House's healthcare bill will result in 13M more uninsured, CMS actuary predicts

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While the CMS Office of the Actuary estimates the House GOP's healthcare bill will reduce federal expenditures by more than $328 billion by 2026, the Congressional Budget Office projected a more modest $119 billion in savings.

While GOP senators continue to labor over their version of a healthcare policy overhaul, prognosticators are not yet finished analyzing the version of the American Health Care Act passed by the House.

In a memo released Tuesday, the Centers for Medicare & Medicaid Services’ Office of the Actuary estimates that the House’s bill will increase the number of uninsured individuals by 12.6 million by 2026, relative to current law.

That estimate is 10 million lower than what the Congressional Budget Office projected. The CBO said that by 2026, the American Health Care Act would increase the number of uninsured individuals by 23 million.

The two estimates also diverge about how much money the AHCA will save. While the CMS actuary estimates the House’s bill will reduce federal expenditures by more than $328 billion by 2026, the CBO projected a more modest $119 billion.

But while both of those estimates are more positive toward the AHCA than what the CBO projected, CMS’ actuary doesn’t let the bill off the hook.

Notably, the memo warns that while its projections assume the individual insurance market will remain viable and stable under either law, “it is possible that certain waivers granted under the AHCA could result in a deteriorating or possibly failing individual market depending on how a state chose to implement the waiver.”

The waivers in question—which were last-minute additions to the AHCA in a bid to get more Republican votes—allow states to opt out of certain Affordable Care Act rules such as community rating and the essential health benefits (EHB) requirement, if they meet certain requirements.

If these waivers end up allowing states to “severely limit” their EHB packages or underwrite healthy individuals on an annual basis, most people’s premiums for comprehensive coverage could soar so high that these plans would become affordable and “cease to be offered,” the memo says.

Predictions about waivers aside, CMS’ actuary estimates that the AHCA would lower gross individual market premiums an average of 13% by 2026. However, those premiums would be an average of 5% higher by 2026 after accounting for subsidies, and average cost-sharing amounts would be roughly 61% higher, the memo says.