Obamacare revision would reduce insured numbers by 24 million, CBO projects
By Amy Goldstein, Elise Viebeck, Kelsey Snell and Mike DeBonis
March 13 at 7:29 PM - The Washington Post
House Republicansf proposal to rewrite federal health-care law would more
than reverse the gains the Affordable Care Act has made in the number of
Americans with health insurance, while curbing the federal deficit, according to
a widely-anticipated forecast by congressional budget analysts.
The analysis, released late Monday afternoon by the Congressional Budget
Office, predicts that 24 million fewer people would have health coverage over
the coming decade, nearly doubling the share of Americans who are uninsured from
10 to 19 percent. But the GOP legislation, which has been speeding through House
committees since it was introduced a week ago, would lower the deficit by $337
billion during that time, primarily by lessening spending on Medicaid and
government aid to help people buy health plans on their own.
The report predicted that premiums would be 15 percent to 20 percent higher
in the first year compared with the Affordable Care Act and 10 percent lower on
average after 2026. By and large, older Americans would pay gsubstantiallyh more
and younger Americans less, the report said.
The 37-page report provides the most tangible evidence to date of the human
and fiscal impact of the House GOPfs American Health Care Act. It also
undermines President Trumpfs pledge that no Americans would lose coverage under
a Republican remake of the ACA.
The reportfs arrival produced starkly different tacks from The White House
and Capitol Hill — with top aides to the president immediately seeking to
discredit it while the Housefs Republican leaders praised the report for
reinforcing their argument that the plan curbs federal spending and gives
Americans the freedom to be insured or not — their choice.
gJust absurd,h was the way Mick Mulvaney, director of the White Housefs
Office of Management and Budget, responded to the forecast, while Health and
Human Services Secretary Tom Price said: gThe CBO reportfs coverage numbers defy
logic.h
House Speaker Paul D. Ryan (R-Wis.), meanwhile, said in a Fox News interview
that the report gexceededh his expectations, and he jumped on its prediction of
reductions in the deficit to try to assuage the chamberfs most conservative
members, many of whom oppose the planfs inclusion of new tax credits to help
some Americans buy coverage on their own.
Declaring that the plans would usher in gthe most fundamental entitlement
reform in a generation,h Ryan said the legislation gis about giving people more
choices and better access to a plan they want and can afford. When people have
more choices, costs go down. Thatfs what this report shows.h
The release of the report marks the beginning of a new phase in the debate
over the week-old health-care bill, which is moving through the House on an
accelerated timetable despite opposition from Republicans, Democrats and
virtually every sector of the U.S. health-care industry.
Democrats used the reportfs finding to continue attacking the House GOP plan.
gThe CBO score shows just how empty the presidentfs promises, that everyone will
be covered and costs will go down, have been,h said Senate Minority Leader
Charles E. Schumer (D-N.Y.). gThis should be a looming stop sign for the
Republicans repeal effort.h
Specifically, the analysis predicts that the number of people without health
coverage would rise to 52 million by 2026, compared with 28 million if the ACA
remains intact. That erosion would mean that fewer than one in five U.S.
residents would be uninsured by 2026 — compared to one in 10 uninsured now and
one in six who were uninsured before the ACA was enacted.
The reduction would result from three factors. A provision rescinding the
penalty imposed on the uninsured would prompt many Americans to drop their
health plans. After that, tax credits that are less generous than current
subsidies would make insurance unaffordable to many more. Finally, some states
may undo the expansion of their Medicaid programs.
The conservative House Freedom Caucus did not immediately provide a response
to the report. Moderate Republicans expressed concerns about the number of
people who would lose coverage.
gThese kinds of estimates are going to cause revisions in the bill,
almost certainly,h said Sen. Susan Collins (R-Maine).
gI donft think that the bill that is being considered now is the bill that
ultimately will be the one that we vote on in the Senate.h
In its current form, the House GOP proposal would administer Medicaid by
giving a fixed per capita amount of funding to states rather than covering a
percentage of all health-care expenses incurred by enrollees.The plan would also
replace federal insurance subsidies in the ACA with age- and income-based tax
credits.
The measure derives most of its budget savings through cuts to Medicaid,
while nearly all of its cost comes from the proposalfs system of tax credits,
which would replace the ACAfs federal insurance subsidies.
While the deficit would be lower, the analysis says, the legislation also
would reduce federal revenue by $592 billion by 2026 by repealing several taxes
that the ACA created to help pay for more people to get insurance — notably
taxes on high-income Americans, hospitals and health insurers.
gI would hope that this would make the Republicans say ewe canft do this,h
said Sen. Patty Murray (Wash.), a member of Democratic leadership.
gTwenty-four million people lose their coverage, it is total chaos to the
country and I hope they pause, say eThis is not what we should be doing,f and
move on.h
The White House has spent the past week engaged in a charm offensive aimed at
bringing conservatives on board, as well as an effort to discredit the CBO
before it released numbers that might cast the plan in a negative light.
The Affordable Care Act has increased coverage by 20 million to 22 million —
almost half of those through the insurance markets the law created for people
who cannot get affordable coverage through a job, and the rest through an
expansion of Medicaid in 31 states and the District of Columbia.
According to the report, an estimated 52 million people would be uninsured in
2026, compared with 28 million who would lack insurance that year under the
current law.
On Capitol Hill, Senate Majority Whip John Cornyn (R-Texas) said Republicans
gobviouslyh want to gimprove those coverage numbers.h
gBut when you donft punish people for their refusal to buy a
government-approved insurance [plan], some people are going to make the decision
not to buy it,h he said.
This reasoning would only account for the immediate increase in the
uninsured, according to the CBO.
Eventually, many people would lose health insurance because the legislationfs
tax credits would be less generous than those in the current law and because
some states might undo the expansion of their Medicaid programs.
gAll I can tell you it is a work in progress,h Cornyn said of the bill.
The estimates projected a significant drop in Medicaid enrollment. Next year,
the forecast says, about 5 million fewer people would be on Medicaid. By 2026,
the programfs rolls would shrink by nearly 15 million – almost one in four of
the 68 million currently in the program.
The CBO also predicted substantial disparities in the effect the legislation
would have on insurance premiums for younger versus older consumers.
If the GOP plan is enacted, a 21-year-old making $68,200 would pay an average
of $1,450 for a yearfs worth of insurance premiums after the new tax credits,
compared with $5,100 under current law.
On the other hand, the cost of a yearfs worth of premiums would stay about
the same for a 64-year-old at the same income level. For a 64-year-old making
$26,500, the cost would rise sharply from $1,700 to $14,600.
Sen. Joe Manchin (D-W.Va.) criticized the planfs approach to the elderly.
gIfm not an attack person — you know that,h he said. gI donft just attack
because youfre on the other side of the aisle. But how can you look at yourself
and say, eOkay, Ifll help the person who needs help the least, the wealthiest
people, with more tax cuts, because Ifm going to be taking away from the elderly
population?fh
The analysis also forecast a reduction in the number of Americans who get
insurance through their employer, in part because the new tax credits would be
available to people with higher incomes than the ACAfs subsidies. Some employers
would also drop coverage, the CBO projected.
Sen. Bill Cassidy (R-La.) recalled Trumpfs promise that the health-clare plan
would insure everyone.
gPresident Trump said that he wants as many people covered as under
Obamacare,h Cassidy said. gHe said that health care should be affordable. If
therefs 14 million people losing insurance — of course itfs concerning. I try to
avoid hyperbole and adjectives, but itfs concerning.h
Abby Phillip, Sean Sullivan and David Weigel contributed to this report.