On a letter dated August 24 sent to Representative Tom MacArthur from Congressional Budget Office (CBO) Director Keith Hall stressed the neutrality of his office in developing cost estimates for the American Health Care Act (AHCA) in recent months. According to the CBO's summary of the letter, Hall and MacArthur met on July 12 to discuss certain questions the Representative had raised regarding the CBO's processes for ensuring the integrity of its work and about the agency's analysis of the effects of the bill. The letter seeks to provide additional details, including the steps CBO takes to ensure that its work is objective, impartial and nonpartisan; the benchmark to which the AHCA was compared and how the percentage of people insured today relates to CBO's estimates of the number under the AHCA and under than benchmark over the next decade; and why CBO and the Joint Committee on Taxation did not provide an estimate of the average effect on premiums for people living in states that would obtain waivers from requirements for both essential health benefits and community rating under the AHCA.
MacArthur had proposed amendments to the AHCA which would have allowed states to opt out of certain ACA requirements regarding essential health benefits and community rating requirements. CBO's analysis of those amendments predicted that they would cause destabilization of insurance markets, a prediction that MacArthur blasted as "wildly inaccurate".