Fifty-one million people would be uninsured within a decade under the House Republicans’ health-care plan. That not only reverses all the coverage gains made under the Affordable Care Act, but also leaves a million more people uninsured than at the height of the recession.

Premiums would be expected to skyrocket for the elderly, increasing by 700 to 800 percent for those with income of about $26,500 per year. And premiums may drop, on average, for younger people because some sicker people would not be able to get insurance at all.

Those numbers come from an analysis of the American Health Care Act released Wednesday by the nonpartisan Congressional Budget Office, almost three weeks after the House narrowly passed the bill.

The report paints a coverage-loss picture that is similar to that of bill's withdrawn predecessor. The earlier report was released when the House nearly voted on a version of the Republican bill in March. Some of the loss-of-coverage increase over current law comes from amendments in the bill allowing states to opt out of key ACA provisions such as protections for people with preexisting conditions. The CBO predicted that states accounting for about half the U.S. population would take advantage of these, and similar, opportunities to roll back the ACA.


As part of those changes, states would be able to change what benefits marketplace insurance plans must offer. Under the ACA, these “essential health benefits” range from covering hospitalizations to mental-health care to prescription drugs. One-sixth of the population resides in states that the CBO expects to drastically alter the preexisting-condition requirement. Predictably, in states that shrink or eliminate that requirement, insurance plans are expected to provide narrower coverage.

In other words, the value of insurance, measured as the percentage of a person’s medical expenses that are covered by insurance, would go down.

Despite that drop in value, premiums are expected to rise substantially for older, low-income Americans over today’s rates, largely because of the sharp subsidy cut. Premiums are, however, lower for some than they would have been under the earlier House bill — not because insurance is more affordable but because sick people are getting less of it.


But the report shows that the bill does have some upside. Like its March predecessor, it meaningfully reduces the deficit, primarily by cutting Medicaid funding. It offers significantly less savings than the amount expected from the March version of the bill, $119 billion over 10 years compared with $337 billion.


But it is unlikely that the House’s bill will be enacted and these changes realized. Senate leaders have said they plan to craft their health-care bill from scratch rather than trying to amend and pass the House’s bill. The Senate’s bill is expected to be more moderate, but it’s very possible that similar effects — lower coverage, less-valuable insurance, lower premiums and lower deficits — will remain.