24 million fewer would be insured by 2026, CBO says
Monday’s report says that 14 million people will lose insurance for 2018 when the Affordable Care Act’s individual mandate is repealed that requires people to buy insurance lest they face a penalty. But those numbers will grow to 21 million in 2020 and 24 million by 2026, according to the report, after Medicaid expansion protections in the ACA are also repealed.
The analysis says that in 2026, an estimated 52 million Americans would be uninsured under the AHCA, compared to an estimated 28 million if Obamacare was kept in place as-is.
There would also be 14 million fewer Medicaid enrollees by 2026, according to the analysis, which would come from the termination of the program in which the feds match states that have opted in to expanded Medicaid under the ACA. The analysis also estimates that Medicaid spending will be 25 percent less of its current rate under the proposed new law.
The CBO estimates that the federal deficit, which sat at $441 billion at the FY 2017 mid-year review, would be reduced by $337 billion under the AHCA through 2026. That represents 8.3 percent of the FY 2017 total budget of $4.07 trillion.
But deficits are scheduled to rise to $731 billion by 2026 according to the mid-year review, so the AHCA could work to eliminate some of that deficit. Under current projections, the deficit would remain around $390 billion under the changes, though that number is also subject to budget changes over the next 10 years, so an estimation is merely theoretical.
Its analysis says that the AHCA’s move to utilize more tax credits than subsidies to offset premium and out-of-pocket costs would “generally be less generous” for people receiving subsidies under Obamacare, but adds that some changes in the new bill would “lower average premiums enough to attract a sufficient number of relatively healthy people to stabilize the market.”
"Under the [AHCA], premiums for older people could be five times larger than those for younger people in many states, but the size of the tax credits for old people would only be twice the size of the credits for younger people," the report says.
Premiums to rise initially, will hit older people hardest
As far as premiums go, the CBO analysis estimates that single policyholders in nongroup plans would see their premiums rise by 15 to 20 percent for 2018 and 2019, but that those increases would be offset by some things stripped from Obamacare starting in 2020 and would eventually lead to premiums 10 percent lower than they are currently for people under the same plan.
That being said, the CBO analysis estimates that changes in premium costs would “differ significantly for people of different ages” since the AHCA would rely more-heavily on age when determining plans and tax credits.
“Insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people,” the CBO wrote in its analysis.
The CBO also wrote that it did not have enough time to prepare a cost estimate on macroeconomic effects to the budget the AHCA would create, something the House GOP has been criticized for in trying to shove the bill through Congress.
The CBO made its estimates based off the idea that the AHCA would be passed and enacted into law by May 2017.
Prior CBO analysis of Obamacare
When the CBO released its estimates for the original ACA in 2010, it estimated that Obamacare would lead to 21 million people gaining coverage through 2016. When it redid its figures when the exchanges opened in 2013, the CBO estimated 22 million would gain coverage.
But its initial (92 percent) and 2013 (89 percent) estimations of the number of people under 65 covered by health insurance was nearly accurate: 89.7 percent of people under 65 had insurance last year.
Despite the CBO’s commitment to “nonpartisan” reviews, as cited in its guidelines, White House press secretary Sean Spicer last week said, “If you’re looking to the CBO for accuracy, you’re looking in the wrong place.”
And Health and Human Services Secretary Tom Price, who said Sunday that "nobody will be worse off financially" under the new bill, argued after the CBO released its analysis that he “disagree[s] strenuously” with the CBO analysis, saying it doesn’t account for future regulations or legislation, and said that the AHCA will "cover more individuals at a lower cost."
But Politico reported Monday night that the White House's own analysis found 26 million people would lose insurance by 2026 to bring the total number of uninsured higher than even the CBO's report. Politico's report says the White House analysis was not dated but "clearly referred to the bill currently being considered in the House."
But the nonpartisan CHI has said removing the federal match in Medicaid would cost Colorado $907 million next fiscal year, which it says would result in the state being unlikely to be able to afford covering the entire expanded Medicaid population in the state.
It said its analysis would take a few more days, but added in a statement to Denver7 Monday that around a half-million Coloradans gained health insurance because of the ACA -- 400,000 through Medicaid expansion and 100,000 through Connect for Health Colorado, according to the institute.
Much of the CBO's analysis also says that some of the effects of the new legislation would be determined by how the states decide to handle the repeal and replacement of Obamacare. "How individual states would ultimately respond is highly uncertain," the report says.