Politics: CBO says GOP healthcare bill would leave 23 million more uninsured, undermine protections for people with preexisting conditions

The CBO's report on the amendments added to the AHCA before the House passed the bill shows that 23 million more Americans could be uninsured by 2026.

The Congressional Budget Office on Wednesday released an updated score for the American Health Care Act, the House GOP healthcare bill, that showed it would leave millions more uninsured while potentially undermining protections for people with preexisting conditions.

The report projected that 23 million more Americans would be uninsured by 2026 compared with the current healthcare system — slightly lower than the 24 million the CBO 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 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 plan to consider the bill under the reconciliation process in the Senate, which means the bill must be projected to shave at least $2 billion from the federal deficit to be considered. 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," said Republican Sen. Lindsey Graham of South Carolina.

About one-sixth of the population in the US lives in a state that the CBO projects would receive a waiver for community rating. That provision says insurers must charge people of the same age living in the same area the same amount for 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 in the CBO projections, which said sick people could eventually be priced out of insurance.

From the report:

"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 non-group 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 H.R. 1628 to help reduce premiums."

The report's conclusions ran contrary to what Republicans leaders had said in the lead up to the passage of the law — that even with the waivers, the AHCA had "layers of protections" to make sure those with preexisting conditions would be covered.

The CBO said roughly one-third of the population lives in states that would receive waivers for the essential health benefits, which impose a mandatory set of procedures and care that an insurer must cover — such as maternity care and emergency-room visits. That would drive down premiums by 20% from the current baseline in those states, according to the CBO, because "insurance policies would provide fewer benefits."

In those states that waive EHBs, 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 health care," said the report. "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 health care or would choose to forgo the services."

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

In each previous report, the CBO said Obamacare and previous versions of the AHCA would not cause the individual health insurance markets to become unstable. Under the new waiver provision, however, that would no longer 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 H.R. 1628."

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

The CBO's report on the amendments added to the AHCA before the House passed the bill shows that 23 million more Americans could be uninsured by 2026. Read Full Story