‘Trumpcare’ would cut premiums and reduce federal deficit by US$119b in 10 years, but some Republicans are walking back from the plan because of massive loss of coverage
An estimated 23 million people would lose health coverage by 2026 under Republican legislation aimed at repealing Obamacare, a nonpartisan congressional agency said on Wednesday in the first calculation of the new bill’s potential impact.
The report from the Congressional Budget Office also said federal deficits would fall by US$119 billion between 2017 and 2026 under the bill, which was approved this month by the Republican-dominated House of Representatives and is called the American Health Care Act.
The CBO’s assessment further complicates the task for the U.S. Senate, which is writing its own healthcare bill. The Senate is unlikely to be able to adopt much of the House version because of the report’s finding that it would result in massive coverage losses. The CBO also found that an amendment in the House bill would over time block some unhealthy people from buying insurance.
After the CBO score’s release, several Republican senators said they do not support the House bill.
“While I am in favour of repealing Obamacare, I am opposed to the American Health Care Act in its current form,” Republican Senator Dean Heller said in a statement. “The AHCA is a first step but not the solution.”
House Republicans came under sharp criticism for passing the bill before the CBO could make its assessment. The Trump administration already has relied on the House bill’s healthcare spending cuts in its proposed federal budget.
The bill would fulfill a long-running Republican goal – repealing and replacing much of former President Barack Obama’s 2010 Affordable Care Act, which provided health insurance to 20 million and came to be known as Obamacare. President Donald Trump, who made dismantling it a key campaign promise in 2016, and other Republicans say Obamacare is too costly and creates unwarranted government interference in healthcare decisions.
Congress is aiming to pass the bill under a process called reconciliation, which requires only a simple majority of votes in the Senate, where Republicans hold a 52-48 majority, instead of 60 votes. Under those rules, all elements of the bill must have a direct budgetary impact or else they must be stricken from the legislation.
A group of 13 Republican senators led by Senate Majority Leader Mitch McConnell are expected to draft their own version of the healthcare bill in the coming months. McConnell, however, said on Wednesday he does not yet know how Republicans will get the necessary votes.
The House bill would eliminate most Obamacare taxes that help subsidise private health coverage for individuals, roll back the government’s Medicaid health plan for the poor and disabled and replace the law’s income-based tax credits for buying medical coverage with credits based on age.
Groups representing hospitals, insurers and doctors who have been against the House bill said the CBO report showed the Senate should start fresh with an eye to maintaining coverage and benefits.
Democrats also blasted the bill and said the CBO report proved it would be catastrophic for millions of people who would lose health insurance. “The report makes clear Trumpcare would be a cancer on the American healthcare system,” Senate Democratic leader Chuck Schumer said at a news
The new CBO score predicts the AHCA would cover 1 million more Americans than a previous version of the bill, which the agency estimated would have left 24 million more people uninsured than Obamacare in 2026.
In the weeks leading up to the House vote on May 4, two controversial amendments were added to the bill that ultimately helped secure its passage, including one that was added the day before the vote.
One amendment would allow states to opt out of a popular Obamacare provision that prevents insurers from charging people with pre-existing conditions higher rates, as well as one that required insurers to cover 10 essential health benefits such as maternity care and prescription drugs.
The CBO found that the amendment would cause instability in the individual insurance market for about a sixth of the population because it would become difficult or impossible for less healthy people to purchase comprehensive coverage. However, the agency found that healthy people could purchase insurance with relatively low premiums.
Another amendment allocates an additional US$8 billion over five years to help people with pre-existing conditions cover medical costs but the CBO said it would not significantly help sick people pay their premiums.
Some Republicans, including House Speaker Paul Ryan, said the report showed the legislation met key goals, including driving down premiums and lowering the deficit.
The CBO said premiums would fall for younger people and rise for older people in states that did not request waivers for an overall decline of about 4 per cent. In states that made moderate changes to their markets, representing about one-third of the US population, premiums would fall 20 per cent on average.