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WASHINGTON — A Republican bill to replace Obamacare would lead to 14 million fewer Americans with health insurance by 2018 and 24 million by 2026, the non-partisan Congressional Budget Office said Monday in an analysis that could make the controversial legislation even tougher for GOP leaders to push through Congress.
Most of the initial increase in uninsured people in 2018 would come from consumers deciding not to buy insurance because they would no longer have to pay a penalty for failing to do so, the CBO said. However, others would stop buying insurance because premiums will go up over the next two years, the analysis said.
The bill is expected to raise the average premiums that Americans would have to pay before 2020, and then lower them after that, the CBO projected. In 2018 and 2019, the average premiums for single policyholders who do not get insurance from their employers would be 15% to 20% higher than under Obamacare, the analysis said.
Starting in 2020, those premiums would begin to go down. By 2026, average premiums would be roughly 10% lower than under the existing Affordable Care Act, the CBO projected.
The number of uninsured Americans would rise dramatically during that same period as states phase out Obamacare's Medicaid expansion, the CBO said.
"In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law," the analysis said.
The Republican bill would reduce federal deficits by $337 billion over the 2017-2026 period, according to the CBO. The biggest savings would come from reductions in outlays for Medicaid and from the elimination of the Affordable Care Act’s subsidies for low-income Americans to purchase insurance.
The CBO report came as Republican leaders in Congress were already scrambling to keep their fractious caucus together on the bill. Some conservatives have denounced the plan as "Obamacare lite," arguing that it does not go far enough in scrapping the Affordable Care Act and creates new entitlements by replacing the current law's federal subsidies for low-income people with tax credits. At the same time, some moderate Republicans in the Senate fear their low-income constituents will lose coverage because the legislation phases out the expansion of Medicaid that Obamacare helped fund in many states.
Democrats are fiercely opposed to the legislation, which they say will reduce coverage and end up costing patients more money. They also argue that the tax cuts in the bill will benefit the wealthy at the expense of middle-class and working-class families. And they say the CBO score underscores that President Trump was wrong when he promised "insurance for everybody" under the GOP plan.
House Speaker Paul Ryan, R-Wis., is leading the push for the bill, saying it is the best hope that Republicans have of ending Obamacare and passing a replacement bill under a fast-track budget procedure that cannot be blocked by Senate Democrats.
Ryan and other GOP congressional leaders were already trying to soften the blow of the CBO analysis even before it came out.
"The one thing I'm certain will happen is CBO will say, 'Well, gosh, not as many people will get coverage.' " Ryan said Sunday on CBS's Face the Nation. "You know why? Because this isn't a government mandate...We're not going to make an American do what they don't want to do. You get it if you want it."
The Congressional Budget Office, which was created by Congress in 1974, is a non-partisan group of economists and analysts that produces hundreds of cost estimates for Congress on proposed legislation each year. The office has a reputation for being impartial and its cost estimates — or "scores" — of bills are taken seriously by lawmakers as they decide whether to support legislation.
Republican leaders unveiled the American Health Care Act last week, and it has already been approved by the House Ways and Means Committee and the House Energy and Commerce Committee. It is scheduled to be taken up by the House Budget Committee on Wednesday, unless an expected snowstorm forces the Capitol to close. The bill will then go to the House Rules Committee, followed by a vote on the House floor as soon as next week. If the House passes the bill, it will be sent to the Senate for approval.
The GOP bill would no longer require Americans to buy health insurance. It also would replace direct federal subsidies with tax credits to help low-income people buy insurance, phase out the expansion of Medicaid, and allow insurance companies to charge older Americans more for their coverage. It increases the amount of money people can contribute to Health Savings Accounts, which are tax-exempt accounts that can be used to pay medical expenses.
Statements from Washington's delegation
Sen. Patty Murray, D-Wash.
“Today’s report is just as terrible as Republicans knew it would be—and it’s also a broken promise to every patient and family who listened when President Trump and Republicans said that their reckless, mean-spirited bill would somehow provide better coverage—for everyone—at lower cost. It’s astounding that any elected official could support an effort to throw tens of millions of people off of coverage, spike premiums, gut Medicaid, target seniors for higher health care costs, and throw our health care system into chaos—not to mention what this bill would mean for women’s access to health care at Planned Parenthood. The facts are in, and Democrats will make sure Republicans can’t hide from them.”
Rep. Cathy McMorris Rodgers, R-5th District
“The CBO report confirms that House Republicans’ process to repeal and replace Obamacare will lower premiums and taxes, reduce the federal deficit, increase consumer choice, and reform Medicaid for the first time in its 52-year history. I hear the concerns people have about CBO’s projected coverage numbers. However, their score doesn’t tell the whole story. CBO doesn’t take into account future actions Congress and the Administration will take to further lower costs and increase coverage options. Our plan will open up the insurance market so more people can find plans they want at prices they can afford, while addressing the disconnect between coverage and access to care.”
Rep. Dave Reichert, R-8th District
"The American Health Care Act is just the first step in our plan to provide Americans with more affordable, patient-centered health care. The CBO’s score does not include the additional steps that are critical to our overall health care solution. Our goal remains to provide access for all Americans. Through work with the Administration and additional reforms, we will continue to increase competition to provide more choices and lower costs for families," said Reichert in a statement to KING 5.
Rep. Rick Larsen, D-2nd District
“The numbers are in and they paint a clear picture: by any meaningful measurement such as health care quality, coverage, or cost, Trumpcare is a disaster when compared against the Affordable Care Act. Instead of improving upon current law – which reduced the deficit and resulted in the lowest uninsured rate in American history – President Trump and Speaker Ryan have devised a scheme that would leave tens of millions of people without health coverage while giving a tax break to the super wealthy.”
Rep. Pramila Jayapal, D-7th District
“The CBO report shows the Republican bill is nothing more than a dangerous ideological wish list that strips 24 million Americans of health care, raises premiums by more than fifteen percent, makes our seniors pay more, and guts Medicaid by almost $1 trillion. All of this in order to give $600 billion in tax cuts to corporations and the wealthiest amongst us. Americans will pay more for health care and get less coverage. This will be life and death – literally – for millions of Americans. This plan is simply not a plan. Republicans who truly care about their constituents will vote no to ripping apart our health care system and leaving millions of families without insurance."
Rep. Suzan DelBene, D-1st District
“While some may use ‘alternative facts,’ my constituents and I live in reality. And there is no denying that the CBO score confirms this is a dangerous and irresponsible bill that threatens to destabilize our nation’s healthcare system, rob millions of Americans of their health insurance and raise costs for middle-class families, seniors, women and people with disabilities,” DelBene said. “House Republicans are clearly trying to jam this bill through because they know they can’t justify the numbers to the American people. Instead of building upon the reforms we’ve already made to expand coverage and reduce costs, Republicans are forcing people to pay more for less.
Rep. Jaime Herrera Beutler, R-3rd District
"There are legitimate concerns about how this bill would impact children's hospitals, low-income and older people that must be addressed. I just came from a meeting with House Republican leadership on this bill and my message to them was: we have to get this right. Even if it takes additional time and consideration, it's worth it to make sure that we repeal Obamacare and replace it with something that works for the people I serve. As far as I'm concerned the bill is still a work in progress and is not our final product."
Rep. Dan Newhouse, R-4th District, said he is still reviewing the CBO report.
Governor Jay Inslee (D)
“Today's analysis from the nonpartisan CBO confirms our worst fears about the Republican effort in Congress to repeal the Affordable Care Act. It would actually leave our nation worse off than before the ACA was implemented. Republican leaders use words like ‘freedom’ and ‘choice’ to hide what they’re really doing, which is ripping away one of our most important safety nets and rewinding the clock to a time before cancer patients could get coverage, all women could get preventative care and thousands could get help for opioid addiction.
“I will be personally contacting every member of Washington's congressional delegation and calling on them to reject this attack on working families and vulnerable Americans.”
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