CBO: 23 million more Americans would be uninsured under House bill

Liz Goodwin
Senior National Affairs Reporter
Senate Majority Leader Mitch McConnell during a Wednesday interview with Reuters in Washington, D.C. (Photo: Joshua Roberts/Reuters)

WASHINGTON — The House-passed health care overhaul would result in 23 million fewer Americans having insurance while shaving a relatively meager $119 billion from the deficit by 2026, according to the Congressional Budget Office. The bill would lower average premiums over 10 years, but potentially push people with preexisting medical conditions out of the market entirely.

The American Health Care Act (AHCA) was changed at the last minute to let states seek waivers that would allow insurance companies to sell policies that don’t include some health benefits, like maternity care, and to charge more for people with preexisting health conditions. House leadership added $8 billion to the bill to fund high-risk pools for people with preexisting conditions, as a response to critics who said the legislation would price people with preexisting conditions out of the market.

But the CBO report said those funds would do little to keep down premiums for people with preexisting conditions — and noted that sicker people would not be able to afford insurance in many states. Out-of-pocket expenses for “maternity care and mental health and substance abuse services” could also increase by thousands of dollars each year for people who purchase insurance on the individual markets in states that take those waivers, the CBO predicted.

House Speaker Paul Ryan defended the score in a statement Wednesday, saying the CBO proved the bill “achieves our mission” because it would lower the deficit and premiums compared to Obamacare. Health and Human Services Secretary Tom Price criticized the score as “wrong” in a statement.

The dismal CBO score could stir up more dissent among Senate Republicans who have spent weeks attempting to hash out their own health care deal behind closed doors.

“I don’t know how we get to 50 [votes] at the moment,” Senate Majority Leader Mitch McConnell told Reuters earlier Wednesday. “But that’s the goal.”

A key moderate in the caucus, Sen. Susan Collins, R-Maine, released a statement that said the AHCA “unfortunately” would not improve health care access and urging her colleagues to find “bipartisan” path forward on reform. (McConnell said Tuesday he doesn’t plan to reach out to Democrats on health care because they are not interested.) “Unfortunately, the CBO estimates that 23 million Americans would lose insurance coverage over the next decade, and the impact would disproportionately affect older, low-income Americans,” Collins wrote. “In addition, for a 64-year old with an income of $26,500, the out-of-pocket premium cost could soar from $1,700 to as high as $16,100, an 850 percent increase.”

Senate Democrats wasted little time using the new CBO score to blast the AHCA. Connecticut Sen. Chris Murphy said in a tweet that the score “confirms that the GOP health bill is still a humanitarian catastrophe.” California Sen. Kamala Harris tweeted that the CBO had confirmed that House bill was “just as terrible as we thought it w​as.”

In March, the CBO found an earlier version of the AHCA would have resulted in 24 million fewer Americans having health care coverage and $150 billion in deficit reduction over 10 years compared with Obamacare.

That uninsured figure fueled a wave of outrage at town halls across the country in March and April, and having it back in the headlines again could be toxic for the delicate negotiations on the subject in the Senate. Democrats are likely to wield the CBO score as a potent political weapon against Republicans, with one GOP group already launching a $2 million ad buy coinciding with the CBO score release this week to defend vulnerable House Republicans from those attacks. Only 21 percent of Americans support the AHCA, according to one recent poll, and a CBO score showing millions losing coverage is also unlikely to boost the plan’s overall popularity.

“Theoretically, I can see it scaring off lots of people,” said Liz Mair, a Republican political operative, adding that GOP moderates as well as fiscal hawks could be spooked by the score.

Senate Republicans have been meeting three times a week to hammer out their own version of legislation designed to repeal and replace Obamacare. But the task is formidable, since McConnell needs at least 50 of the Senate’s 52 Republicans — moderates and conservatives — to agree on the politically risky plan. And so far, the Senate group has not put forward any new ideas that would result in significantly higher coverage numbers than the AHCA.

Demonstrators at the U.S. Capitol after the House passed the AHCA. (Photo: Kevin Lamarque/Reuters)

Wednesday’s CBO score underscores the political risk senators are taking on health care, since it will be tough for lawmakers to defend a bill that could result in 23 million fewer people having insurance with just $119 billion in deficit savings to show for it. Fourteen million fewer people would have health care in 2018 if the bill becomes law, potentially affecting the midterm elections.

Mair predicted Sens. Rand Paul, R-Ky., Mike Lee, R-Utah, Ted Cruz, R-Texas, Jeff Flake, R-Ariz., and Ben Sasse, R-Neb., would all likely object to lower predicted deficit savings in the House bill. (Lee and Cruz are part of the 13-person Senate working group tackling the health care issue.)

Sen. Rand Paul, R-Ky., speaks to reporters in April. (Photo: J. Scott Applewhite/AP)

The CBO score also could lead some Republicans to decide they want to keep more of Obamacare’s taxes in the Senate bill in order to fund higher tax credits for people who want to buy insurance, Sen. Rand Paul, R-Ky., told Yahoo News before the score came out. That would potentially drive down the high uninsured number.

“I think what’s going to happen is there’s probably a dozen Republicans in the Senate who want more subsidies for people, they want to keep more of the Obamacare subsidies,” he said. “But I think they’re going to find out when the CBO scores it that there’s not much money they have to play with and that they would have to actually keep some of the Obamacare taxes.”

But if Republicans go that route, they could lose Senate conservatives, like Paul, who were pushing for a full repeal of Obamacare.

Republican leadership in the Senate will likely dismiss any furor over the CBO score Wednesday as irrelevant, since they are crafting their own bill that will be different from the AHCA. But lawmakers say they are likely keeping many of the key aspects of the House bill — including its Medicaid cuts and tax credit structure to purchase insurance on the individual market.

“When we get that score, we’ll use that as a backdrop against which to plan some of our Senate options,” Sen. John Thune, R-S.D., said Tuesday. “It’s instructive because there’s some things we’ll build on that the House did.”

The Senate version of health care reform must achieve the same deficit reduction as the House version in order for it to pass by reconciliation, a procedure that would allow lawmakers to enact the bill on a bare majority without needing to attract any Democratic votes.

Meanwhile, Democrats are likely to seize upon the CBO score to remind their base that Republicans are attempting to push through a law that is unpopular in the polls and could result in millions of Americans losing health care.

“This health care bill is morally bankrupt and a disaster for children, middle class families, seniors and individuals with disabilities,” said Sen. Bob Casey, D-Pa., in a statement. “And all of this — the higher costs and reduced protections for families — are done in order to finance a massive tax cut for the wealthiest.”

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