WASHINGTON — Congress’ official budget analyst is projecting that the House Republican health care bill would produce 23 million more uninsured people and costly, perhaps unaffordable coverage for the seriously ill. Now Republicans in the Senate have to decide how to make their version different.
The Congressional Budget Office report, issued Wednesday, also found that average premiums would fall compared with President Barack Obama's health care overhaul, a chief goal of many Republicans. But that would be partly because policies would typically provide fewer benefits and sicker people would be priced out, it concluded.
The results gave Democrats ammunition to attack the GOP drive to scuttle former President Barack Obama's health care overhaul as damaging to patients.
Three weeks after the House narrowly approved the measure with GOP-only votes and after several embarrassing setbacks, Republican senators said they'd move in their own direction and dismissed the report's impact.
In closed-door meetings aimed at crafting a measure, GOP senators have discussed changing the House's proposed Medicaid cuts and aiming health care tax credits more toward low earners, but they've reported little progress.
“We'll get ‘em,” Senate Finance Committee Chairman Orrin Hatch, R-Utah, said when asked if GOP leaders would round up the votes they'll need to pass a bill. “But it's going to be difficult.”
The report found that under the House measure, people in some regions with pre-existing medical conditions or the seriously ill “would ultimately be unable to purchase” robust coverage at premiums comparable to today's prices, “if they could purchase at all.”
That was a knock on 11th-hour changes Republicans made in the bill to gain conservatives’ votes by letting states get waivers to boost premiums on the ill and reduce coverage requirements.
The budget office said older people with lower income would disproportionately lose coverage. Over half of those becoming uninsured, 14 million people, would come from the bill's $834 billion in cuts over 10 years to Medicaid, which provides health coverage to poor and disabled people.
“The report makes clear that Trumpcare would be a cancer on the American health care system,” said Senate Minority Leader Chuck Schumer, D-N.Y., using the nickname Democrats have tried pinning on the bill.
Trump's Health and Human Services secretary, Tom Price, assailed the CBO for being inaccurate, and the White House issued a similar critique.
“The CBO was wrong when they analyzed Obamacare's effect on cost and coverage,” Price said of the agency's report on Obama's law, “and they are wrong again.”
Many congressional Republicans took a sharply different tack, emphasizing some of the report's more positive findings.
“This CBO report again confirms that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit. It is another positive step toward keeping our promise to repeal and replace Obamacare,” said House Speaker Paul Ryan, R-Wis.
The analysis said the House bill, the American Health Care Act, would reduce federal deficits by $119 billion over the next decade. The previous version of the bill reduced shortfalls by $150 billion.
In a late compromise, House GOP conservatives and moderates struck a deal letting states get federal waivers to permit insurers to charge higher premiums to some people in poor health, and to ignore the standard set of benefits required by Obama's statute.
CBO said states adopting those waivers could destabilize coverage for people with medical problems. The agency estimated that about one-sixth of the population - more than 50 million people - live in states that would make substantial changes under the waivers.
The budget office projected that premiums in those states would be lower for healthy people than under current law because their coverage would be narrower, but did not estimate an amount.
For ill people in those states, “it would become more difficult” for seriously ill people to buy insurance “because their premiums would continue to increase rapidly,” the report said.
Benefits likely to be excluded from required coverage in some states would include maternity, mental health and substance abuse services, the report said.
In states not getting waivers, where it estimated half the country lives, average premiums would be about 4 percent lower in 2026 than under Obama's law, the report said. For the one-third of the nation in states modestly reducing coverage requirements, average premiums would be about 20 percent lower, the analysts estimated.
The budget office said average premiums in those states would go down because younger and healthier people would buy coverage and the policies would cover less.
The report said that under Obama's law, the nation's health insurance market is expected to remain “stable in most areas” because federal subsidies to millions of consumers largely rise with premiums. Citing markets where insurers have left or sought huge premium increases, Republicans have repeatedly said the statute must be dismantled because it is in a death spiral.
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