In their latest assessment of Senate Republicans’ attempts to rewrite the Affordable Care Act, congressional budget analysts say a plan that Senate Majority Leader Mitch McConnell (R-Ky.) pulled from consideration this week would increase the ranks of the uninsured by 22 million a decade from now — the same as a previous version.
The Congressional Budget Office forecast issued early Thursday afternoon looked at a rejiggered iteration of the Better Care Reconciliation Act, which Senate GOP leaders unveiled a week ago in a so-far unsuccessful attempt to win enough support from the chamber’s Republican majority.
Compared with earlier versions, it would give more money to states to help pay for insurance for high-cost patients and would preserve some Affordable Care Act taxes. It would still eliminate the law’s requirement that most Americans carry health insurance, phase out the law’s expansion of Medicaid and transform the rest of Medicaid funding.
According to Congress’s nonpartisan budget scorekeepers, this version would have a greater impact on lowering the federal deficit — a $420 billion reduction between next year and 2026, compared with $321 billion under the previous form of the bill. The change is largely because the new plan would keep more Affordable Care Act taxes.
The CBO also says that the most recent version would cause a slightly slower erosion of health coverage — with 15 million fewer Americans predicted to be insured in 2018, compared with current law. That would be 2 million fewer losing insurance next year than under an earlier form of the legislation.
As of 2026, however, the predicted 22 million increase in the ranks of the uninsured would be the same as under the bill’s previous version, the CBO says.
The CBO also looked at the latest provisions’ impact on deductibles and found they would increase. A single person buying a typical plan with inexpensive premiums could potentially confront a deductible of $13,000 a year after a decade.
Those deductibles would make insurance financially unattractive to many consumers, especially the poor. “Many people with low income would not purchase any plan even if it had very low premiums,” CBO director Keith Hall wrote in a letter conveying the estimates to Sen. Mike Enzi (R-Wyo.), who chairs the Senate Budget Committee.
In addition, a new form of tax credit for people who buy health plans on their own would be pegged to less generous insurance, covering about three-fifths of a patient’s expected medical costs instead of about 70 percent with the current ACA subsidies.
The bill that CBO scored does not include a controversial amendment put forward by Sen. Ted Cruz (R-Tex.), which would allow insurers to sell minimal plans with limited benefits and lower premiums. Opponents say that it could destabilize the individual coverage market.
McConnell has set aside the bill for now, saying that he plans to bring a different measure to a vote next week. That other measure would rescind major aspects of the Affordable Care Act without any alternative health policies, which would leave 32 million more Americans uninsured by 2026, according to CBO estimates released Wednesday night.
The repeal-only strategy, according to the CBO, would render an additional 17 million Americans uninsured in 2018. Their ranks would jump to 27 million two years later when the bill would end two cornerstones of the Affordable Care Act: subsidies that help the vast majority of consumers buying health plans through its marketplaces pay for monthly premiums, and the expansion of Medicaid to people slightly above the poverty line.
The analysis on the straight repeal measure also estimates that premiums for individual policies would rise by 25 percent next year if the number of people buying such policies plummets and concentrates sicker people in that insurance pool.
After first saying this week that the Affordable Care Act should be allowed to fall apart, President Trump urged GOP senators Wednesday to revive their efforts to reach consensus on a plan that would repeal and replace portions of the Affordable Care Act.
After a lunch with Senate Republicans at the White House, McConnell said Wednesday that “we all agree it’s better to both repeal and replace. But we could have a vote on either.”
Max Ehrenfreund contributed to this report.