Conservative lawmakers in the House and Senate continued to attack the Republican health-care plan Tuesday after congressional budget analysts found it would dramatically increase the number of uninsured Americans while raising premium costs in the short-term.
The reaction from Republican hard-liners to the Congressional Budget Office report cast doubt on the viability of the American Health Care Act, House Speaker Paul D. Ryan’s proposal to revise Obamacare, which could receive a House vote within two weeks.
Though the bill is projected to lower the federal budget deficit over the next decade and produce a 10 percent average decrease in premiums after that, its skeptics on the right remain unconvinced it would go far enough in pulling back elements of former president Barack Obama’s 2010 health-care law.
“This bill doesn’t repeal Obamacare,” Rep. Jim Jordan (R-Ohio), a member of the House Freedom Caucus, told “Fox & Friends” Tuesday morning.
“This bill doesn’t unite Republicans. This bill doesn’t bring down the cost of premiums . . . . There’s a reason every major conservative organization in the country is opposed to this legislation.”
Meanwhile, the White House pushed back on a Politico report that its internal analysis on the impact of the AHCA showed an even steeper loss of health insurance than calculated by the CBO.
“This story is totally misleading,” White House press secretary Sean Spicer tweeted. “The projection was an estimate of what CBO would conclude. It was not a [White House] analysis.”
The CBO report predicted that 24 million fewer people would have health insurance in a decade under the AHCA compared with the current system. According to Politico, the White House analysis found 26 million more people would go without coverage under the GOP bill.
White House Budget Director Mick Mulvaney said the Office of Management and Budget, which produced the document reviewed by Politico, can’t produce coverage estimates.
“I don’t know if the document exists because I haven’t seen it,” he told the host of CNN’s “New Day.” “If it does exist, you just confirmed what I said, which is that we don’t have the ability to do [those estimates] independently at the OMB.”
Mulvaney continued the administration’s assault on the credibility of the CBO, calling its analyses “deeply flawed.”
In a reference to the snowstorm hammering the East Coast of the United States, he said, “According to the CBO, it’s sunny and 75 degrees this morning.”
“This is exactly what we thought the CBO would come forward with,” he said of Monday’s coverage-loss projection. “They’re terrible at counting coverage.”
House Republicans’ proposal to rewrite federal health-care law would more than reverse the gains the Affordable Care Act has made in the number of Americans with health coverage and nearly double the share of uninsured people from 10 percent to 19 percent in 10 years, the CBO found. The number of uninsured people would jump 14 million after the first year alone.
Premiums would be 15 to 20 percent higher in the first year compared with under the ACA but 10 percent lower on average after 2026, the report stated. By and large, older Americans would pay “substantially” more and younger Americans less.
The 37-page report provided the most tangible evidence to date of the human and fiscal impact of the House GOP plan. It also called into question President Trump’s pledge that no Americans would lose coverage under his health-care plan.
Ryan (R-Wis.), meanwhile, said in a Fox News interview Monday that the report “exceeded” his expectations, and he jumped on its prediction of a smaller deficit to try to assuage the chamber’s conservatives, many of whom oppose the idea of new tax credits to help some Americans buy coverage on their own.
Declaring that the plans would usher in “the most fundamental entitlement reform in a generation,” Ryan said the legislation “is about giving people more choices and better access to a plan they want and can afford. When people have more choices, costs go down. That’s what this report shows.”
Despite that sales pitch, early signs emerged that the report may not help solidify GOP support. Rep. Rob Wittman (R-Va.) announced he would oppose the bill.
“I do believe that we can enact meaningful health care reforms that put the patient and health care provider back at the center of our health care system, but this bill is not the right answer,” he said in a Facebook post.
Wittman’s stance could represent a new front of House Republican dissent. A six-term member who leads a House Armed Services subcommittee and represents a district that favored Trump by 12 percentage points, Wittman is neither a hard-right firebrand nor a wary moderate from a Medicaid expansion state. Rather, he is the sort of mainstream conservative that Ryan is counting on to toe the party line and pass the bill.
The release of the analysis marked the beginning of a new phase in the debate over the week-old health-care bill, which is moving through the House despite opposition from many Republicans, Democrats and major sectors of the U.S. health-care industry.
Democrats used the report’s findings to continue excoriating the House GOP plan. “The CBO score shows just how empty the president’s promises — that everyone will be covered and costs will go down — have been,” said Senate Minority Leader Charles E. Schumer (D-N.Y.). “This should be a looming stop sign for the Republicans’ repeal effort.”
The analysis predicts that the number of people without health coverage would rise to 52 million by 2026, compared with 28 million if the ACA remains intact. That erosion would mean that about 1 in 5 U.S. residents would be uninsured by 2026 — compared to 1 in 10 uninsured now and 1 in 6 who were uninsured before the ACA was enacted.
The reduction in the number of insured people would result from three factors. A provision rescinding the penalty imposed on the uninsured could prompt many Americans to drop their health plans. After that, tax credits that are less generous than current subsidies could make insurance unaffordable to more people. Finally, some states may undo the expansion of their Medicaid programs.
The conservative House Freedom Caucus did not immediately respond to the report. Moderate Republicans expressed concerns about the number of people who would lose coverage, foreshadowing possible problems for the legislation if it reaches the Senate.
“These kinds of estimates are going to cause revisions in the bill, almost certainly,” said Sen. Susan Collins (R-Maine).
“I don’t think that the bill that is being considered now is the bill that ultimately will be the one that we vote on in the Senate.”
In its current form, the House GOP proposal would administer Medicaid by giving each state a fixed amount of funding per person in the program rather than covering a fixed percentage of its Medicaid costs, no matter how high. The plan would also replace the Affordable Care Act’s federal insurance subsidies with age- and income-based tax credits, which would involve considerably less spending, the report shows.
While the deficit would be lower, the legislation also would reduce federal revenue by $592 billion by 2026 by repealing several taxes that the ACA created to help pay for more people to get insurance — notably taxes on high-income Americans, hospitals and health insurers.
“They are implementing the biggest transfer of wealth in our history,” House Minority Leader Nancy Pelosi (D-Calif.) told reporters Monday. “In terms of insurance coverage, it’s immoral. In terms of giving money to the rich at the expense of working families, it is indecent and wrong.”
The ACA has increased coverage by 20 million to 22 million — almost half of those through the insurance markets the law created for people who cannot get affordable coverage through a job, and the rest through an expansion of Medicaid in 31 states and the District of Columbia.
On Capitol Hill, Senate Majority Whip John Cornyn (R-Tex.) said Republicans “obviously” want to “improve those coverage numbers.”
But Cornyn noted that, by eliminating the penalty for violating the ACA’s requirement that most Americans carry insurance, “some people are going to make the decision not to buy it.”
The elimination of that penalty would account for the immediate increase in the uninsured.
The CBO also predicted substantial disparities in the effect the legislation would have on insurance premiums for younger versus older consumers.
If the GOP plan is enacted, a 21-year-old making $68,200 would pay an average of $1,450 for a year’s worth of insurance premiums after the new tax credits, compared with $5,100 under the current law.
On the other hand, the cost of a year’s worth of premiums would stay about the same for a 64-year-old at the same income level. For a 64-year-old making $26,500, the cost would rise sharply, from $1,700 to $14,600.
Sen. Joe Manchin III (D-W.Va.) criticized the plan’s approach to the elderly.
“I’m not an attack person — you know that,” he said. “I don’t just attack because you’re on the other side of the aisle. But how can you look at yourself and say, ‘Okay, I’ll help the person who needs help the least, the wealthiest people, with more tax cuts, because I’m going to be taking away from the elderly population?’ ”
The analysis also forecast a reduction in the number of Americans who get insurance through their employers, in part because the new tax credits would be available to people with higher incomes than with the ACA’s subsidies. Some employers would also drop coverage, the CBO projected.
Sen. Bill Cassidy (R-La.), a physician and strong Affordable Care Act critic in the Senate, sounded apprehensive about the report’s implications.
“President Trump said that he wants as many people covered as under Obamacare,” Cassidy said. “He said that health care should be affordable. If there’s 14 million people losing insurance, of course it’s concerning. I try to avoid hyperbole and adjectives, but it’s concerning.”
Abby Phillip, Sean Sullivan and David Weigel contributed to this report.