THE OFFICIAL numbers on the Senate health-care bill are in, and they are grim: The Congressional Budget Office (CBO) found Monday that the Better Care Reconciliation Act would result in 22 million fewer people with health-care coverage in a decade. “By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law,” the experts concluded.
These figures may seem like a slight upgrade relative to the House’s repeal-and-replace bill, which the CBO estimated would cut even more people from coverage rolls. But make no mistake: Every one of those 22 million is gratuitous. Leaving things the way they are would result in none of these losses, according to the CBO.
The CBO also concluded that the coverage people would get under the Senate bill would be significantly worse. Though average premiums for benchmark plans may eventually drop under the Senate bill, these would be offset by high deductibles — about $6,000 for a single person enrolled in a benchmark plan after 2020, the analysts projected — and the retraction of subsidies to help people pay such costs. “Some people enrolled in nongroup insurance would experience substantial increases in what they would spend on health care,” the CBO found. “As a result, despite being eligible for premium tax credits, few low-income people would purchase any plan.” Older people, too, would feel the pain, as the bill would allow their premiums to rise.
Meanwhile, enrollment in Medicaid, the state-federal program for the poor and near-poor, would decline by 15 million by 2026, as the GOP bill cut $772 billion in spending on the program, and the CBO expects enrollment would continue to fall after that. Many people who had gotten comprehensive Medicaid coverage would have to fall back on the shoddier individual insurance market described above. The difference would be huge: The former Medicaid enrollees would likely get coverage they could not afford to use, if they bought insurance at all.
Yet perhaps nothing in the CBO’s analysis was more damning than its conclusion that none of this disruption is needed. The current system is not perfect, but it is also not collapsing. Though the CBO acknowledged that “premiums have been rising under current law,” it projected “sufficient demand for insurance by enough people, including people with low health care expenditures, for the market to be stable in most areas.” The Senate bill’s system, meanwhile, would struggle to serve people in sparsely populated and other difficult-to-cover areas, just as the Affordable Care Act has. Obamacare requires fixes, not a destabilizing “rescue.” The Senate bill contains provisions to shore up the existing system before transitioning to the shoddier one. It should just pass the fixes and move on.
Republicans pre-spun the CBO score by arguing that Congress’s official scorekeepers could not be trusted. Health and Human Services Secretary Tom Price said Sunday that the CBO does “a relatively poor job on what the coverage consequences of a health plan are.” Projections are hard, but neither Mr. Price nor anyone else has produced any that are more credible. In fact, the CBO’s record on forecasting the effects of Obamacare is respectable. And its analysts would have to be fantastically wrong for either of the Republican health-care bills to look good.
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