The number of uninsured by 2026 would increase by 22 million, 1 million less than what was estimated under the House bill.
Under the new Senate bill, the number of people who would be uninsured by 2026 would increase by 22 million as compared to the number under the current Affordable Care Act and 1 million less than what was estimated under the House bill’s American Health Care Act, according to a score of the bill released Monday afternoon by the Congressional Budget Office and the staff of the Joint Committee on Taxation.
By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under the current Affordable Care Act, the CBO said.
In 2018, 15 million more people would be uninsured under this legislation than under current law–primarily because the penalty for individuals and employers for not having insurance would be eliminated.
In later years, other changes in the legislation–lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market–would also lead to increases in the number of people without health insurance, the CBO said.
By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent.
Senate Majority Leader Mitch McConnell reportedly wants a vote prior to the July 4 recess but it’s unknown whether he’ll have the votes necessary among his own party members.
Democrats were quick to denounce the bill because of the CBO findings.
“Today’s CBO score has pulled back the curtain of Senate Republicans’ healthcare bill: it’s about giving huge tax cuts to millionaires and billionaires and dismantling important middle class programs like Medicaid and Medicare, all in the name of ‘health care reform,’ said Ways and Means Committee Ranking Member Richard Neal, a Democrat from Massachusetts.
Providers also find little to like in a bill that takes away coverage in both the individual market and through Medicaid.
“The Senate’s Better Care Reconciliation Act would be as damaging to the country as its deeply unpopular House counterpart, the American Health Care Act,” said Bruce Siegel, MD, president and CEO America’s Essential Hospitals.
The score reflects a last-minute amendment by McConnell to stabilize the insurance market through a continuous coverage provision giving a penalty for a lapse in insurance.
The Senate’s Better Care Reconciliation Act of 2017 is the Senate’s answer to H.R. 1628 put forward by House Majority Leader Paul Ryan in May.
The CBO forecasts stability for the nongroup market in most areas of the country under the new bill, including in states that obtain waivers for coverage of essential benefits.
This is because there would be substantial federal funding to directly reduce premiums available through 2021. Premium tax credits would continue to provide insulation from changes in premiums through 2021 and in later years, the CBO said.
Lower premiums will help attract enough relatively healthy people for the market in most areas of the country.
That stability would continue even when cost-sharing reduction payments to insurers are eliminated starting in 2020, a move payers have said would drive up the price of premiums.
A small fraction of the population resides in areas in which — because of this legislation — no insurers would participate in the nongroup market or insurance would be offered only with very high premiums.
Insurance covering certain services would become more expensive–in some cases, extremely expensive–in some areas because the scope of coverage for essential health benefits would be narrowed through waivers affecting close to half the population, CBO and JCT said.
The CBO and JCT estimate that enacting this legislation would reduce the federal deficit over the 2017-2026 period by $321 billion. This is $202 billion more than the estimated net savings for the version of H.R. 1628 that was passed by the House.
The largest savings would come from reductions in Medicaid. Spending on the program would decline by 26 percent in 2026 compared with what CBO projects under current law.
Spending would be reduced because of the elimination of federal spending for Medicaid expansion under the ACA’s subsidies for nongroup health insurance.
Those savings would be partially offset by the effects of other changes to the ACA’s provisions dealing with insurance coverage including additional spending designed to reduce premiums and a reduction in revenues from repealing penalties on employers who do not offer insurance and on people who do not purchase insurance.
The largest increases in deficits would come from repealing or modifying tax provisions in the ACA that are not directly related to health insurance coverage, including repealing a surtax on net investment income and repealing annual fees imposed on health insurers, the CBO said.
HENRY KOTULA 