Here is the benchmark for coverage:
The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill. Later, after the elimination of the ACA’s expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million, and then to 32 million in 2026.
If the GOP’s replacement insures “everyone,” or at least as many as the ACA did, Republicans can claim partial success. Cost, however, may confound Republicans:
Premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by 20 percent to 25 percent—relative to projections under current law—in the first new plan year following enactment. The increase would reach about 50 percent in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026.
In other words, without Obamacare, price hikes get much higher; Republicans will need to shoot for cost increases below the ACA to chalk up a win.
Unfortunately for Republicans, previously circulated plans do not seem to improve upon the ACA. Under H.R. 3762 from 2015 (eliminate the mandate and phase out Medicaid expansion), CBO says that “in the first full plan year following enactment, by CBO and JCT’s [Joint Committee on Taxation’s] estimates, about 18 million people would become uninsured. That increase in the uninsured population would consist of about 10 million fewer people with coverage obtained in the nongroup market, roughly 5 million fewer people with coverage under Medicaid, and about 3 million fewer people with employment based coverage.” After Medicaid expansion phases out the 18 million figure goes to 27 million. As for the costs, “In total, as a result of reduced enrollment, higher average health care costs among remaining enrollees, and lower participation by insurers, CBO and JCT project that premiums in the nongroup market would be about 50 percent higher in the first year after the marketplace subsidies were eliminated—relative to projections under current law—and would about double by 2026.”
To be clear, Republicans plan on offering, if House Speaker Paul D. Ryan’s (Wis.) “Better Way” plan is a guide, health-care credits (not dependent on income) and flexible health-savings accounts (to promote saving for health insurance). There would be no individual mandate, however, so young and/or healthy people might go back to risk-taking (i.e. going uninsured). Those currently enjoying expanded Medicaid would be going from a very generous plan to whatever the tax credit would buy them (perhaps less than Obamacare).
Democrats argue that there literally is no way to remove the individual mandate, increase choice and quality, lower deductibles, roll back Medicaid and remove Obamacare taxes and cover “everyone” at lower cost to the taxpayer. They might just be right. Stay tuned.