- Jonathan Ernst/Reuters
The Congressional Budget Office on Monday estimated that as many as 24 million more people would be uninsured and that the federal budget deficit would shrink by more than $300 billion over the next decade under the Republican healthcare bill.
The findings came in a much-anticipated report detailing the possible effects of the American Health Care Act, the GOP leadership’s plan to repeal and replace the Affordable Care Act.
The report estimated the effects of the AHCA in several areas, including coverage totals, the federal deficit, and the cost of premiums in the individual market.
Here’s a rundown of the major findings:
14 million more people would be uninsured under the law in 2018, increasing to 24 million by 2026. The CBO projected that as many as 14 million more Americans would be without health insurance under the AHCA in 2018. If possible changes to Medicaid were to go into effect, this number would increase to 24 million by 2026, the CBO projected. “The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment – because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped,” the report said. “In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.” 7 million fewer people would get insurance through their employer by 2026. The report estimated that without the ACA’s penalties associated with not having insurance, fewer Americans would sign up for coverage through their workplaces. Thus 2 million fewer people would choose not to have insurance in 2020, increasing to 7 million by 2026. “Part of that net reduction in employment-based coverage would occur because fewer employees would take up the offer of such coverage in the absence of the individual mandate penalties,” the report said. “In addition, CBO and [the Joint Committee on Taxation] expect that, over time, fewer employers would offer health insurance to their workers.” The federal deficit would shrink. The CBO, along with the JCT, estimated that the bill would decrease the federal deficit by $337 billion over the next 10 years. Roughly $880 billion would be cut from outlays because of the decrease in funding for Medicaid expansion, and $673 billion in spending would be cut because of decreases in tax credits, but that would be partially offset by a reduction in revenue from the mandate and other taxes from the ACA. The individual market would remain stable. The report said the individual market – that is, people getting coverage who do not have it from an employer or government program – would remain stable if the AHCA were passed. The CBO also said that the market under the ACA was stable as well. “In CBO and JCT’s assessment, however, the non-group market would probably be stable in most areas under either current law or the legislation,” the report said. Premiums in the individual market would increase in 2018 and 2019 before falling because of lower enrollment. The report also estimated the effect on premiums in the individual market, saying that costs would increase in 2018 and 2019 before declining. The CBO and JCT said that provisions of the AHCA would raise premiums for older Americans “substantially” while shrinking them for younger Americans. “The legislation would tend to increase average premiums in the non-group market prior to 2020 and lower average premiums thereafter, relative to projections under current law,” the report said. “In 2018 and 2019, according to CBO and JCT’s estimates, average premiums for single policyholders in the non-group market would be 15 percent to 20 percent higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up.”
Critics of the law had pointed to the CBO score as a way to better understand the potential effects of the AHCA on the federal budget and the US healthcare system.
In a statement after the release of the report, House Speaker Paul Ryan, the Wisconsin Republican, focused on the projected premium decreases, saying it proved that the AHCA could be successful:
“I recognize and appreciate concerns about making sure people have access to coverage. Under Obamacare, we have seen how government-mandated coverage does not equal access to care, and now the law is collapsing. Our plan is not about forcing people to buy expensive, one-size-fits-all coverage. It is about giving people more choices and better access to a plan they want and can afford. When people have more choices, costs go down. That’s what this report shows. And, as we have long said, there will be a stable transition so that no one has the rug pulled out from under them.”
On the other hand, Senate Minority Leader Chuck Schumer, the New York Democrat, focused on the increase in the number of uninsured people.
“The CBO’s estimate makes clear that Trumpcare will cause serious harm to millions of American families,” a statement from Schumer said. “Tens of millions will lose their coverage, and millions more, particularly seniors, will have to pay more for healthcare. The CBO score shows just how empty the president’s promises, that everyone will be covered and costs will go down, have been. This should be a looming stop sign for the Republicans’ repeal effort.”
The White House and proponents of the AHCA have spent much of the past week casting doubts on the CBO score in an attempt to blunt the widely expected blow from the report.
In a press conference last week, White House press secretary Sean Spicer said, “If you’re looking at the CBO for accuracy, you’re looking in the wrong place.” Other White House surrogates, such as National Economic Council Director Gary Cohn and Office of Management and Budget Director Mick Mulvaney, criticized the CBO’s accuracy in interviews on Sunday.
The AHCA passed the House Energy and Commerce Committee and Ways and Means Committee on Thursday, and it is scheduled to be considered by the House Budget Committee on Wednesday.