The Congressional Budget Office released estimates on March 23 for how House Republicans' proposal to revise the Affordable Care Act might affect Americans. (Sarah Parnass,Bastien Inzaurralde/The Washington Post)

On Monday afternoon, the Congressional Budget Office released its analysis of the American Health Care Act, the Republican legislation intended to replace the Affordable Care Act, more commonly known as Obamacare.

One of the most highly anticipated parts of the analysis was how the CBO would estimate that the AHCA might affect insurance coverage. Independent analysis from Standard & Poors and Brookings estimated that anywhere from 6 million to 15 million fewer people might be insured in the 2024 to 2026 time period if the AHCA went into effect.

The CBO’s estimate is higher.

The nonpartisan office’s analysis looked at the effects of the AHCA on three pools of insurance recipients: Those who get Medicaid, those who buy insurance on the exchange, and those who get coverage through their employers. The CBO figures look at the possible reductions in the number of people receiving insurance through each pool relative to current law. Meaning that the comparison here is between life under Obamacare and life under the AHCA — not between the AHCA and a world where Obamacare never existed at all.

In short:


By 2018, the CBO estimates, 14 million more people would lack insurance. Six million of those would be people who would otherwise be buying individual insurance, 5 million would otherwise be covered by Medicaid and 2 million would lose employer-based coverage. (Due to rounding, the figures don’t total as you might expect.) Most of the reason those 6 million would lose coverage would be voluntary, with the removal of the individual mandate meaning they didn’t face a tax penalty for not being covered. The total pool of those uninsured would be about 41 million — some 15 percent of the population that’s under the age of 65.

By 2020, the figures increase. Nine million fewer people would have coverage through individual insurance or Medicaid, and 2 million fewer would have it from an employer, for a total of 21 million. That would mean that about 17 percent of the non-senior population would lack coverage.

By 2026, we hit 24 million fewer people with coverage than would have it under Obamacare. Fourteen million fewer people would have it under Medicaid, 7 million fewer from an employer and 2 million fewer people would buy it from the exchange. (Why the drop in those not buying coverage individually? In part, the CBO says, because people would be more used to the tax credit structure under the new legislation.)

That’s means that about 19 percent of the non-senior population in the United States would lack coverage, as opposed to an estimated 10 percent who would lack it if Obamacare were kept in place. That’s the trade-off being made by the Republicans, the CBO suggests: a reduction in federal spending for a reduction in coverage.


Republican leaders, though, argue that this is only part of the revisions they propose, and that, over the long run, reduced costs could mean no net loss in the number of insured — or even a gain.

Working with the AHCA as introduced, though, the CBO clearly doesn’t agree with that prediction.