Senate Weighs 22 Million Uninsured Against $321 Billion Reduction in Federal Spending

McConnell Health J Scott Applewhite AP

(J. Scott Applewhite/AP)

The Senate health care bill is released and scored. The bill could change the lives of tens of millions of people. But different media sources regard the bill in very divergent ways. Let’s see how they do that and why it matters.


What Happened:

The non-partisan Congressional Budget Office released its score of the Republican Senate health care plan (titled the “Better Care Reconciliation Act”) on Monday afternoon. The CBO score was awaited by many members of Congress because it quantifies the projected impacts of this bill.

Here are the major points:

  • An additional 22 million people would be uninsured by 2026, starting with 15 million uninsured next year. This would primarily be driven by cuts to Medicaid and the removal of the insurance mandate would contribute too.
  • Federal spending would be reduced by $321 billion. This is largely from cuts to Medicaid.
  • The hardest hit group would be older Americans on currently Medicaid. This is because premiums would increase while Medicaid would provide less support.
  • Premiums would initially increase, but then decrease 20% by 2026. This would be achieved by a combination of federal spending and higher deductibles (ie. premiums lower because the insurance benefits are reduced).

For a more in-depth look at the key impacts, check out this New York Times article.


Senator Mitch McConnell wants to vote on the bill this week, prior to the Congressional recess. No Democrats support the bill. There are multiple Republicans that are not supporting the bill at this time. But the most notable rejections are Republican Senator Dean Heller of Nevada, who said last week he would not support the bill without changes. Senator Rand Paul (R-KY) opposes the bill for not being conservative enough. And, after the CBO score came out, Republican Senator Susan Collins of Maine said she would not support the bill.


The Coverage:

Let’s start by being clear that all media organizations agree on the findings of the CBO. Today’s issue illustrates that what they choose to highlight determines how people view this bill’s objectives, challenges, and significance.

We are going to compare Fox News to The Washington Post today. The Washington Post coverage of the CBO report is closely mirrored by the rest of the mainstream media in terms of what is prioritized and the balance given to supportive responses versus opposition responses.

First we present Fox News because they have the most Republicans granting interviews to them of any network.

Fox News is leading their coverage by mentioning the lower deficit first. Second, they mention the amount of uninsured second. This is the opposite of every other major news network. When mentioning the number of uninsured, Fox points out that the cause is due to removal of the mandate requiring people to buy insurance.

They also include the White House’s criticism of the CBO, “has consistently proven it cannot accurately predict how healthcare legislation will impact insurance coverage.”

Fox also points out that, “In some ways, the “score” was better for the Senate bill than for the related House bill that passed last month, projecting more deficit savings and better enrollment.”

The second half of the article goes on to lay out the opposition to the bill.

Key quote: “Our plan will help address Obamacare’s ballooning costs for consumers by lowering premiums over time and cutting taxes, and today’s estimate confirms that,” Sen. John Cornyn, R-Texas, said. “I look forward to continuing to work with my colleagues this week as we get closer to finally replacing this failed law with better care at a cost that Texans will be able to afford.”

Let’s compare to The Washington Post. Their first paragraph is about the 22 million uninsured. The second paragraph mentions the deficit. So immediately we can see that one source is presenting this bill as primarily a bill to reduce the deficit, while the other is presenting it as a bill that leaves people uninsured. I’m using the Washington Post here, but you can find the same pattern at The New York Times, CNN, NBC News, CBS News, etc. This is important because it changes the entire way the readership views the priorities of the bill, and therefore the context of the debate.

The Washington Post goes on to point out the group most hurt will be, “And among the millions now buying private health plans through ACA marketplaces, the biggest losers would be roughly the same as under the House’s legislation: The sharpest spike in insurance premiums would fall on middle-aged and somewhat older Americans.”

The Washington Post also includes the White House’s criticism. However, they precede it with a paragraph clarifying that the CBO is nonpartisan and that its current director is a conservative who served President George W. Bush and was appointed by a Republican Congress. In this way, the Post is defending the integrity of the CBO. Compared to Fox News, where the reader could see the White House criticism and assume the CBO has an alternative agenda.

The Post goes on to compare the impacts of the Senate bill with the House bill and with the existing ACA.

The Post also differs from Fox in that there are fewer quotes, despite being a much longer and more in-depth article. Additionally, there is only one quote supporting the bill – from Mitch McConnell – “The American people need better care right now…This legislation includes the necessary tools to provide it.”

Key quote: “Early evening, Sen. Susan Collins (R-Maine) tweeted that she would not agree to proceed on Tuesday. The measure would “hurt most vulnerable Americans” and failed to solve the problems of access to care in rural Maine where, she wrote, “hospitals are already struggling.”



Different political viewpoints are framing this bill in their own way. The coverage has primarily boiled down to the one of two key bullet points from the report. One point is that the bill increases the amount of uninsured people by 22 million over today’s law by 2026. The other point is that the bill reduces the deficit by $321 billion.

1.) So the key question to ask yourself is, is this bill’s benefits worth the cost? Is reducing federal spending by $321 over ten years worth the effects of having an additional 22 million people uninsured? Also consider that millions of those uninsured will be people who no longer qualify for Medicaid under this new bill. Millions of people, elderly, sick, and broke, will have no way to pay for necessary medications or nursing care. At the same time, millions of healthy uninsured people will not need to buy health insurance each year.

Senate Health Tax Cuts

2.) The other important question to ask is, who benefits? The CBO is very clear that those hurt most are low-income older people currently under Medicaid. We can debate whether or not it is a benefit to healthy people whom choose not to purchase insurance. But the other key beneficiaries are wealthy and the medical industry. Under the ACA, both groups pay taxes that would be removed under the Senate bill. This amounts to nearly $1 trillion over the next decade.


There are other issues to resolving health care that we view as ancillary given the bill as it exists and McConnell’s ambitious timeline to vote on it. These other issues include topics like, what would be the ideal fix for the ACA? Or, should government be involved in health care at all? Or is health care a privilege or a right? We mention these because they may infiltrate the debate in the coming days. However, there is enough to debate simply by focusing on the core of this bill and the real impact it could potentially have on millions of lives.







Everybody in Congress agrees that the Affordable Care Act needs to be altered. But the Affordable Care Act expanded insurance coverage to millions of Americans. Those people do not want to lose coverage.







The individual mandate was included in the ACA because you need healthy people to buy insurance in order to keep premiums lower. Without the mandate, it is expected millions of healthy people will not buy insurance, thereby causing premiums to increase.

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