KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Analyses: CBO Director Elmendorf Becomes Center Of Attention

Several analyses today on the Congressional Budget Office, and its director, Douglas Elmendorf, who has been at the center of increasing debate over health care reform after the recent release of the CBO's "score" of health system overhaul legislation. President Barack Obama met with him Monday in a move that has spurred Republican criticism.

The Wall Street Journal: "If President Barack Obama's push for simultaneously expanding health coverage while restraining cost growth dies, history may record that it was stabbed on July 16, 2009. That day a slight, plain-spoken technocrat, Douglas Elmendorf, director of the Congressional Budget Office, said that, despite political rhetoric, pending legislation didn't make 'fundamental changes… necessary to reduce the trajectory of federal health spending by a significant amount'... The 'emperor has no clothes' moment forced Congress to redouble efforts to squeeze the health system and reduced chances that a health bill will pass this year. It also highlighted two facts: One, in a city riddled with dysfunctional institutions, the CBO survives as a call-it-as-we-see-it outfit that rarely bends to political winds. Two, this health-care thing is hard."

Columnist David Wessel writes: "CBO often is suspected of low-balling cost savings and high-balling the price tag on new benefits... CBO, like the White House, says a lot of spending in health care doesn't contribute much to the nation's health and could be squeezed out by fundamental changes to health financing and delivery. Doing that requires Congress to make uncomfortable and unpopular changes. Mr. Elmendorf insists CBO will give big credit for big changes. CBO critics fear that if it won't certify politically possible changes as money-savers, there is little incentive for Congress to do anything -- and the effort will collapse" (Wessel, 7/23).

Meanwhile, an ABC News blog reports: "Republicans on Wednesday criticized as inappropriate a meeting President Obama held Monday with the director of the Congressional Budget Office, Douglas Elmendorf. Elmendorf, a Democratic appointee, has been a thorn in the side of President Obama and congressional Democrats for the way he has analyzed health care reform legislation." One frustration for health care advocates is that the CBO does not factor in savings from prevention efforts.

ABC News notes: "Last week, frustrated at one analysis by Elmendorf, Senate Majority Leader Harry Reid, D-Nev., snapped, 'what he should do is maybe run for Congress.' 'No one blames Mr. Elmendorf for accepting an invitation from the President of the United States,' House Minority Leader John Boehner, R-Ohio, said in a statement. 'The issue is whether it was appropriate for the White House to invite him to discuss pending legislation before Congress at all.' Said Senate Minority Leader Mitch McConnell, R-Kentucky: 'I noticed that the CBO director was sort of called down to the White House yesterday. It strikes me as somewhat akin as the owner of the team asking the umpires to come up to the owner's box'... Writing about the meeting on his blog, Elmendorf said President Obama asked him and other outside experts for their 'views about achieving cost savings in health reform. I presented CBO's assessment of the challenges of reducing federal health outlays and improving the long-term budget outlook while simultaneously expanding health insurance coverage' (Tapper, 7/22).

A Fox News blog also weighed in on the issue: "Although Elmendorf is a Democratic appointee, some say he has done extensive political damage to President Obama and Congressional Democrats leading the charge on health care reform" (Emanuel, 7/22).

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