Senate Republicans’ latest strategy for demolishing major elements of the Affordable Care Act would leave 32 million more Americans uninsured in a decade, while three-fourths of the population would no longer have access to the kind of individual health plans sold through the law’s insurance marketplaces, according to congressional budget analysts.
The Congressional Budget Office issued an assessment late Wednesday afternoon of a bill that Senate Majority Leader Mitch McConnell (R-Ky.) has said he will bring to a vote early next week, even though it appears to have little chance of passing. Having failed to win support even within his own party for any plan to substitute parts of the ACA with more conservative policies, the new version would dismantle large swaths of the 2010 law without a replacement.
That strategy, according to the CBO, would render an additional 17 million more Americans uninsured in 2018; that number would jump to 27 million two years later when the bill would end two cornerstones of the ACA: subsidies that help the vast majority of consumers buying health plans through its marketplaces to pay for monthly premiums and the expansion of Medicaid to people slightly above the poverty line.
In 2026, the CBO predicts, an additional 32 million more Americans would lack health insurance than under the current law, compared with 22 million under the most recent Senate bill. That would bring the total number of people without coverage to 59 million.
The analysis 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.
The forecast by Congress’s nonpartisan budget scorekeepers is similar, though not identical, to updated estimates from January that they issued of the repeal-only legislation that passed the House and the Senate in late 2015 before being vetoed by President Barack Obama.
The version that McConnell plans to bring to a vote would immediately stop enforcement of the ACA’s requirement that most Americans carry health coverage. In 2020, it would cease other ACA payments provided to health plans designed to help 7 million lower-income customers afford deductibles and other out-of-pocket insurance expenses. The bill would repeal a variety of ACA taxes, too.
Hours after the majority leader said this week that this bill would be his fallback, three Senate Republicans publicly said they would oppose it, depriving McConnell of enough votes to pass it given the GOP’s slender majority.
Were the repeal-only legislation to become law, the CBO forecast also estimates that the federal deficit would be reduced by $473 billion over 10 years.
The predictions about McConnell’s latest tack differ in an important regard from the CBO’s appraisal of the health-care legislation narrowly passed this spring by House Republicans and the Senate’s Better Care Reconciliation Act, which collapsed this week. Both of those measures would keep health plans available in the ACA’s marketplaces across most of the country. That would not be true under the repeal-only measure, the budget analysts predict.