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OMB Director Mulvaney Blowing Smoke on Health Law’s Impact

Rob Garver
OMB Director Mulvaney Blowing Smoke on Health Law’s Impact

The director of the Trump administration’s Office of Management and Budget, former South Carolina Rep. Mick Mulvaney, sat for a pair of interviews on Sunday morning, in which he questioned the credibility of three of the federal government’s most respected non-partisan agencies and twisted himself into verbal knots in explaining how the proposed replacement for the Affordable Care Act currently being considered by Congress would improve the nation’s health care system.

Mulvaney, appearing on CNN, was asked by host Jake Tapper to comment on the job growth numbers put out by the Bureau of Labor Statistics on Friday, which showed unemployment shrinking to 4.7 percent even as wages increased and the economy created an estimated 235,000 jobs.

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Tapper pointed out that during the campaign, Trump had repeatedly called the BLS statistics “fake” and insisted that the “real” rate of unemployment was actually as high as 40 percent. But on Friday, the White House celebrated the numbers. What changed?

Mulvaney began with some hand-waving about the alternative measure of unemployment known as the U6, which, unlike the more broadly cited U3, accounts for people marginally attached to the workforce and people involuntarily working only part-time.

“What I think changed is you start to look at some of the underlying numbers you look at the U6 number, already boring your audience. There are things like U3, U6, what you should really look at is the number of jobs created.”

It should be noted here that there was absolutely nothing remarkable in Friday’s U6 number. It was well within the range it has occupied since prior to the election.

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Then, Mulvaney accused the BLS, which is staffed by career professionals, of cooking the books during the Obama administration.

“We thought for a long time, I did, that the Obama administration was manipulating the number in terms of the number of people in the workforce to make the unemployment rate that percentage rate look smaller than it actually was. We used to tell people back home the only thing you should look at is the number of jobs created.”

But if there were something magical about the number of jobs created in February, 235,000, Trump certainly wasn’t acting like it when the economy added that many jobs or more in multiple months during his presidential campaign.

Mulvaney was forced, in the end, to admit that, despite the administration’s change in attitude toward the BLS numbers, there is actually nothing really different about them. “The BLS did not change the way they count, I don’t think, but you can have a long conversation when you’ve got a numerator and a denominator how to arrive at a percentage.

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Tapper then asked if President Trump was breaking his campaign promise not to touch Medicaid by supporting the House Republicans’ American Health Care Act, which would strip hundreds of millions of dollars from the program and repeal the expansion it underwent through the Affordable Care Act.

“Just because you spend less money on something doesn’t mean it can’t get better,” Mulvaney said, insisting that improvements in efficiency and increased state-level control would improve the system for those using it.

When Tapper pointed out that the ACHA’s changes would result in many million fewer Americans being enrolled in the program, Mulvaney tried to thread the needle by insisting that because people currently covered under the expansion would be allowed to remain -- but new enrollees would not be accepted -- that the bill isn’t really reducing anyone’s access to healthcare.

“It doesn’t kick anybody off,” he said.

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In an interview on ABC, Mulvaney took the opportunity to criticize the well-respected Congressional Budget Office in advance of its expected release of an analysis of the ACHA’s impact on healthcare markets, expected on Monday.

Asked by host George Stephanopoulos about expert analysts who expect CBO to report that as many as 15 million Americans could lose coverage under ACHA, Mulvaney joined others in the White House, like Press Secretary Sean Spicer, who have challenged the competency of the agency.

“We continue to think and have for a long time that CBO is scoring the wrong thing,” he said. The congressional budget watchdog, he said, fails to consider the benefits of market competition, which he insisted the ACHA would generate, and also didn’t take into account what he predicted as the “collapse” of Obamacare.

He also took a swipe at the Joint Committee on Taxation, which last week released a report that found the repeal of multiple taxes related to the ACA would greatly benefit the wealthy, and another from the AARP, which found that it would increase costs for seniors by thousands of dollars a year.

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“I seriously doubt that any of those analyses take into account the fact that the use of Health Savings Accounts and the lower premiums that come from competition. Look, everybody’s got skin in this game. Everybody has an interested party and they’re trying to protect their own.”

In fact, Health Savings Accounts, which allow individuals to set aside income tax free to pay for health-related expenses, are being asked to do an awful lot of the heavy lifting when it comes to the purported “improvements” to that ACHA proponents are promising.

Again addressing the changes to the Medicaid program, Mulvaney insisted, “What we’re doing is making sure that the truly indigent have care. Medicaid is still there. In fact, we think it’s going to be even better. The people who are just above Medicaid but still have difficulty buying their own premiums will not only have the refundable tax credit but they will have the ability to use HSA’s to pay for their health care on a tax-advantaged basis just like you and I get. So I don’t understand the criticisms lobbed in that fashion.”

There’s a lot to unpack here:

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First, the tax credits being offered under the proposed ACHA would provide much, much less money for premium payments than the existing subsidy system under the ACA.

Second, the idea that people on the cusp of qualifying for Medicaid are somehow going to find enough spare income to fund an HSA at the level needed to pay for a decent health insurance policy is laughable on its face. (Not to mention that “tax advantaged” savings for people with income too low to trigger significant tax liability is not much of a benefit.)

Finally, Mulvaney presents HSAs as though they are something new and innovative when in fact they have been around in their current form since 2003, and in different manifestations since the 1990s. If they were some sort of magic bullet to help the poor pay for care, they’d have solved the health care affordability problem years ago.

The upside to Mulvaney’s appearances is that he repeatedly said that the administration views the existing proposal as a “framework” and is open to improvements offered through the amendment process in Congress.

Given the level of opposition the ACHA is generating on both sides of the aisle, it will need them.

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