A newly released report of the impact of Republicans’ revised plan to repeal and replace parts of the Affordable Care Act calls into serious question President Donald Trump’s decision to publicly celebrate the American Health Care Act (AHCA) with House Republicans in the Rose Garden last month.
According to an estimate by the nonpartisan Congressional Budget Office (CBO) on Wednesday, so-called Trumpcare would destabilize significant portions of the insurance market and leave millions without health insurance coverage.
"In 2026, estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law," the Congressional Budget Office’s report read.
The highly anticipated estimate came almost three weeks after House Republicans rushed through their revised healthcare plan, too quickly for the CBO to estimate how much it would cost and how many people would be affected. The CBO had scored an earlier version of the Republican bill back in March and estimated that 24 million more people would become uninsured by 2026. The prior version of the House bill was also projected to lead to premium increases in 2018 and 2019 that are higher than prices under Obamacare would be.
But both the hard-right and the more moderate wings of the House Republican Caucus rejected that iteration of the bill. The “moderate” Tuesday Group initially balked at the 24 million more uninsured under the first version of Trumpcare, but evidently considered only 1 million fewer uninsured people to be good and reasonable. The big concession the conservative House Freedom Caucus got in the revised bill was giving their states the freedom to destabilize their own insurance markets.
The current bill includes an amendment that would allow states to obtain waivers from Obamacare rules barring insurers from charging higher prices to people with preexisting conditions. In states that pursue AHCA waivers, CBO says average premiums would fall but "less healthy people would face extremely high premiums" because many sick people would opt for community-rated plans.
CBO estimates one-sixth of the population will be in states that use AHCA waivers to substantially alter benefits and community rating. The CBO concluded: “Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly.”
In the short-term, Trumpcare would also make individual premiums go up 20 percent more than expected. The CBO did estimate, however, that by 2026, individual premiums under Trumpcare would be 10 percent lower than Obamacare premiums are expected to be by that year.
For families on employer-sponsored health insurance plans, premiums under Obamacare rose less (20 percent) than in the previous 5 year period (31 percent), according to a Kaiser Family Foundation study. CBO estimated that in states requesting AHCA waivers, premiums for low-income elderly enrollees would go up 800 percent.
Furthermore, states that allow insurers to drop so-called essential health benefits would face hikes of “thousands of dollars” a year for services including “maternity care, mental health and substance abuse benefits, rehabilitative and habilitative services, and pediatric dental benefits,” the CBO predicted.
And while the Republicans’ plan to repeal and replace Obamacare would reduce federal support for health coverage by $993 billion over 10 years, it will cut taxes by $874 billion and reduce the deficit by $119 billion -- $32 billion less than the first version of the bill.
Reportedly the Senate is only making tweaks to the House bill — with little to no input from medical or insurance experts.
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