House Republicans forced a vote on the revised American Health Care Act late last month before the CBO could re-score the bill with its added amendments. It passed by a 217-213 vote.
Deficit not reduced by as much, 23M fewer insured by 2026
Cutting those 23 million people from insurance over the next decade would reduce the federal deficit by an estimated $119 billion over that time period—which is expected to be enough to meet rules regarding budget reconciliation that has so far kept the House from even sending its version of the bill to the Senate.
However, the $119 billion in savings is about $31 billion short of the savings projected under the previous CBO score, which was released in late March before the bill was changed.
The previous CBO score estimated that 24 million fewer people would be insured under the AHCA as it was—before the MacArthur amendment was instituted, which put in place waivers to help fund pools for people with pre-existing conditions.
And the CBO estimates that 14 million people will lose insurance next year alone when the Affordable Care Act’s individual mandate requiring people to be insured runs out.
It will also cut a little more than $800 billion in Medicaid funding over the next decade.
The Colorado Health Institute has said that removing the federal match in Medicaid funding would cost Colorado $907 million in the next fiscal year alone.
CBO: Waivers, preexisting condition coverage could price-out some entirely
There are two waiver types written into the AHCA: one that allows states to modify requirements for the minimum essential health insurance benefits offered in non- and small-group markets. The other would allow insurance companies to set their own premiums for people with preexisting conditions if they haven’t had continuous coverage.
The CBO’s analysis says those waivers, which would apply to about one-sixth of the U.S. population, could bring down premiums for healthy people as we head toward 2020, but are likely to have devastating effects on people with preexisting conditions and older people.
“Premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums, despite the additional funding that would be available under [the AHCA] to help reduce premiums,” the CBO wrote.
“Over time, it would become more difficult for less health people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly.”
The report says that in those states, the non-group insurance market would “start to become unstable beginning in 2020” because of the insurance market’s responses to the waivers in some states.
“Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive non-group health insurance at premiums comparable to those under current law, if they could purchase it at all,” the CBO wrote.
The report said that out-of-pocket costs would increase in states with those waivers as well.
Senate working on own bill; Colorado reacts to new score
Sen. Cory Gardner, R-Colo., is one of the dozen or so senators working on the Senate version of the bill. The Senate is reportedly starting its bill afresh.
“The CBO score is regarding the House legislation, and the Senate is currently working on its own legislation to rescue Coloradans,” Gardner said Wednesday, saying that the Affordable Care Act is “collapsing.”
“The status-quo is unacceptable, and Democrats and Republicans have a responsibility to put politics aside,” he added.
But even Senate Majority Leader Mitch McConnell expressed concern about the Republicans’ efforts to repeal and replace Obamacare, telling Reuters Wednesday he doesn’t “know how we get to 50 (votes) at the moment” and adding that he wouldn’t speculate on what the Senate version would look like.
“Today’s analysis confirms what we knew: The Republican health care bill is yet another broken promise to the American people,” said Sen. Michael Bennet, D-Colo. “Coloradans deserve better than this hopelessly broken plan.”
Three of Colorado’s Democratic members of the House, Ed Perlmutter, Diana DeGette and Jared Polis, voted against the bill, and offered their critiques of the bill again following the CBO score.
“Congress should have found out what the bill did before they passed it,” Polis said. “The nonpartisan analysis reaffirms the danger of the Republican health care plan…It has every day consequences that could be the difference between wellness and sickness or even life and death.”
“The latest analysis from the Congressional Budget Office confirms how detrimental the Republicans’ health care bill is in terms of reducing coverage, reducing essential benefits and allowing for discrimination against those with preexisting conditions,” Perlmutter said.
“Trumpcare is bad news for a lot of people, as the CBO has shown yet again. If this bill becomes law, it will ration care and put insurance companies back in charge,” said Rep. Diana DeGette, another Democrat who voted against the bill. “President Trump promised that no American would lose health insurance under his plan and that he wouldn’t cut Medicare or Medicaid. This bad bill breaks those promises and spells disaster for countless Americans.”
Rep. Scott Tipton, a Republican who vote for the AHCA, stuck to the line that the CBO analysis isn’t always correct, and said that the AHCA will “give Coloradans more choice over their insurance plans, affordable premiums and deductibles, and better access to health care services,” despite the CBO forecasting that won’t be the case.
“The CBO has a long history of making inaccurate predictions about the ACA…Additionally, the CBO cannot predict the decisions individuals will make when they are no longer forced by the federal government to buy an insurance product they don’t want,” Tipton said.
Rep. Ken Buck, R-Colo., did nothing to reinforce his vote in favor of the bill, calling it the “first step” in a process to replace Obamacare.
"The AHCA is only the first step in the process of replacing our flawed healthcare system with a free-market, patient-centered system that makes coverage accessible and affordable," he said.
The Colorado Consumer Health Initiative estimates that “at least” 600,000 Coloradans would lose health insurance under the plan as it currently stands, and also slammed the three Republicans from Colorado who supported the bill—Reps. Ken Buck, Doug Lamborn and Scott Tipton—saying they “voted blindly.”
“Rep. Mike Coffman had the good sense to listen to constituents and buck his party to vote against the bill pushed through in a rushed and opaque process that the Senate seems inclined to repeat,” said CCHI’s Adam Fox. “We thank Reps. Coffman, DeGette, Perlmutter and Polis for their votes against this terrible bill and will work to ensure that their votes on any future bills protect Coloradans’ health.”
To read the full CBO analysis of the House-passed version of the bill, click here.