Premiums would decline over long term, but so would coverage; Medicaid would take a 26 percent cut, analysis says

Health.com
June 27, 2017

MONDAY, June 26, 2017 (HealthDay News) -- The Senate Republican plan to repeal and replace the Affordable Care Act would leave 22 million more Americans uninsured by 2026, the Congressional Budget Office (CBO) said Monday.

Hours earlier, Senate Republicans released an updated version of their bill that includes a provision requiring people with a gap in health insurance to wait six months before new coverage would start. That so-called continuous coverage provision is meant to encourage more Americans to buy health insurance, and not wait to buy it until a medical need arises.

As it is, the Senate bill would reduce the federal deficit by $321 billion over the next decade by cutting Medicaid spending and repealing or modifying taxes under the Affordable Care Act -- also known as Obamacare, the nonpartisan CBO said. The House bill unveiled last month shaved the federal deficit by $119 billion.

Average premiums would be about 20 percent higher in 2018 than under the Affordable Care Act, Monday's report said. That's largely because the penalty for not having health insurance -- the Affordable Care Act's so-called individual mandate -- would be eliminated.

However, by 2020, average premiums under the Senate proposal would be about 30 percent lower than under current law. One reason? Those plans would cover fewer benefits than under Obamacare.

The highly anticipated CBO report comes ahead of an effort by Senate Republican leaders to push the bill toward a vote, perhaps as early as this week, before the July 4 recess.

The White House remains "very confident" about prospects for the bill, spokesman Sean Spicer said ahead of the report's release. And President Donald Trump will "continue to listen to senators who have ideas about how to strengthen it," he added.

According to the CBO report, the Senate bill would result in 49 million people lacking health coverage by 2026 -- 22 million more than would have been uninsured under Obamacare.

That's slightly better than the House GOP bill. An earlier CBO analysis said that measure would cause 23 million more Americans to lose health coverage by 2026.

However, more Americans would lose health insurance in the short run under the Senate bill as it stands: an estimated 15 million fewer Americans would have coverage in 2018, compared to 14 million under the House bill.

Senate Republicans crafted their bill behind closed doors, irking some Republicans as well as Democrats who got their first glimpse of the measure on June 22 -- just days ahead of a planned vote.

To move the proposal ahead, 50 of the Senate's 52 Republican members must vote in favor of the bill, with Vice President Mike Pence serving as the tie-breaker.

However, the fate of the Senate measure remains in doubt, with five GOP legislators going on record last week that they cannot support the bill as written. Senate Majority Leader Mitch McConnell (R-Ky.) has indicated he would continue negotiations to bump up the vote count.

"It's going to be very close, but we're working with each one of them in trying to accommodate their concerns without losing other support," said No. 2 Senate GOP leader John Cornyn of Texas. He added, "When senators tell me they want to get to yes, that means that we have a very good chance to get to yes," the Associated Press reported.

Senate Minority Leader Chuck Schumer (D-N.Y.) said, "This bill is every bit as mean as the House bill."

The Senate bill's largest savings would come from reductions in spending for Medicaid, the government-run insurance program for lower-income Americans, which would drop 26 percent over the next decade compared with current law, the CBO said.

A majority of Americans -- 51 percent -- now say they have a favorable view of the Affordable Care Act, according to the latest Kaiser Family Foundation tracking poll. It's the first time since the foundation began conducting the poll in 2010 -- the year Obamacare was signed into law by then-President Barack Obama -- that favorable sentiments have topped 50 percent.

More information

Visit the Congressional Budget Office for more on the analysis of the Senate's health bill.

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