Why CBO plays a bigger role in healthcare policy

The Congressional Budget Office is playing a bigger role in shaping federal health care and health insurance policy these days, as this is where the health policy expertise lies. of Congress.

Jamease Kowalczyk, senior policy associate at Acumen LLC, spoke about this trend on Monday, in a session at the 2021 Society of Actuaries health meeting.

Actuaries are professionals who have demonstrated that they have the mathematical and risk analysis skills to understand insurance operations, pension plans, and other financial arrangements that involve many different types of risk.

Related: CBO Outlines Possibilities For A Public Health Plan

SOA is hosting a three-day online conference this week and offering additional sessions on demand throughout the month.

Kowalczyk – who spent 12 years working at CBO as a health policy analyst and also worked with congressional staff – briefed meeting participants on how health policy making actually works in Washington.

When things have changed

Prior to the 1980s, Democratic and Republican committee members often drafted and fashioned laws in a bipartisan fashion, through the process described in the old Schoolhouse Rock video of how bills go through Congress, Kowalczyk said. .

In the early 2000s, when members of Congress were holding the discussions that led to the drafting of the Affordable Care Act, Congress was teeming with seasoned health care experts, according to a session slide show prepared by Kowalczyk. and session moderator Kirsten Kari. Staveland, an actuary with Lewis and Ellis.

Former President Barack Obama signed the two bills that created the ACA in early 2010.

“After the adoption of ACA, there was an exodus of seasoned content experts” from the ranks of congressional assistants, and many successors were former interns, who tended to lack the kind of expertise available to seasoned experts, Kowalczyk and Staveland reported.

Since Kowalczyk became involved in health care politics, the “New Normal” system has prevailed and party leaders have dominated the drafting and development of legislation, she said.

The New Normal system

The New Normal system and the brain drain of veteran caregivers to Congress have increased the influence of lobbyists and business groups, Kowalczyk said.

Kowalczyk noted that the real drafters of the legislation are usually lawyers in the Office of the Legislative Counsel or lawyers for outside interest groups, not the lawmakers themselves or ordinary employees.

In one instance, Kowalczyk said, when she was at CBO, she saw a bill, which had been passed by a committee, the letterhead of a lobbying firm.

The influence of the CBO has also increased, in part due to the expertise of CBO analysts and in part due to lengthy behind-the-scenes discussions between law drafters and CBO rating analysts before the official analyzes were released. Kowalczyk said.

Actuaries and CBO

For actuaries, she said, one of the challenges is that the CBO has focused primarily on hiring analysts for the doctoral programs in economics and the masters in public policy. Most of the actuaries she works with sit on advisory committees.

“CBO is very protective of its non-partisan status,” Kowalczyk said. “Often, actuaries are considered, because of their place of work, as incapable of maintaining this status. “

But Kowalczyk said she often wanted actuarial advice when working at CBO.

Staveland said actuaries have a responsibility to help policymakers draft health care and insurance legislation and to help them understand the many types of unintended consequences that legislation could have.

The uninsured

Gregory Fann, actuary at Axene Health Partners, spoke in another session about efforts to track the number of uninsured people in the United States.

The COVID-19 pandemic has made it more difficult to count the uninsured and understand what it really means to be uninsured, and some of the monitoring efforts now focus more on what uninsured people think, rather than on the number of uninsured people, Fann said.

One thing the polls have revealed is that up to 4 million people who say they are uninsured because health insurance is too expensive may be eligible for free coverage, Fann said.

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