Samakow (@jsam1126) March 24, 2017

Supporters of the House Freedom Caucus–a far-right group that strongly opposed the bill and is largely responsible for sinking it–also found joy in the health care debacle. These two blamed lawmakers they deem Republicans In Name Only (RINOs) for the failed effort:

Thank you, #FreedomCaucus! We’re showing the RINOs that we the people are a force to be reckoned with!#KillTheBill #Ryan

— Deplorable Zilla (@deplorablezilla) March 24, 2017

#KillTheBill
#RyanCare #ObamacareLite #FullRepeal
I Stand With The @freedomcaucus @POTUS @realDonaldTrump @SpeakerRyan @SenateGOP pic.twitter.com/dkJtjs4EiX

— #1775Lexington (@luckyone6565) March 24, 2017

Some people focused on Ryan, the leading force behind the Republican effort to repeal and replace Obamacare, and his perpetually mopey facial expression:

Time to repeal and replace Paul Ryan.#KillTheBill #FireRyan pic.twitter.com/e6G5lMRSMP

— P Martucci☆NYC4TRUMP (@martucci_peter) March 24, 2017

And, of course, people used Ryan’s first and only true love (hint: it’s not health care) to visualize how he was probably feeling deep in his heart on Friday afternoon:

pic.twitter.com/VS9daWXvzV

— Sean Dove (@_space_plans) March 24, 2017

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

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House Speaker Paul Ryan likely didn’t wake up this morning expecting to become a viral meme, but that’s exactly what happened.

During a press conference earlier today, Ryan delivered a presentation to explain the GOP’s proposed Obamacare replacement, the American Health Care Act. The house speaker used an old-school PowerPoint to explain key points with graphs and visual aides.

It didn’t take long before Twitter, trained to sniff out prime, meme-worthy blank canvases, offered up some alternative visual aides for Ryan’s presentation. Check out the top ten funniest Paul Ryan PowerPoint memes below!

10. Certified dab pro

Paul Ryan just gave a PowerPoint Presentation… pic.twitter.com/iOqvtglEhe

— President Goodtime (@SethGoodtime) March 9, 2017

Alexis Evans

Alexis Evans is an Assistant Editor at Law Street and a Buckeye State native. She has a Bachelor’s Degree in Journalism and a minor in Business from Ohio University. Contact Alexis at aevans@LawStreetMedia.com.

The post Twitter Made Paul Ryan’s PowerPoint Presentation 100 Times Better appeared first on Law Street.

You may have noticed a lot of tweets pitting Obamacare against a new GOP bill recently. That’s because on Monday, Republican lawmakers introduced the American Health Care Act (AHCA), a measure meant to replace former President Barack Obama’s Affordable Care Act (ACA), also known as Obamacare, which helped provide about 20 million Americans with healthcare.

The proposal wouldn’t undo the ACA entirely: provisions allowing young adults to remain on their parents’ health insurance until age 26 and ensuring coverage for people with pre-existing conditions will remain intact. But the bill would eliminate Obamacare’s individual mandate that taxes people who don’t purchase healthcare and allow insurers to charge a 30 percent higher premium for those who let their coverage lapse for more than 63 days. It would also roll back the expansion of Medicaid (which is currently used by more than 70 million Americans) by 2019, restrict Medicaid funding to Planned Parenthood, and postpone the “Cadillac tax”–which fines employers for offering high-cost coverage to their workers–until 2025. Additionally, the measure could allow providers to charge older people five times more for insurance than younger people (under Obama the limit was three times more). For more information, read “What You Need to Know About the New GOP Health Care Plan.”

House Speaker Paul Ryan praised the bill, saying it would “drive down costs, encourage competition, and give every American access to quality, affordable health insurance,” and President Donald Trump has also tweeted out his support of the AHCA. But a handful of Republican senators and several Democrats, who have labeled the measure “Trumpcare,” see it as a downgrade that will increase healthcare costs.

Naturally, opposition toward the bill picked up on Twitter, where users began to draw comparisons between the ACA and the AHCA to famous movies, shows, or characters and their lower-quality knockoffs and sequels. Here are some of the most creative examples.

Obamacare v. GOP replacement pic.twitter.com/C1o8sIXB2I

— Lauren Duca (@laurenduca) March 7, 2017

https://twitter.com/morninggloria/status/838907799040114694

Obamacare vs Trumpcare pic.twitter.com/8VDZEAAtQx

— billy eichner (@billyeichner) March 7, 2017

Obamacare // the GOP replacement pic.twitter.com/sqTC8yUhAj

— Dave Itzkoff (@ditzkoff) March 7, 2017

Obamacare // the GOP replacement pic.twitter.com/MNbNfhC3sI

— Dave Itzkoff (@ditzkoff) March 7, 2017

Obamacare vs. the Obamacare replacement pic.twitter.com/vf6rQRou2l

— Fun_Beard (@Fun_Beard) March 7, 2017

Obamacare vs. Replacement Obamacare pic.twitter.com/hLyW5sX8HU

— Andi Zeisler (@andizeisler) March 7, 2017

Obamacare vs. GOP replacement pic.twitter.com/wQ9gi9hPsG

— Alia (@MizzzAlia) March 7, 2017

Obamacare vs. GOP Replacement pic.twitter.com/Ajs2fhzKnk

— Ira Madison III (@ira) March 7, 2017

obamacare vs gop replacement pic.twitter.com/74C01phBqh

— Ashley Feinberg (@ashleyfeinberg) March 7, 2017

Obamacare VS GOP replacement pic.twitter.com/3G20CtCckf

— shackas (@shackas) March 7, 2017

Obamacare vs GOP replacement pic.twitter.com/NdpwOqS75y

— Philip Lewis (@Phil_Lewis_) March 7, 2017

Reasons why people are against the bill differ, though. A handful of conservatives in Congress, like Sen. Rand Paul (R-Kentucky), want to overhaul Obamacare completely and have nicknamed the AHCA “Obamacare Lite” or “Obamacare 2.0.” All this criticism could mean that the bill won’t get the support it needs to pass.

Victoria Sheridan

Victoria is an editorial intern at Law Street. She is a senior journalism major and French minor at George Washington University. She’s also an editor at GW’s student newspaper, The Hatchet. In her free time, she is either traveling or planning her next trip abroad. Contact Victoria at VSheridan@LawStreetMedia.com.

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