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18 million would lose insurance in first year of Obamacare repeal without replacement, CBO report says

As Republicans in Congress gear up to repeal the Affordable Care Act, two Pennsylvanians reflect on their different experiences under Obamacare. (Video: Alice Li/The Washington Post)
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At least 18 million people would lose health insurance in the first year if Republicans move ahead with plans to repeal major portions of the Affordable Care Act without a replacement plan, estimates a report from the nonpartisan Congressional Budget Office.

The number of people without insurance would grow to about 32 million within the first decade if congressional Republicans follow a 2015 plan to repeal the health-care law without an alternative, the new report says. It also estimates that health insurance premiums for people buying individual non-group coverage would double within a decade, further complicating GOP promises that people will not lose coverage under their plan.

The report comes as Republican leaders in Washington are working furiously to tamp down concerns within their ranks that a speedy push to repeal major portions of the law known as Obamacare could create chaos in the insurance markets and provoke a backlash from voters.

Over the weekend, President-elect Donald Trump promised in an interview with The Washington Post that he was nearing completion of a plan to provide “insurance for everybody.” Trump did not provide any details of what that plan would include, but his timeline and promises of coverage for everyone clash starkly with the CBO report estimating that millions of people would lose coverage.

The report increases the pressure on Republicans to come up with a replacement plan that fills in the gaps for Americans covered by the ACA while adhering to GOP principles.

Sylvia Mathews Burwell, the outgoing secretary for health and human services, told reporters that the CBO report showed the importance of having a replacement health-care plan ready when the ACA is repealed. But as of now, “we really  haven’t seen a plan,” she said. “An outline is not a plan. A framework is not a plan.”

Repealing the law without a replacement in place would send the marketplaces into a “negative” spiral of falling enrollment and soaring premiums, Burwell said. But she added that she is “an optimist” and believes that Republicans will adjust their plans when faced with the realities. She added that she believes consumers, doctors, patients and insurers will increasingly be “the voices of reality” as the debate over health care continues.

Looking back on how the Obama administration handled the ACA, she said, it’s clear that officials underestimated the time it would take for consumers and insurers to adjust to a new system for the individual market. “We thought it would be faster,” Burwell said.

Trump vows ‘insurance for everybody’ in Obamacare replacement plan

The report, which is an update of a previous analysis of the 2015 repeal legislation, sparked bickering among lawmakers Tuesday. Republicans dismissed it, arguing that the forthcoming GOP repeal plan will also include some elements of replacement. Senate Finance Committee Chairman Orrin G. Hatch (R-Utah), one of four committee chairman who will help draft the repeal and replacement measures, said the report was one-sided.

“Today’s report shows only part of the equation — a repeal of Obamacare without any transitional policies or reforms to address costs and empower patients,” Hatch said. “Republicans support repealing Obamacare and implementing step-by-step reforms so that Americans have access to affordable health care.”

AshLee Strong, a spokeswoman for House Speaker Paul D. Ryan (R-Wis.), said, “This projection is meaningless, as it takes into account no measures to replace the law nor actions that the incoming administration will take to revitalize the individual market that has been decimated by Obamacare.”

Senate Democrats, including Minority Leader Charles E. Schumer (D-N.Y.), requested the report to provide an updated estimate of the effect of a 2015 repeal measure that ended in a veto from President Obama. Republican leaders have said that bill was a “dress rehearsal” for efforts in 2017.

“Nonpartisan statistics don’t lie: it’s crystal clear that the Republican effort to repeal the Affordable Care Act will increase health care costs for millions of Americans and kick millions more off of their health insurance,” Schumer said in a statement.

But Republicans insist that they are working on a replacement plan. House Majority Whip Steve Scalise (R-La.), the third-ranking Republican in the House, responded Tuesday by dismissing the report on Twitter.

Congress took its first step toward repealing Obama’s health-care overhaul Friday when the House voted along party lines to pass a budget measure that paves the way for a repeal vote in the coming months. Committees in the House and Senate are set to begin writing legislation that will roll back major elements of the law, including penalties for those who don’t get insurance and credits that help people buy insurance on the private market.

Republicans are now facing the far more difficult task of assembling a viable replacement for a law that has expanded health insurance coverage to about 20 million Americans and eliminated unpopular insurance-industry practices, such as lifetime coverage caps and widespread refusal to cover already-sick individuals.

The Senate is set to begin confirmation hearings Wednesday for Trump’s nominee for secretary of health and human services, Rep. Tom Price (R-Ga.). If confirmed, Price is poised to be one of the key architects of Republican health policy in the Trump era.

Price is among the only lawmakers to have crafted an alternative to the Affordable Care Act. The former House Budget Committee chairman proposed making deep cuts to Medicaid and creating a voucherlike system for older Americans who use Medicare as their primary insurance. His plan would also end subsidies for people to buy private insurance, in favor of tax breaks to encourage investments in private health savings accounts.

Many voters like the benefits of the ACA, but the public is split over whether the health-care law was a good idea overall. A Washington Post-ABC poll conducted from Jan. 12 to 15 found that 46 percent of respondents supported repealing the ACA, while 47 percent opposed repeal. Voters are less excited about repealing the law without a replacement. Thirteen percent supported repeal and said it should be done before a replacement is created — compared with 31 percent who said the law should be repealed simultaneously with a replacement.

Mike DeBonis and Laurie McGinley contributed to this report. 

Correction: A previous version of this story referred to Rep. Steve Scalise (R-La.) as Minority Whip. He is House Majority Whip.