Why CBO won’t estimate cost of Bernie Sanders’s ‘Medicare for all’ bill

A recent study concluding that Sen. Bernie Sanders’s (I-Vt.) “Medicare for all” bill would cost $32 trillion has set off a furious debate over the cost of the plan.

But there’s one estimate that would make an even bigger splash: the score from the nonpartisan Congressional Budget Office (CBO).

{mosads}However, it does not appear that CBO is working on a spending estimate, despite a request from Sen. John Barrasso (R-Wyo.), who asked for a cost analysis in September in order to highlight the steep costs for Medicare for all, also known as single-payer.

Barrasso told The Hill last week that he doesn’t recall receiving a response from the CBO, suggesting that his request was not accepted.

The CBO declined to comment, but former directors said the fact that passing single-payer legislation is not a priority for the Republican-controlled Congress means the CBO is unlikely to devote time to scoring the bill.

Doug Elmendorf, a former CBO director, said the budget scorekeeper is required to provide estimates only for bills that have made it out of committee and that other measures it scores are usually the priority of a chairman or ranking member.

Elmendorf, who was CBO director from 2009 to 2015, noted that “it would take months” for the CBO to score a bill as complex as single-payer.

“You have to ask yourself, ‘Is there likely to be serious legislative action on it?’ And clearly the answer to that is no,” said Robert Reischauer, who was CBO director in the 1990s before becoming head of the Urban Institute.

CBO staff are busy working on more pressing legislation, Reischauer said. “The cost estimating units are usually operating at full or over capacity,” he said. “It isn’t like they can accept all requests.”

The release of the crucial spending analysis is therefore likely to wait until sometime when the measure is moving through Congress and appears to have a chance of passage.

Republicans have been pointing to Democratic calls for single-payer as a key rebuttal in this year’s midterm campaign, part of an effort to push back against Democratic attacks on GOP bills to repeal ObamaCare. A CBO score before the Nov. 6 elections would give Republicans a key analysis to point to on the campaign trail.

The releases of CBO estimates were defining moments in last year’s debate over Republican efforts to repeal ObamaCare, with the analyses showing that millions of people would lose coverage under the GOP-backed legislation.

A CBO score would likely prove pivotal again with Sanders’s single-payer plan, as opponents have criticized the trillions of dollars in new government spending that would be required.

Reischauer said that in this case, “opponents or people who want to embarrass advocates of the plan want it and nobody else does.”

The release of an outside study from the right-leaning Mercatus Center at George Mason University in late July gave a taste of the frenzy that would occur over the release of a CBO score of single-payer legislation.

Republicans seized on the Mercatus study’s finding that a single-payer, government-run health insurance system for all U.S. residents would cost the government an additional $32 trillion over 10 years.

Speaker Paul Ryan (R-Wis.) called the cost “absurd.” The Republican National Committee cited the study to say that Sanders’s plan would “bankrupt taxpayers.”

Barrasso pointed to the Mercatus study as fodder for the GOP in the absence of a CBO analysis.

“There have been a number of different reports out there, $32 trillion,” Barrasso said. “It looks like we have some pretty solid numbers on how expensive it is.”

But Sanders also touted the report, just a different aspect of it. He pointed to the finding that total U.S. spending on health care, as opposed to just the government’s share, would decrease by $2 trillion over 10 years under his legislation.

Elmendorf, highlighting the consequential decisions that go into any CBO score, said that the agency might not estimate the bill’s effects on total U.S. health-care spending, since its core mission is to examine spending by the government. Leaving that part of the analysis out would deprive Sanders of a key argument for his bill.

“I think they would do it if they had enough time,” Elmendorf said.