Without any analysis from the Congressional Budget Office (CBO) to tell them how their health care bill would affect millions of Americans, House Republicans are nonetheless plowing ahead with a planned vote to replace Obamacare.
The CBO score on the first iteration of their bill found that it would cause 24 million people to lose their insurance by 2026.
A planned vote in March on the Affordable Health Care Act (AHCA) never took place once House Republicans concluded they didn’t have the support to pass it. But after several rounds of changes intended to make it more palatable to the full House GOP caucus, the CBO released a second cost estimate that considered new amendments. This score did not take into account an amendment gutting essential health benefits.
Since the last attempt to vote on the AHCA, Republicans have made even more major changes to the bill, most of which cater to far-right Republicans in the House Freedom Caucus. In April, Republicans added provisions that would allow states to waive essential health benefits, the community rating provision, and age rating rule. The essential health benefits provision mandates a minimum standard of coverage, including for things like maternity care, prescription drugs, and substance abuse treatment. The age rating rule lowers premiums for older people, and the community rating provision protects people with preexisting conditions from being charged too much for coverage.
These changes to the bill — including letting insurers deny coverage for essential health benefits in states that receive waivers — would also affect people’s employer-based plans. The ACA prohibited employer-based plans from putting certain limits on coverage, but in 2011, the Obama administration said employers could follow the state’s required benefits.
Republicans say that their new high-risk pool program would address the needs of people with pre-existing conditions, but experts say that is highly unlikely. At first, Republicans allocated only $15 billion more per year to stability fund used to partially subsidize care of high-risk patients. Though they later added changes that would provide an additional $8 billion in funding for the program, Larry Levitt, senior vice president of the Kaiser Family Foundation, said it won’t be enough.
$8 billion could provide coverage to a few hundred thousand high-risk enrollees, out of millions who might need it.
— Larry Levitt (@larry_levitt) May 3, 2017
Even under pretty conservative estimates, a minimally adequate high-risk pool could cost $25 billion per year nationwide.
— Larry Levitt (@larry_levitt) May 3, 2017
A Center for American Progress analysis released in April found that the risk pool program would do little to offset costs for the sickest Americans. The analysis also found that for pregnant individuals, insurers would charge $17,320 more for premiums. People with metastatic cancer would be charged $142,650 more. (ThinkProgress is an editorially independent news site housed in the Center for American Progress.)
But reports on the program and comments from health care policy experts did not stop Republicans from insisting that the additional $8 billion would protect people with preexisting conditions. A couple Republicans who came out against the bill this week quickly reversed course and supported it on Wednesday. Rep. Fred Upton (R-MO) and Billy Long (R-MO) said the addition of $8 billion to the risk-sharing program caused them to change their minds and vote for the bill.
On Thursday, about a dozen Republicans said they were undecided on the bill, according to Politico.
Rep. Upton defended his choice to back the bill without a CBO score by blaming the CBO for not producing a new score in a matter of hours.
Rep. Fred Upton (R-MI) on his health care bill tweaks: I called for the CBO to release a score. And sadly we don't have it
— Chad Pergram (@ChadPergram) May 4, 2017
Rep. Warren Davidson’s (R-OH) chief of staff, Jason Yaworske, formerly of Heritage Action for America, said Republicans shouldn’t be expected to seek a new CBO score every time they make changes.
It's been public for about 2 months.
There is a CBO score. Do you expect every amendment to cause 1 month delay for re-score? @salimfurth https://t.co/9dpEJZI3go
— Jason Yaworske (@jasonyaworske) May 4, 2017
Rep. David Schweikert (R-AZ) said people should make calculations themselves if they wanted to know how the health care bill would affect people.
Schweikert says "if you pull out your calculator, you can actually do some of the layers of math" on AHCA instead of waiting for a CBO score
— Haley Byrd (@byrdinator) May 4, 2017
Influential groups within the health care industry announced their opposition to the bill last week. The American Medical Association, American Hospital Association, Catholic Health Association, and AARP all came out against the bill.
On Friday, AARP said it sent a letter to each member of the House that told representatives it pledged to “let all 38 million of our members know exactly how their representative votes on this bill.”