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 insurance, while curbing the federal deficit, according to a widely-anticipated forecast by congressional budget analysts.
The analysis, released late Monday afternoon by the Congressional Budget Office, predicts that 24 million fewer people would have health coverage over the coming decade, nearly doubling the share of Americans who are uninsured from 10 to 19 percent. But the GOP legislation, which has been speeding through House committees since it was introduced a week ago, would lower the deficit by $337 billion during that time, primarily by lessening spending on Medicaid and government aid to help people buy health plans on their own.
The report predicted that premiums would be 15 percent to 20 percent higher in the first year compared with the Affordable Care Act and 10 percent lower on average after 2026. By and large, older Americans would pay “substantially” more and younger Americans less, the report said.
The 37-page report provides the most tangible evidence to date of the human and fiscal impact of the House GOP’s American Health Care Act. It also undermines President Trump’s pledge that no Americans would lose coverage under a Republican remake of the ACA.
The report’s arrival produced starkly different tacks from The White House and Capitol Hill — with top aides to the president immediately seeking to discredit it while the House’s Republican leaders praised the report for reinforcing their argument that the plan curbs federal spending and gives Americans the freedom to be insured or not — their choice.
“Just absurd,” was the way Mick Mulvaney, director of the White House’s Office of Management and Budget, responded to the forecast, while Health and Human Services Secretary Tom Price said: “The CBO report’s coverage numbers defy logic.”
House Speaker Paul D. Ryan (R-Wis.), meanwhile, said in a Fox News interview that the report “exceeded” his expectations, and he jumped on its prediction of reductions in the deficit to try to assuage the chamber’s most conservative members, many of whom oppose the plan’s inclusion 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.”
The release of the report marks the beginning of a new phase in the debate over the week-old health-care bill, which is moving through the House on an accelerated timetable despite opposition from Republicans, Democrats and virtually every sector of the U.S. health-care industry.
Democrats used the report’s finding to continue attacking 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.”
Specifically, 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 fewer than one in five U.S. residents would be uninsured by 2026 — compared to one in 10 uninsured now and one in six who were uninsured before the ACA was enacted.
The reduction would result from three factors. A provision rescinding the penalty imposed on the uninsured would prompt many Americans to drop their health plans. After that, tax credits that are less generous than current subsidies would make insurance unaffordable to many more. Finally, some states may undo the expansion of their Medicaid programs.
The conservative House Freedom Caucus did not immediately provide a response to the report. Moderate Republicans expressed concerns about the number of people who would lose coverage.
“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 a fixed per capita amount of funding to states rather than covering a percentage of all health-care expenses incurred by enrollees.The plan would also replace federal insurance subsidies in the ACA with age- and income-based tax credits.
The measure derives most of its budget savings through cuts to Medicaid, while nearly all of its cost comes from the proposal’s system of tax credits, which would replace the ACA’s federal insurance subsidies.
While the deficit would be lower, the analysis says, 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.
“I would hope that this would make the Republicans say ‘we can’t do this,” said Sen. Patty Murray (Wash.), a member of Democratic leadership.
“Twenty-four million people lose their coverage, it is total chaos to the country and I hope they pause, say ‘This is not what we should be doing,’ and move on.”
The White House has spent the past week engaged in a charm offensive aimed at bringing conservatives on board, as well as an effort to discredit the CBO before it released numbers that might cast the plan in a negative light.
The Affordable Care Act 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.
According to the report, an estimated 52 million people would be uninsured in 2026, compared with 28 million who would lack insurance that year under the current law.
On Capitol Hill, Senate Majority Whip John Cornyn (R-Texas) said Republicans “obviously” want to “improve those coverage numbers.”
“But when you don’t punish people for their refusal to buy a government-approved insurance [plan], some people are going to make the decision not to buy it,” he said.
This reasoning would only account for the immediate increase in the uninsured, according to the CBO.
Eventually, many people would lose health insurance because the legislation’s tax credits would be less generous than those in the current law and because some states might undo the expansion of their Medicaid programs.
“All I can tell you it is a work in progress,” Cornyn said of the bill.
The estimates projected a significant drop in Medicaid enrollment. Next year, the forecast says, about 5 million fewer people would be on Medicaid. By 2026, the program’s rolls would shrink by nearly 15 million – almost one in four of the 68 million currently in the program.
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 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 (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 employer, in part because the new tax credits would be available to people with higher incomes than the ACA’s subsidies. Some employers would also drop coverage, the CBO projected.
Sen. Bill Cassidy (R-La.) recalled Trump’s promise that the health-clare plan would insure everyone.
“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.