REUTERS/Joshua Roberts
Donald Trump meets with Speaker of the House Paul Ryan on Capitol Hill in Washington.
The Congressional Budget Office, the nonpartisan legislative office, has yet to score the AHCA, and the political fate of the bill could depend on the CBO's decision.
The CBO score is the legislative equivalent of an environmental-impact report required before a new skyscraper is built. The CBO score looks at the broad effects of the bill on a variety of factors, measuring its benefits against its costs.
For the AHCA, the CBO will assess the effects not only on the government's finances, but also the implications for Americans' insurance coverage.
The White House, Democrats, and even House GOP members have all said the CBO should be taken into account as Congress shapes the legislation.
"That's the work that somebody mentioned over here - the Congressional Budget Office score, and once the Congress receives that score, then they'll be working through that to make certain that in fact it is fiscally responsible," Secretary of Health and Human Services Tom Price said Tuesday.
There is a problem for the House GOP, however: Most analysts assume the score will be ugly - possibly really ugly.
Chris Jacobs, a Republican health policy adviser who worked under current Vice President Mike Pence during the original Obamacare debate, reported in The Federalist that Republican staffers were expecting a rough score from the CBO.
In fact, Jacobs wrote, sources told him the CBO could estimate that 10 million to 20 million people on employer-based insurance could use coverage as companies decide to allow people to use the tax credits in the AHCA to buy their own insurance instead of offering them through work.
Additionally, Jacobs said, the CBO score indicated that the repeal of the taxes associated with Obamacare while also maintaining tax credits would lead to a sizable increase in the federal deficit. While there were tweaks made to the AHCA between his reporting, based around a draft version, and the final bill, most of the plan remains intact from the one Jacobs described.
Other health policy analysts have suggested the CBO score could put the GOP in a politically perilous situation.
"If Democrats drag out the markup until next week, the CBO score will land smack dab in the middle of the markup. That will be...devastating," tweeted Topher Spiro, head of healthcare policy for Center for American Progress, a liberal-leaning think tank.
Avik Roy, a long-time critic of Obamacare and former health policy adviser to multiple Republican presidential candidates, wrote in Forbes that the CBO score will likely show massive insurance losses.
"The CBO is likely to score the AHCA as covering around 20 million fewer Americans than Obamacare," Roy wrote in a post on Forbes attacking the AHCA. "There are flaws in the way the CBO models health reform legislation, but the AHCA itself contains enough flaws that there can be little doubt that the plan will price millions out of the health insurance market."
In light of this, Republicans seem to be preemptively undercutting the agency.
Republican Sen. Tim Scott told Talking Points Memo in an interview that "the CBO is consistently inconsistent." Rep. David Brat said the CBO has "scored everything wrong for decades." White House press secretary Sean Spicer also took a jab at the agency Wednesday.
"If you're looking at the CBO for accuracy, you're looking in the wrong place," Spicer said during the White House press briefing.
The bill is currently being debated and marked up by the House Energy and Commerce and Ways and Means committees before it goes to the full House for a vote.
Due to the last minute changes, however, Ryan said in a press conference on Wednesday he does not expect the CBO score until sometime "early next week." Staffers for House Minority Leader Nancy Pelosi said they expect the score on Thursday, March 16, well into the process.
Ryan has said that he wants to get the AHCA to a full floor vote within two weeks.