House s much larger OMB. No longer would the legislative branch have tO rely on the executive branch's economic assessment ofthe effects that le islation mi ht have. ln the 43 years since, the CBO has become a widely respected institution. lts director is appointed by congressional leaders, sometimes Democrats, sometimes Republicans. A few of the most distinguished economists in Washing- ton have run it, including Alice Rivlin, a Demo- crat, its first director and later an acclaimed head of the OMB, as well as Douglas Holtz-Eakin, arguably the top Republican economist today. TO be fair, presidents and even members of Congress have ripped int0 the CBO before. June O'Neill, who ran the offce in the 1990S under House Speaker Newt Gingrich, used t0 get chewed out regularly by Gingrich, whose wrath was made worse by the giant model ぉ既 head in his 0 伍 ce. "I have a folder of all the times he threatened to fire me, but he never did and was usually very gracious, says O'Neill, whom I worked for in the 1980S. Obama and BiII Clinton both took issue with the way the CBO scored their respective he alth care plans. But no one in the White Hous e ever questioned whether the CBO was "capable" 0f scoring bills, as Mulvaney did. What the CBO surmised about the Trump health care plan will set the parameters for the debate over the coming months. That's true even ifthe bill undergoes a rewrite, which seems likely, since the measure is being attacked by all Democrats and big chunks ofthe GOP. (Conser- vative Republicans feel it t00 closely resembles Obamacare, while Democrats and moderate Republicans worry about poorer Americans los- ing their coverage under the plan. ) The CBO's trenchant analysis gets at the basic problem ofhealth care under America s uniquely crazy quilt ofpublic money and private insurance. The Republican plan set out to do a few things: lower lnsurance premums, provide more ChOice tO consume rs and keep, if not exp and, insurance coverage with much less regulation and federal spending. But the CBO report essentially says the GOP has failed. By dramatically scaling back the expansion 0f Medicaid—an integral part 0f Obamacare—it le 代 millions of p eople unable to afford health care, the report shows. The Repub- lican plan offers tax credits based on age t0 help people buyinsurance, but that's not nearly enough tO compensate for the Medicaid cuts and the e as- ing ofregulations that limited what insurers could char e 01der Americans. The result: A typical 64-year-01d would pay an astounding $ 13 , 000 more each year on health insurance 2026 under the GOP plan than he would under Obamacare. Younger Americans d0 better. Under the Republican plan, they d no longer be required t0 buy insurance, and ifthey buy it, they can get the kind of catastrophe-only, high-deductible plans Obamacare prohibited. By 2026 , a typical 21-year-old would be paying much less for insur- ance, on average. When you throw in Other ele- ments 0f the Republican plan—eliminating the mandate for larger employers to provide health lnsurance , scrapping the surtaxe s on the rich th at helped pay for Obamacare and so on, you get this: The wealthy get a huge tax break, younger people make out better, older Americans pay more, and the lower middle class gets screwed. Estimating health care costs isn t an exact SC1ence, and there are unanswered questlons about the ramifications of the GOP's plan. DO insurers leave certalll markets? DO young peo- ple flee the system after Congress repeals the WHAT'S GOING TO HAPPEN IF TRUMP TRIES TO CONVINCE THE WORLD IRAN IS CHEATING ON THE NUCLEAR D EAL? individual mandate? The CBO doesn't know for sure. But its record on the AffordabIe Care Act was strong, according tO a report from the Com- monwealth Fund, a nonpartisan think tank. And it's still the best oddsmaker in Washington for this kind ofgame. ¯All health care plans create wlnners and losers, and if the ℃ B O is rightj=Trumpcare 's lose rs will include many Of the president's voters. Rather than trymg t0 significantly change its the White House seems content tO bully the math ner S on D Street. But W en ran 1 れ a goes nuts because her premmms explode, the nerds may have their revenge. ロ P A G E 0 N E / H E A L T H C A R E N E W 5 W E E K 15 A P R 比 0 7 , 2017

、第粤扉第オ 十 BLOND BUT NOT FORGOTTEN: Far-right, anti- 恰 m politician WiIders,Ieft, didn't win the Dutch general election, but he pushed the coun- try rightward. Germany. Lastyear, the party announceditwillexplore banning thefull-faceveil ⅲ somepublic places—eventhoughonlya small minority 0fGerman MusIims wear it, and a 血Ⅱ ban seems unconstitutional. Like Rutte, Merkel's party seems to be taking cues 仕 om nationalists: The hard- rightAlternativefor Germany party had already called for a んⅡ The Dutch Touch ban ontheveil and minarets. ln France,wherethe first THE ELECTION IN THE NETHERLANDS SHOWS WHY round ofpresidential elections POPULISTS DON'T NEED TO WIN TO GAIN INFLUENCE is in April, far-right candidate Marine Le Penhas a shotattaking AS RESULTS flooded inafterthe Netherlands to "be normal or the Elysée PaIace. Her chiefrival, Dutch generalelection, incum- front-runner EmmanuelMacron, go away ・ bentPrime MinisterMark Rutte MeanwhiIe, the center-right is anultra-Iiberalpro-European. was beaming ・ Christian DemocraticAppeal But Frangois FiIIon, the candidate The country, he said, had hit party, whichtookjointthirdplace for the center-right Republicans, back against far-right, anti- with 19 seats, campaigned ona iS a Catholic social conserva- lslam politician Geert WiIders nationalist, SOC1ally conservatlve tivewhose once-commanding and the hate he espoused. platform. Unlike Wilders, the lead was derailed by a financial Wilders's Party for Freedom Christian Democrats support scandal()e denies any wrong- came a distant second, with 20 EU membership, and the party doing). The partypicked Fillon seats, tO Rutte's People's Party believes Muslims should be free overthe establishmentcandidate, for Freedom and Democracy, tO practice theirreligon. Butit AlainJuppé, whoseviews are which won 33. "The Netherlands has calledforDutchTurkswith moreliberal. EvenifFillon loses, said, 'Whoa! ' tO the wrong passports 仕 om bOth countries traditionalvalues and anti-lslam kind ofpopulism, ' Rutte told togrve upthe Turkishones, and animus will continue tO lnfluence supporters at a rally. Headlines itbacks symbolicinitiatives like his party. proclaimed that, despite the introducingsmgingthe national ln the Netherlands, Rutte will nativist msurgencies 0f2016 , anthemin schools—adramatic have tO lead acoalition in apar- the Dutch had rallied ⅲ support move inthe Netherlands,which liament whose center has been oftheliberalcenter. wouldn'tnormallygoinforsuch hollowed out. The center-left But the truth is not that forthright patriotism. Labour Party sawatotal collapse simple. Wilders is out ofpower, Elsewhere in Europe, candi- ⅲ its support, winning Just nine but his influence is everywhere. dates facing their own popu ts compared with 29 last He has shown how populists can list challengers will consider time. A sizable minority ofDutch transform political norms, even whether they t00 should move voters backed paftles further tO when they lose. Rutte's party t0 the right. theleft, including the envrron- responded tO rising populism in ln Germany, where elec- mentalist GreenLeft partyand the NetherIands by toughening tions will be held ⅲ September, the progressiveliberal D66 party. ー-ー・ itsstanceonimmi hancellorAngela Merkel' hat could meana governmen cobbled together 仕 om parties point: Durmg the campaign, center-right Christian Demo- Rutte tOOk out an ad in a Dutch cratic Union has alreadybegun whose only unitmg principle is paper that urged migrants ⅲ the totalktoughonlslam's place ⅲ "NeverWilders. ”ロ BY JOSH LOWE 当 @JeyyLowe NEWSWEEK 23 APR 比 07 , 2017