The House-passed Republican health-care bill would leave 23 million more people uninsured over a decade and could spike costs for people with pre-existing conditions in many states, the Congressional Budget Office projected in a highly-anticipated analysis released Wednesday afternoon.
The new report is likely to exacerbate the political backlash against Republicans who voted for the party’s replacement for the Affordable Care Act without an updated estimate of its impact. It will also factor heavily into the deliberations on health care in the Senate, where Republicans decided to start from scratch rather than try to fix an unpopular House bill that many of them consider deeply flawed. The top-line numbers in the report from the nonpartisan congressional scorekeeper changed little from an earlier version of the American Health Care Act would have resulted in 24 million fewer people having insurance after a decade and an initial increase in the cost of coverage premiums.
But that analysis did not account for several significant changes Republicans made to the bill in order to secure more votes, including amendments that weaken federal protections for people with pre-existing conditions. Once the GOP leadership locked in the 216 votes it needed for a majority, Speaker Paul Ryan did not want to risk losing support while waiting for a new CBO score—a highly unusual move for such far-reaching legislation and one that drew condemnation from Democrats and independent policy analysts.
The fresh projection did bring relief to Republicans in one respect: The CBO found that the House-passed bill complied with budget reconciliation rules that it decrease the deficit after the first decade of enactment. A finding to the contrary would have fatally doomed the bill in the Senate, forcing House Republicans to make more revisions and hold another vote to comply with the complicated legislative procedure they initiated to circumvent a Democratic filibuster and pass their bill with just a simple majority in the Senate. In another unusual move, Ryan held the measure in the House for weeks after it passed while waiting for confirmation from the CBO that it contained sufficient deficit reduction.
The speaker told reporters on Tuesday that he did so “out of an abundance of caution” while noting that CBO can be unpredictable. “We have every reason to believe we’re going to hit our mark,” he said. The most recent CBO report in March found that the GOP bill would have reduced the deficit by $150 billion, leaving Republicans plenty of room to maneuver. They added only $8 billion in new spending to boost support for people with pre-existing conditions earlier this month, but policy analysts warned that late changes allowing states to opt out of Obamacare’s insurance regulations—which won the crucial support of conservatives—could lead to a much greater drain on the federal budget. A separate report on the legislation issued Wednesday by the Joint Committee on Taxation found that it would represent a $663 billion tax cut over a decade, largely through the repeal of increases levied on the wealthy as part of the Affordable Care Act.
Republican supporters of the AHCA have tried to sidestep the impact of the CBO’s findings throughout the process, either by disagreeing with its assumptions or cherry-picking more favorable parts of its analysis. They dismissed its core projection that the bill would cause a spike in the uninsured rate, arguing that it was a predictable result of repealing Obamacare’s mandate that all Americans purchase insurance. “It’s a technical procedural step,” Senate Majority Leader Mitch McConnell said on Wednesday morning, before the new report came out. “Beyond likely reiterating things we already know—like that fewer people will buy a product they don’t want when the government stops forcing them to—the updated report will allow the Senate procedurally to move forward in working to draft its own health-care legislation.”
Democrats, however, were relishing Wednesday’s release with all the excitement of a wrestler about to body-slam his opponent—for a second time. The CBO’s confirmation of coverage losses resulting from the AHCA will be plugged into attack ads that Democrats run against Republican incumbents in the House, perhaps as soon as in the special election the party hopes to win in Georgia next month.
Republicans have made lowering premiums a priority of their effort to replace Obamacare, and they were hopeful that the CBO would score their amendments allowing states to opt out of the law’s insurance regulations as a savings on the cost of an average health-care plan. But neither party was expecting a significant change in the projected impact on coverage itself, and Republicans were unlikely to benefit from a modest improvement that still left millions more people without insurance. They have acknowledged the potential political cost of passing legislation that, polls show, is backed by only about one-fifth of the public. But they argue that action is necessary to fix an individual insurance market that GOP lawmakers and President Trump have said is “collapsing.” Republicans seized on the announcement that Blue Cross Blue Shield would exit the market in Kansas City, leaving parts of Missouri and Kansas without an insurer on the Obamacare exchange. Democrats, however, have accused the Trump administration of sabotaging the law by refusing to guarantee future payments of subsidies that insurers need to make a profit.
The practical ramifications of the CBO’s latest report were more limited than its immediate political implications. The House bill, as written, will not become law. Whatever proposal the Senate comes up with will have significant differences and will need a separate assessment by the CBO before a vote. Then either the House would have to accept that version, or the two chambers would reconcile the differences in a conference committee. And whether McConnell can get 50 out of his 52 members to agree on any health-care bill is unclear. Though the Republican conference as a whole and a smaller working group of 13 members have been meeting on the issue multiple times a week, the majority leader and other senior members have been skeptical about their prospects for success. “I don’t know how we get to 50 [votes] at the moment. But that’s the goal,” McConnell told Reuters on Wednesday.
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