CBO Score on Senate Bill: 50 Million Americans Uninsured by 2026 and Sharp Increases in Premiums and Deductibles


This week the Congressional Budget Office (CBO) released its report on the impact of the revised Better Care Reconciliation Act (BCRA), the Senate bill to repeal and replace the Affordable Care Act. The revised bill made changes aimed at winning over Republicans who oppose the bill.

The CBO score indicates that those changes made no difference in the number of people who would lose insurance under the bill if it were to become law. The CBO projects that 22 million people would lose their coverage by 2026 — and millions more would see increased out-of-pocket costs. But the CBO score does not include an analysis of the most controversial change in the revised bill, an amendment modeled on one offered by Senator Cruz that would allow insurers to charge people more on the basis of their health. The insurance industry has already pointed out that this amendment would create conditions that could lead to a premium death spiral in the individual market and widespread losses of insurance. So it is likely that the CBO report underestimates the coverage losses under the revised BCRA.

Coverage Losses

The CBO projects that if the BCRA were to become law, the number of people without health insurance would nearly double to 50 million people by 2026, or more than the number of uninsured in the year the Affordable Care Act (ACA) passed.

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