CBO: 22M more uninsured, but Senate healthcare reform bill would stabilize markets, reduce deficit

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The CBO predicts that 22 million more people will be uninsured under the Senate healthcare bill to replace the Affordable Care Act.

An estimated 22 million people would either lose or voluntarily give up their health insurance by 2026 under the Senate’s plan to repeal and replace the Affordable Care Act. That’s just a little less than the increase in the number of uninsured estimated for the House-passed legislation. 

The Affordable Care Act added an estimated 20 million people to the insurance rolls.

"By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law," according to the report, released by the nonpartisan Congressional Budget Office.

RELATED: CBO releases score for House Republican healthcare bill, estimates that 23M will lose insurance by 2026

The federal budget impact

The report also says the bill, dubbed the Better Care Reconciliation Act of 2017, will reduce the cumulative federal deficit over the 2017-2026 period by $321 billion. That amount is $202 billion more than the estimated net savings for the version of H.R. 1628 that was passed by the House of Representatives.

That means Republicans can block a filibuster and pass it without Democrats.

By 2026, enacting the legislation would reduce direct spending by $1,022 billion and reduce revenues by $701 billion, for a net reduction of $321 billion in the deficit over that period, the CBO says. 

The largest savings would come from reductions in outlays for Medicaid—spending on the program would decline in 2026 by 26% compared to what the CBO projects under current law—and from changes to the ACA’s subsidies for nongroup health 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 market impact

The CBO also weighed in on how the bill would impact the stability of the individual insurance market. 

"Under this legislation, nongroup insurance markets would continue to be stable in most parts of the country. Although substantial uncertainty about the effects of the new law could lead some insurers to withdraw from or not enter the nongroup market in some states, several factors would bring about market stability in most states before 2020," it said. 

RELATED: Anthem exit from Ohio's ACA exchange adds urgency to GOP efforts to repeal and replace healthcare reform law

Key factors include:

  • Subsidies to purchase insurance, which would maintain sufficient demand for insurance by people with low healthcare expenditures
  • The appropriation of funds for cost-sharing subsidies, which would provide certainty about the availability of those funds
  • Additional federal funding provided to states and insurers, which would lower premiums by reducing the costs to insurers of people with high health care expenditures

Senate Majority Leader Mitch McConnell, R-Ky., who has promised there would be plenty of time to read and amend the healthcare bill, has said he intends to bring it to a vote this week.

RELATED: Medical community says ‘back to the drawing board’ with Senate GOP version of reform bill

But the number of Republicans who are wavering has grown from four last week to as many as 10 who either oppose the bill in its current form or have concerns with it. If three Republicans vote against the bill, it will fail.

Republicans and the Trump administration—including HHS Secretary Tom Price—started playing down the score early, as they did with the House’s plan to repeal and replace the ACA. The White House tweeted before the score came out that the score for “Obamacare” was off by 100%.

Their calculations don’t include those covered under Medicaid expansion, however.

The CBO’s report on the House version of the bill, the American Health Care Act, estimated that roughly 23 million people would be without health insurance by 2026—some voluntarily as tax penalties for the uninsured would go away.

It also predicted the House version would raise premiums for enrollees in the individual exchanges in the short term by 20% in 2018 and about 5% in 2019. However, the CBO projects that premiums on average will decline beginning in 2020 under the House plan, though the benefits included in those individual market plans would be less comprehensive.

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