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May 25, 2017

The Congressional Budget Office projected yesterday afternoon that the American Health Care Act would leave 14 million Americans uninsured after one year, increasing to 23 million by 2026. That score makes the Senate’s effort to craft a bill significantly more difficult.

Speaking of, the Senate’s Republican health reform working group continues to inch its way forward on its replace bill without much clarity, other than their bill will not be what the House passed. An analysis of the American Health Care Act can be found here.

Sticking points over the scope of Medicaid expansion, premium subsidies, state waivers on essential health benefits and high risk pools continue to muddy the waters.

Yesterday, Majority Leader McConnell said he doesn’t see how he gets to 50 votes on the bill, and Senate Finance Committee Chairman Orrin Hatch acknowledged this morning that yesterday’s CBO score makes their task significantly more difficult. The biggest takeaways from the score are:

  • 14 million fewer people will be insured one year after passage.
  • 23 million fewer will be insured in 10 years.
  • AHCA would cut spending on Medicaid, the joint federal-state health program for low-income people, by $834 billion. The program would cover 14 million fewer people.
  • Premiums will go up in 2018 and 2019. After that, there will be significant variation depending on whether someone lives in a state that opts out of key Obamacare insurance rules.
  • In states that waive some Obamacare rules, premiums would decline by 20 percent over a decade compared to current law.
  • One out of 6 Americans will live in an area with an unstable insurance market in 2020 where sick people could have trouble finding coverage. But 5 out of 6 would have access to relatively stable markets.
  • Poor, older Americans would be hit especially hard. The average 64-year-old earning just above the poverty line would have to pay about 9 times more in premiums.
  • In 2026, 51 million people under age 65 would be uninsured — almost twice as many as the 28 million who would have lacked coverage under Obamacare.
  • The bill will save $119 billion, which is $32 billion less than a previous version of AHCA.
  • It repeals $664 billion worth of taxes and fees that had financed Obamacare.

In a victory for House Speaker Paul Ryan, the CBO score meets the reconciliation and budget standards, and the threat of having to amend the legislation and have another House vote was avoided. Last night, Speaker Ryan said the score was “great,” while HHS Secretary Tom Price said the numbers were flawed.

Meanwhile, the House moved forward this week on additional health measures that didn’t see their way into the AHCA. The House Ways and Means Committee approved legislation to allow veterans to retain eligibility for the ACA’s subsidies in the event that the American Health Care Act becomes law; a bill to allow tax credits available under the American Health Care Act to be applied to COBRA plans; and a bill that would require individuals to verify their income eligibility and citizenship or legal immigration status with the Social Security Administration before accessing premium tax credits.

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