The House-passed Republican health care plan would increase the number of Americans without health insurance by 23 million over 10 years, but would reduce premiums for those who maintain coverage, according to a new Congressional Budget Office analysis of the bill released Wednesday evening.
If the American Health Care Act were to become law this year, an estimated 14 million people would lose coverage by 2018, the CBO estimates, with that number increasing to 19 million by 2020 and 23 million by 2026. That's slightly less than the 24 million Americans that the CBO estimated would lose health care coverage under the original version of the bill, before it was amended in early May.
Replacing Obamacare with the AHCA would reduce the federal deficit by an estimated $119 billion over the next 10 years, the CBO estimates, which is less than the $150 billion savings included in the original version of the bill (and baked into the budget plan released by the White House this week). Almost all the budgetary savings—an estimated $834 billion, most of which is canceled out by other elements of the bill—come from changes to Medicaid, the joint federal-state program to provide health coverage for the poor, including a major provision of the AHCA that would allow states to handle more Medicaid decision-making.
While the numbers have changed a bit since the initial CBO score for the bill was released in March, the basic trade-offs within the AHCA remain largely the same. The bill would maintain many elements of Obamacare, but would repeal the individual mandate that requires Americans to purchase health insurance, while allowing insurance companies to offer plans that are considered sub-par by Obamacare's coverage mandates and to price plans differently based on an individual's health record, in some circumstances.
The result is that some people will choose not to purchase insurance, while others might not be able to afford to do so—though the bill provides tax credits to help make insurance more affordable. Those tax credits, the CBO says, would "lower average premiums enough to attract a sufficient number of relatively healthy people to stabilize the market."
The CBO estimates that premiums would be reduced under the rewritten version of the AHCA, but that would not be the case for everyone, as "premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums, despite the funding that would be available." Many of those people would end up in state-run "high risk pools" created by the legislation.
Wednesday's release is the first CBO analysis of the AHCA since it was passed by the House with a 217-213 vote on May 4. Republicans faced criticism for rushing to a vote in the House before the CBO could finish scoring the rewritten bill, but so far the Senate has not touched the AHCA and further changes are likely to happen before the bill reaches President Donald Trump's desk (if it ever does).
Prior to the re-write, the CBO said the Republican health care plan would result in 14 million fewer people having insurance next year, with a decline of 24 million after 10 years. Premiums were estimated to rise by 15 to 20 percent through 2020, and would continue to rise during the 2020s but at a slower rate than what is projected under current law.
The new report is sure to be a major factor in the Senate's deliberations on the AHCA, which remains a flawed (and deeply unpopular) attempt at replacing Obamacare.