Twenty-two million more people will be left uninsured under the Better Care Reconciliation Act (BCRA) than under current law, according to the Congressional Budget Office (CBO). The number of uninsured is largely due to the drastic cuts in the Medicaid program; 15 million people will lose Medicaid coverage by 2026.
Fifteen million more people will be uninsured by 2018. That number will increase to 19 million in 2020, and 22 million by 2026. The number of uninsured will be disproportionately larger among older people with lower incomes.
Other major takeaways from the CBO report published Monday include:
- $321 billion reduction in the federal deficit by 2026 (largely due to Medicaid cuts and a reduction in subsidies; the repeal of Affordable Care Act taxes helped increased the deficit).
- In 2020, average premiums for benchmark plans for single individuals will be 30 percent lower than current law; however, they will be less comprehensive.
- These benchmark plans, with an actuarial value of 58 percent — meaning insurers will only need to pay 58 percent of out-of-pocket costs — will make the plan “unattractive” overall. The high deductibles will especially discourage low-come people.
Senate Republicans have already revised Thursday’s draft health care bill, and that’s the bill the budget office accounted for. The revised bill was revealed shortly before the CBO published its score. (A side by side comparison of the revised and old bill can be seen here.) The draft bill will likely change again before the Senate is set to vote later this week, leaving no time for an accurate estimate of how many millions of people could lose their health care.
As long as the key aspects of the BCRA remain in tact, the high number of uninsured will likely remain and the quality of the coverage will be less comprehensive, according to health experts like the Center on Budget and Policy Priorities. More people will be uninsured compared to current law as long as the BCRA insurance plans have insurers pay less of the out-of-pocket expenses, tax credits are tethered to a less generous benchmark, and funding to Medicaid is fixed.
Senate Republicans changed the draft bill mainly by adding a continuous coverage provision. This added provision locks patients out from enrolling in the individual market for six months if they’ve had at least a 63-day gap in coverage. The move is a counter-intuitive way to get people coverage.
As Kaiser Family Foundation senior vice president Larry Levitt pointed out on Twitter, the provision delays care for both healthy and sick people, even if they apply for insurance during open enrollment. In a tweet, he said the “likely biggest effect of a 6-month waiting period would be to prevent some sick people from getting care immediately after signing up.” He also noted that it could lower premium costs, but only by changing the quality of care to sick individuals.
The Senate bill revealed Thursday repealed the individual and employer mandate, but left nothing in its stead. Without any sort of requirement to get health insurance, as ThinkProgress reported last week, the insurance market is subject to collapse.
One of the more disastrous changes to the Affordable Care Act is the overall massive cut to the Medicaid program. The revised bill ends Medicaid expansion by 2024, and for eight states with “trigger” laws — that automatically end the expansion if federal funds are decreased — as early as 2021. (The Center on Budget and Policy Priorities projects that Alaska’s Medicaid expansion could end as early as 2020, due to local state law.)
In addition to ending Medicaid expansion, the Senate bill, like the House bill, would impose a per capita cap on Medicaid funding. After 2026, the Senate bill breaks from the House by adjusting the metric by which the federal government funds each beneficiary, thus shifting even more costs to the states.
The most apparent trade off at the center of the Senate bill is cuts to the Medicaid program in exchange for generous tax cuts to the wealthy. Like the House bill, except for some implementation dates, the Senate bill repeals Obamacare taxes imposed primarily on the wealthy, that amount to about $765 billion dollars. By 2026, the federal government will reduce Medicaid funding by $772 billion, according to the CBO.
The Senate bill could cut between $2.0 and $3.8 trillion from total (federal and state) Medicaid spending between 2017–2036, according to the American Association of Retired Persons (AARP). Unlike the CBO, the AARP’s 20-year projection accounts for the Senate’s overall cuts to the program, which are slated to begin in 2026.
The CBO’s projection of the Senate uninsured rate, compared to the House’s of 23 less insured, is largely due to how the premiums tax credits are set up. However, the quality of care is not as good as under current law; ACA requires insurers to cover essential benefits and under the senate bill, states could opt out.