CBO clears GOP health bill for Senate; only 23 million to lose coverage this version

The News:

A bill to disassemble the Affordable Care Act that passed the House by a razor-thin margin earlier this month would leave 14 million more people uninsured next year than under President Barack Obama’s health law and 23 million more in 2026, the nonpartisan Congressional Budget Office said Wednesday (May 24, 2017). Some of the nation’s sickest would pay a lot more for health care.

@USCBO finds that #AHCA would leave 14 million people uninsured next year Click To Tweet

The AHCA, also known as Trumpcare, would repeal portions of the Affordable Care Act, rolling back the ACA’s Medicaid expansion and allowing insurance companies to sell more meager plans that don’t require coverage of essential health benefits. States could opt out of certain coverage provisions and insurers could charge more money if Americans decided to delay signing up for coverage, Forbes points out.

“The number of people with health insurance would be slightly higher and average premiums for insurance purchased individually…would be lower, in part because the insurance, on average, would pay for a smaller proportion of healthcare costs,” the CBO said in its report. “In addition, the [CBO expects] that some people would use the tax credits authorized by the act to purchase policies that would not cover major medical risks and that are not counted as insurance in this cost estimate.”

The numbers contrast with a CBO analysis of an earlier version of the AHCA, which wasn’t even voted on because of lack of support among Republicans in the House. That version also rolled back the Obamacare’s Medicaid expansion and would lead to 14 million fewer Americans with insurance by 2018. Eventually, 24 million would lose coverage by 2026, the CBO said in March.

Like the earlier version of the AHCA, a signature initiative of Speaker Paul Ryan, Trumpcare takes away most coverage from poor Americans insured by state Medicaid programs. There were 31 states plus the District of Columbia that expanded Medicaid under the ACA and the AHCA would revoke that coverage, CBO said.

“The largest savings would come from reductions in outlays for Medicaid and from the replacement of the Affordable Care Act’s subsidies for nongroup health insurance with new tax credits for nongroup health insurance,” the CBO said. “Those savings would be partially offset by other changes in coverage provisions–spending for a new Patient and State Stability Fund, 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 CBO report comes as the US Senate considers the AHCA while health insurers like Aetna, Humana and UnitedHealth Group scaled back their offerings in certain states after being unable to manage rising costs of individual policyholders purchasing coverage on exchanges.

The CBO said the AHCA “would reduce the cumulative federal deficit over the 2017-2026 period by $119 billion,” which is “$32 billion less than the estimated net savings for the version” that was submitted to the agency in March but never voted on by the House.

The CBO forecast is another potential blow to efforts to undo Mr. Obama’s signature domestic achievement, says The New York Times.

Republican senators have said they will make substantial changes to the measure passed by the House, but even Senator Mitch McConnell of Kentucky, the majority leader, sounds uncertain about his chances of finding a majority to repeal and replace the health law.

In states that obtain waivers from certain health insurance mandates, “premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums,” the budget office said.

In addition, it said, “out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars.”

Steve’s Take:

So what just happened.

The CBO said that after a number of amendments to Trumpcare 1.0 were adopted in order to get it across the finish line in the House, Trumpcare 2.0 will actually cost a little more than the previous version, so there’s less deficit savings–only $119 billion in 10 years–and only 23 million Americans will lose their health insurance. That’s only one million fewer than a previous version.

Overall, what the CBO found was that a series of provisions that were added to get those holdouts from conservative Republicans and moderates on board and introduce some flexibility into the insurance market to stabilize it would instead cause premiums to go up for sick and for older Americans and potentially price many people out of healthcare entirely.

Some of these changes and the way in which these changes play out are going to make it that much harder for senators to somehow now explain and potentially “fix things.” It might mean that they even have to introduce more changes or throw in the towel and just start over, a bit more completely than they were intending.

The GOP Senate panel tasked with drafting its chamber’s health measure has been meeting behind closed doors but, oddly, the House bill still hasn’t been sent over to the Senate. The CBO score is helpful and a few things may still need to be ironed out before the bill makes it over to the Senate. When it gets there they will be trying to figure out how to craft something that will attract 50 votes.

That’s not going to be easy, even if Sen. Majority leader Mitch McConnell employs the same sleight-of-hand tactics that Speaker Paul Ryan used successfully to keep the House bill in the dark, holding zero public meeting and keeping countless GOP members clueless about what the bill actually contained up until the final draft. Many members actually never read a single page of it while nonetheless voting in favor of it.

Bottom Line:

Senate Republican leaders are likely to brag about the ways they have improved the House bill or early versions of their own bill. They will also point to problems in insurance markets, some of which President Trump is deliberately creating, as reason to do something.

But these are the entirely wrong values. The correct one is whether the bill improves the US healthcare system. Any bill that takes away health insurance from 15 million, 10 million or one million Americans–rather than the 23 million or so of the House bill–would still deserve utter defeat.

Steve's Take: Any bill that takes away #healthinsurance from millions deserves utter defeat Click To Tweet

The final part of the GOP strategy will be arm-twisting. If victory is in sight, McConnell will invoke party loyalty to sway his colleagues, whatever specific concerns some may have. Being the Republican who spoiled nearly eight years of time, effort and political capital to repeal despised Obamacare won’t sit well.

So the time is nigh for action. It’s a time for all those groups that oppose the bill, and for the engaged progressive base, to put senators on notice. They shouldn’t be spending their time–that we put them there to serve us–tweaking a bill that would hurt the middle class and the poor, the sick and elderly, children and the disabled. They won’t get credit for making things marginally less heartless.

They should hear a loud message that Americans aren’t in favor of taking health insurance from their fellow citizens. The senators work for those citizens, not for Mitch McConnell, Paul Ryan and Donald Trump.

And remember that making phone calls to your Senator’s office or attending events is far more effective than merely posting to Facebook, Twitter, LinkedIn and the many other social media sites.

Editor’s note:

A small group of Senate Republicans has shown signs of being persuadable, and only three are likely needed to stop a GOP bill. The group includes Lamar Alexander, Shelley Moore Capito, Bill Cassidy, Susan Collins, Dean Heller, Lisa Murkowski and Rob Portman.