The hardest job for the C.B.O. is estimating the effects of the MacArthur Amendment, which allows states to waive several insurance regulations. In order to make calculations, the office’s economists must first estimate how many states will decide to pursue the waivers, how many people live in those states, and which rules they will choose to waive. To figure that out, C.B.O. employees have probably spent the last few weeks speaking with state officials and studying how states have previously tried to change program requirements.
Some experts have said the waivers will be unpopular, and only a few states will pursue them. Others have argued that they are likely to become widespread. Our panel estimated a wide range of effects, saying as few as 10 percent of Americans would be affected or as many as half.
“One could argue 100 percent, depending if the definition is just one provision and Secretary [Tom] Price is lenient in granting waiver requests,” wrote G. William Hoagland, the senior vice president at the Bipartisan Policy Center and a former director of the Senate Budget Committee. The answer matters, both politically and in terms of the report’s headline numbers.
Bottom line: If few states pursue waivers, then the Senate is dealing with a bill that’s much like the one scored in the early C.B.O. report. If many do, then the amendment will broadly reshape what health insurance covers and who can afford it.