The Republican bill to repeal and replace Obamacare would cause 23 million more people to become uninsured over a decade and reduce the deficit by $119 billion, $32 billion less than previous projections, the Congressional Budget Office said Wednesday in its updated score of the legislation.
The report on the American Health Care Act includes an evaluation of the most recent additions to the bill, which would allow states to apply for waivers to opt out of certain Obamacare requirements for insurers and add billions of dollars for the creation of high-risk pools to help insure people with pre-existing illnesses.
The report’s release comes as senators debate how to craft their own healthcare bill, and GOP members have said they will view it as a guide to inform their ideas.
The uninsured estimates show one million fewer people — 23 million instead of 24 million — would go without insurance by 2026 than the original score of the bill in March, before several major amendments were added. The loss was attributed to the repeal of Obamacare’s individual mandate and freezing Medicaid expansion enrollment starting in 2020.
Deficit savings in the bill of $119 billion mean that the House will not have to revote on the package. However, that is $32 billion less than a prior estimate because of provisions that were made for the creation of high-risk pools.
The House hasn’t sent the bill to the Senate yet, despite passing it a few weeks ago.
The reason was to see if the bill’s deficit savings were decimated in the CBO score, as the bill needs to save a certain amount for Republicans to use budget reconciliation, which allows it to be approved in the Senate by only 51 votes.
House Republicans this month angered Democrats when they passed the American Health Care Act without waiting for projections on the revised bill, including how it would affect the federal deficit, uninsurance rates and health insurance costs.
Here are a few highlights from the report and how they compare to previous drafts of the American Health Care Act.
• In the short term, 14 million will become uninsured.
By 2018, an election year, the number of people who are uninsured would increase by 14 million people. The numbers are a result of the American Health Care Act’s repeal of the individual mandate that obligates people to acquire coverage or pay a penalty. That figure will be closely watched by centrists who worry about repeal going too far and also by Democrats who are trying to derail the GOP’s efforts.
• One-sixth of the population would be affected by waivers that make some states exempt from Obamacare’s regulations.
The Congressional Budget Office projected that about a sixth of the population lives in areas in which the individual market would become unstable beginning in 2020, after some states begin to waive the Obamacare mandates. People who are healthier would choose to buy less expensive, skimpier plans, the report projects, while people who are have more medical needs would have only expensive plans to choose from, and may not be able to buy coverage at all.
”As a result, the nongroup markets in those states would become unstable for people with higher-than-average expected healthcare costs,” according to the report. “That instability would cause some people who would have been insured in the nongroup market under [Obamacare] to be uninsured. Others would obtain coverage through a family member’s employer or through their own employer.”
Democrats and some Republicans worry that the waivers would not provide adequate protection for people with pre-existing illnesses. Some centrist Republicans have said the funding for high-risk pools should be significantly higher, while Democrats have pointed to failed attempts at high-risk pools in states before the passage of Obamacare.
• Premiums would rise initially, and then fall, but results would vary by state.
The score shows that premiums would rise by 20 percent in 2018, an election year, and then by 5 percent the following year. After that, results would vary by state depending on which applies for a waiver.
States that keep Obamacare mandates, which the report estimates would be about half, would see premiums fall by 4 percent in a decade. About a third of states are expected to repeal one mandate and would see premiums fall by 20 percent over the same period. Those that take the waivers would see significant variation on premium costs according to medical status. A previous score found that premiums would fall by 10 percent over a decade, taking into account national premium decreases versus only half.
• Spending on Medicaid would fall by $834 billion over 10 years.
The Medicaid portion was largely unchanged from the prior CBO score as the MacArthur amendment and additional funding focus on Obamacare’s insurance mandates.
After Medicaid expansion is phased out, states can choose between two options on how to get federal Medicaid dollars: one choice is to get a block grant, which is a fixed amount, and the other is a per capita cap that delivers dollars based on the number of beneficiaries in a state at a given time.
