The GOP’s only concrete plan to repeal Obamacare would leave 23 million more people uninsured than under the current law, according to the nonpartisan scorekeepers at the Congressional Budget Office (CBO).
Republicans in the U.S. House of Representatives narrowly passed the American Health Care Act (AHCA) in early May by making last-minute changes and rushing the bill to the floor before CBO could gauge its effect on people’s access to health care. House Speaker Paul Ryan (R-WI) in March was forced to yank a previous version that would have cost 24 million people, including 14 million Medicaid beneficiaries, their health insurance. That was before Republican leaders eliminated essential health benefits and piled on other conservative sweeteners to gain the support of the far-right House Freedom Caucus.
“In comparison with the estimates for the previous version of the act, under the House-passed act, the number of people with health insurance would, by CBO and [Joint Committee on Taxation’s] estimates, be slightly higher and average premiums for insurance purchased individually—that is, nongroup insurance—would be lower, in part because the insurance, on average, would pay for a smaller proportion of health care costs,” the CBO said in the new score, released Wednesday afternoon.
In other words, one million more people will have access to health insurance that covers a narrower range of services under the latest GOP proposal.
CBO projected that by 2026, the number of uninsured people younger than 65 will reach 51 million—”compared with 28 million who would lack insurance that year under current law.”
And the state waivers for essential health benefits and pre-existing conditions that newly resigned co-chair of the “moderate” Tuesday group Rep. Tom MacArthur (R-NJ) negotiated with House Freedom Caucus Chair Mark Meadows (R-NC) could worsen insurance options for about one-sixth of the U.S. population, especially those who need more coverage, according to CBO.
In affected states, “Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all—despite the additional funding that would be available under H.R. 1628 to help reduce premiums,” CBO found.
The revised bill saves $119 billion, mostly thanks to gutting Medicaid and replacing Obamacare subsidies with tax credits that may be unusable in California and New York due to laws requiring insurance coverage of abortion care.
President Trump’s plan instead axes $610 billion from Medicaid over ten years on top of the assumption that Republicans in the U.S. House of Representatives succeed in ushering their American Health Care Act’s more than $800 billion in Medicaid cuts into law.
Ryan in a statement praised the findings, focusing on how the AHCA “achieves our mission: lowering premiums and lowering the deficit,” rather than on the legislation’s human cost.
Per CBO, the human cost in states that opt for the waivers involves “substantial increases in out-of-pocket spending” or a so-called choice to forgo essential health benefits likely including “maternity care, mental health and substance abuse benefits, rehabilitative and habilitative services, and pediatric dental benefits.”
“In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services,” the CBO reported.
Republicans in the U.S. Senate have said they’ll write their own version of Obamacare repeal, but the CBO data is all but certain to inform their path forward. Senate Republicans remain committed to including a one-year ban on Medicaid reimbursements for Planned Parenthood, although Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK), who have inconsistent voting records when it comes to reproductive health care, may defect over the issue.
CBO had determined in March that “defunding” Planned Parenthood, and only Planned Parenthood, would disproportionately hurt poor and rural people. Planned Parenthood’s Title X funding stream is also in jeopardy at the state level after congressional Republicans revoked federal protections for it.
“The American Health Care Act is the worst legislation for women’s health in a generation,” Planned Parenthood Federation of America Executive Vice President Dawn Laguens said in a statement. “This bill cruelly slashes Medicaid—which one in five women of reproductive age rely on—while prohibiting millions with Medicaid coverage from getting health care at Planned Parenthood.”