Twenty days after House Republicans voted on the American Health Care Act – their plan to replace Obamacare – the Congressional Budget Office finally finished assessing what the bill would do if enacted. According to the nonpartisan agency, 23 million fewer people would be insured in 10 years, the deficit would see a moderate reduction, individuals with preexisting conditions would lose coverage in certain states and the elderly poor would see massive increases in their health care costs.
As bad as all that sounds, leaders in the House are breathing a sigh of relief because there was a chance, based on the CBO's findings, that the bill would have to be re-worked and put to a second vote – a vote it was unclear the bill would survive – before it could be sent to the Senate. Unfortunately for everyone else, that didn't happen.
Still, the bill's future is uncertain. Health care reform is Mitch McConnell's problem now, and the majority leader is not particularly optimistic about its chances at the moment.
Here's what you need to know about this incarnation of the AHCA in the meantime.
Under the AHCA, 23 million more people would be uninsured than under Obamacare.
If the current health care law is left in place, the CBO estimates that in a decade some 28 million Americans will not have insurance. Under the Republican replacement plan, that number would nearly double, to 51 million people. A "few million" of those, the CBO says, would be paying for policies so skimpy that they essentially don't count as insurance – policies that would not cover "major medical risks," for instance. While stupefying, the figure is a hair better than the first incarnation of the GOP health care bill, which the CBO estimated would have left 24 million people uninsured by 2026.
It would reduce the deficit, mostly through cuts to Medicaid.
The AHCA would at least achieve the Republicans' goal of reducing the deficit. The CBO pegs the savings at $119 billion over 10 years. To put that in perspective,earlier this week the Trump administration proposed increasing the defense budget by about half that amount, $54 billion, next year alone.
According to the CBO, most of those savings would come from cuts to Medicaid, a program Trump promised to protect on the campaign trail. Those cuts, along with the elimination of Obamacare's insurance subsidies, are designed to offset other provisions of the bill that would increase the deficit; one such provision repeals a tax on investment income, while another repeals annual fees paid by health insurers. That's right: The plan takes away money from sick, poor people in order to make more money available to rich people and health insurance companies.
Insurance markets would become unstable.
One of the major reasons the American Health Care Act got through the House earlier this month was because of the addition of the so-called MacArthur amendment. Written by the former CEO of an insurance company, Rep. Tom MacArthur, the amendment would allow insurers in certain states to cover less than what is the bare minimum under current law – things like doctors' and hospital visits, prescription drugs, pregnancy and childbirth and mental health services (otherwise known as essential health benefits). It would also allow insurers in certain states to charge higher premiums to individuals with pre-existing conditions.
According to the CBO, the insurance markets in those states – where about a sixth of the U.S. population lives – would become unstable as a result, starting in 2020. Premiums would increase so dramatically for people with pre-existing or new medical conditions that, if they could purchase insurance at all, they wouldn't be able to buy it at rates comparable to what they would under the current law.
MacArthur, for his part, rejects the CBO's assessment. "That is somebody's opinion at CBO. I have a different opinion," he reportedly said.
The most vulnerable would see "substantial" increases in health costs.
The CBO says that under the AHCA, the cost of premiums on average would decrease in states that opted out of covering essential health benefits, but people who need those benefits the most – pregnant women, individuals seeking help for mental health or substance abuse, anyone needing rehabilitative and habilitative services – would see dramatic cost increases, to the tune of "thousands of dollars in a given year." Individuals with conditions that require expensive treatment would also be out of luck: The bill does away with the annual and lifetime limits on health care spending that exist under current law.
Finally, while the new bill would mean lower insurance premiums for the youngest and healthiest Americans, it would mean the opposite for the country's oldest and poorest. A senior with an income of $26,500 currently pays a premium of $1,700; under the Republican bill, the same insurance plan would cost that senior $13,600 – more than half of her annual income.