- Under the latest version of the GOP bill to replace the Affordable Care Act (ACA) about 23 million Americans would lose coverage, a slight decrease from an earlier version of the bill, according to the Congressional Budget Office (CBO).
- The American Health Care Act (AHCA) would also reduce the cumulative federal deficit by $119 billion over the next 10 years.
- The agency also found that premiums for single policyholders buying in the nongroup market would increase by an average of about 20% in 2018 and 5% in 2019.
After weeks of anxious foot tapping to see the effects of last-minute amendments to the AHCA, the new CBO score shows it changed very little. The bill would result in far higher uninsurance rates and would mean higher costs and less coverage for the poor, the elderly and people with pre-existing conditions.
The latest analysis has very little good news for Republicans. The previous bill was found to likely save $337 billion in federal budget deficits, but GOP leaders still praised that the AHCA cuts $119 billion. They also pointed to lower premiums for some groups, although substantial tradeoffs complicate that issue. Republicans have also historically criticized the CBO as inaccurate. A White House official reportedly said after the new score dropped that "history has proven the CBO to be totally incapable of accurately predicting how healthcare legislation will impact health insurance coverage."
A score of the previous version of the bill estimated 24 million people would lose coverage, so the new estimate just below that won't change rhetoric. This number is a key statistic for lawmakers. Many have faced angry crowds at town halls in their home districts and potential political opponents are using the issue in attack ads. The new score is unlikely to change that. So that number is likely to play a key part in whether moderate Republicans will vote to approve the AHCA, and the GOP can only manage a few defections if they want to keep their bill alive.
In fact, the AHCA passed the House by only two votes. The Senate has said it's working on its own bill, but reports indicate negotiations aren't productive so far.
The CBO score is also important for procedural reasons, because the GOP’s only hope of passage lies in the budget reconciliation process. That requires only a simple majority for approval, but has rules restricting what can be included. The CBO report released Tuesday indicates that method will be viable, but there is no clear conclusion.
Reactions from industry groups echoed what they have already said in opposition of the AHCA, and specifically the number of people who would lose coverage. American Medical Association President Dr. Andrew Gurman said in a statement the score shows the last minute changes to the AHCA “offered no real improvements." “We urge the Senate to ensure that any changes made to current law do not cause Americans to lose access to affordable, meaningful health insurance coverage,” he said.
The newest analysis is not good for Republicans eager to push forward with the AHCA, which is growing more and more unpopular with voters. The CBO starkly contradicts assurances from the GOP that their law would protect people with pre-exisitng conditions, who have been vocal in opposing the law. The CBO concluded that those with pre-existing 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."
The CBO score also confirms that the elderly and poor would be hardest hit by the changes from the new law. Under the AHCA a 64-year-old earning $26,500 would pay premiums nine times higher than under the ACA.
The AHCA does seem likely to achieve one GOP goal of bringing down premiums, but the tradeoff is far less coverage in many plans, including some without mental health or rehabilitation services. The CBO said millions of people would be buying policies that don't cover major medical risks.
CBO noted that estimates from the law are uncertain because of the many ways hospitals, payers and governments would respond to the legislation. “The array of market regulations that states could implement makes estimating the outcomes especially uncertain,” according to the report.
The analysis is particularly difficult because of all the variables surrounding AHCA provisions that give more control to states. Under the law they could apply for waivers to ignore essential health benefit requirements and change Medicaid eligibility rules.
Insurance markets under the AHCA would be stable for most people, but one in six Americans (those in states with waivers) would be in unstable markets that price sicker people out of coverage, according to the CBO.