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13Mar17

CBO ignites firestorm with ObamaCare repeal score

The Congressional Budget Office (CBO) on Monday projected that the number of people without health insurance would grow by 14 million in 2018 under the Republican ObamaCare replacement bill, with that number rising to 24 million in a decade.

The bombshell estimate was larger than even many analysts had predicted, stirring fresh doubts about whether the legislation can pass ahead of a possible vote in the House next week.

Democrats highlighted President Trump's campaign promises to provide "insurance for everybody," saying the bill falls woefully short.

"The CBO's estimate makes clear that TrumpCare will cause serious harm to millions of American families," Senate Democratic Leader Charles Schumer (N.Y.) said in a statement.

"Tens of millions will lose their coverage, and millions more, particularly seniors, will have to pay more for health care. The CBO score shows just how empty the president's promises, that everyone will be covered and costs will go down, have been."

The CBO estimated that 24 million people would become uninsured by 2026 under the bill, largely due to the proposed changes to Medicaid. Seven million fewer people would be insured through their employers over that same time frame because some people would choose not to get coverage and some employers would decline to offer it.

The CBO calculated that premiums would decrease an average of 10 percent by 2026 after an initial increase of 15 percent to 20 percent due to the repeal of ObamaCare's requirement that everyone buy coverage. Costs would rise for older people but fall for younger people, it said.

Out-of-pocket costs, including deductibles, "would tend to be higher" under the GOP plan than under ObamaCare because of looser requirements on insurers. High deductibles have been one of the GOP's main lines of attack against ObamaCare.

In perhaps the best finding for Republican leaders, the CBO found the legislation would decrease the deficit by $337 billion over a decade.

Speaker Paul Ryan (R-Wis.) in a statement seized on findings in the CBO report that could help sell the legislation to skeptical conservatives, including the projected drop in premiums and the overall savings to the government.

"I recognize and appreciate concerns about making sure people have access to coverage," Ryan said. "[O]ur plan is not about forcing people to buy expensive, one-size-fits-all coverage. It is about giving people more choices and better access to a plan they want and can afford."

The Trump administration, meanwhile, cast doubt on the CBO numbers, saying they don't take into account the next phases of the Republican healthcare push.

Secretary of Health and Human Services Tom Price said "we disagree strenuously" with the report and called it "virtually impossible" to have 14 million people lose coverage in 2018.

The coverage losses projected by the CBO could make the bill's path to passage incredibly steep.

While conservatives have complained that the measure does not go far enough to repeal ObamaCare, centrists in both chambers are concerned about people losing coverage.

Even if Ryan can muscle the healthcare bill through the House, there's no guarantee it can pass the Senate.

"If half of the CBO [report] is true, I think we should slow down," Sen. Lindsey Graham (R-S.C.) said Monday.

Asked for reaction to the score, Sen. Bill Cassidy (R-La.), who is physician, said, "It's awful."

"President Trump says he wants as many people covered as under ObamaCare," he added.

The findings from the nonpartisan CBO are significant because both parties have long pointed to the office's findings when pushing legislation.

Republicans had expected that the CBO would show a rise in the number of uninsured people and pre-emptively went on the offensive against the agency.

The CBO's report on the GOP bill, titled the American Health Care Act, found that some of the projected reduction in coverage would be from people choosing not to buy coverage because of the repeal of the individual mandate under ObamaCare. That mandate requires people to either buy coverage or pay a fine.

But the report also finds that people would go without coverage because of cuts to Medicaid and a drop in financial assistance under the bill

The GOP bill repeals core elements of ObamaCare, including its subsidies to help buy insurance, expansion of Medicaid after 2019, taxes and mandates. In its place, the legislation would create a smaller tax credit to help people buy coverage.

Among the CBO's other findings:

  • The tax credits under the GOP plan would provide 50 percent less financial help in affording coverage than those under ObamaCare by 2026.
  • The elimination of ObamaCare's individual mandate would prompt fewer healthy people to sign up for insurance, which could cause premium costs to increase 15 percent to 20 percent in 2018 and 2019.
  • Starting in 2020, the increase in average premiums would be offset by a number of provisions in the GOP plan: grants to states, a younger mix of enrollees and the elimination of some insurer requirements.
  • The GOP plan would substantially reduce premiums for younger people while raising them for older people, mostly because of a provision that would allow insurers to charge older people more.
  • By 2026, premiums in the individual market for a 21-year-old would be 20 percent to 25 percent lower, but premiums for a 64-year-old would be 20 percent to 25 percent higher.
  • Overall, by 2026, average premiums for single policyholders in the individual market would be about 10 percent lower than under ObamaCare.
  • The cuts to Medicaid would be sharp, with 14 million fewer enrollees and 25 percent less spending by 2026. Those cuts to Medicaid could be concerning for many governors.

The GOP plan, if enacted, would also block all Medicaid reimbursements to Planned Parenthood for one year.

That provision would result in several thousand births in the Medicaid program and increase spending for Medicaid by $21 million in 2017 and by $77 million over the 2017-2026 period, the report found.

The CBO notes that defunding Planned Parenthood would primarily affect women living in areas without other healthcare clinics.

[Source: By Peter Sullivan and Jessie Hellmann, The Hill, Washington, 13Mar17]
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