paul ryan
House Speaker Paul Ryan. Ty Wright/Getty Images


The Congressional Budget Office on Wednesday released an updated score for the American Health Care Act, the House GOP healthcare bill, that said it could leave millions more uninsured and undermine protections for people with preexisting conditions.

The CBO projected that 23 million more Americans would be uninsured by 2026 compared with the current healthcare system — slightly lower than the 24 million more Americans it estimated would be uninsured under the previous iteration of the bill.

“Premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums,” the CBO’s report said.

The report, conducted in the wake of two amendments to the bill before it passed the House earlier this month, projected that the AHCA would cut the federal deficit by $119 billion — $32 billion less than the savings the CBO estimated in March.

That aspect is crucial because Republicans introduced the bill using a process known as budget reconciliation, which means it must be projected to shave at least $2 billion from the federal deficit to be able to pass with a simple majority in the Senate. House Speaker Paul Ryan had delayed sending the bill to the Senate in anticipation of the latest CBO score.

The report also confirmed one of the biggest worries of health-policy experts and constituents: that the bill could undermine protections for people with preexisting conditions.

The CBO looked at the possible effects of an amendment that would allow states to apply for a waiver to repeal the essential health benefits and community-rating protections established by the Affordable Care Act, the healthcare law also known as Obamacare.

Ryan, who championed the AHCA, said the report confirmed it “achieves our mission: lowering premiums and lowering the deficit.” But Democrats and some Republicans slammed the bill and suggested that a new approach might be needed.

“With today’s news, the ‘collapse and replace’ of Obamacare may prove to be the most effective path forward,” Republican Sen. Lindsey Graham of South Carolina said on Wednesday.

About one-sixth of the US population lives in a state that the CBO projects would receive a waiver for community rating, which mandates insurers charge people of the same age living in the same area the same premiums. Health-policy experts have said that by repealing community rating, insurers could charge people with preexisting conditions more and price them out of the market.

That concern was echoed by the CBO and Joint Committee on Taxation’s report, which projected that sick people could eventually be priced out of insurance:

“CBO and JCT expect that, as a consequence, the waivers in those states would have another effect: Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under HR 1628 to help reduce premiums.”

The report’s conclusions run contrary to statements from Republicans leaders who had said that even with the waiver provision, the AHCA had “layers of protections” to make sure people with preexisting conditions would be covered.

The CBO said that about one-third of the population lived in states that would receive waivers for the essential health benefits, a set of procedures and care — such as maternity care and emergency-room visits — that insurers are mandated to cover. Their elimination would cause premiums to fall 20% from the current baseline in those states, according to the CBO, because “insurance policies would provide fewer benefits.”

In states that waive the benefits, the CBO said, more people could have coverage but end up paying higher costs.

“Although premiums would decline, on average, in states that chose to narrow the scope of EHBs, some people enrolled in nongroup insurance would experience substantial increases in what they would spend on healthcare,” the report said. “People living in states modifying the EHBs who used services or benefits no longer included in the EHBs would experience substantial increases in out-of-pocket spending on healthcare or would choose to forgo the services.”

The report said out-of-pocket costs for things like maternity care, substance-abuse treatments, and mental-health care would increase substantially for some people.

In its earlier reports, the CBO said previous versions of the AHCA would not cause the ACA’s individual insurance exchanges to become unstable. With the waiver provision, however, that wouldn’t be the case.

“The agencies estimate that about one-sixth of the population resides in areas in which the nongroup market would start to become unstable beginning in 2020,” the report said. “That instability would result from market responses to decisions by some states to waive two provisions of federal law, as would be permitted under HR 1628.”

The Senate is expected to craft a healthcare bill of its own instead of using the current form of the AHCA.

As reported by Business Insider