Budget savings are larger but a revised Senate health bill would still leave 22 million uninsured by 2026 compared to leaving current law intact, the Congressional Budget Office concluded Thursday.
Make it 32 million if Congress repeals the Affordable Care Act without a replacement handy, CBO said.
Both plans have struggled to find enough Republican votes to pass the Senate, though leadership has vowed to keep pushing for a vote to fulfill a longstanding campaign promise as early as next week.
“The CBO scores are not helpful for either bill,” blogged Timothy Jost, author and emeritus professor at the Washington and Lee University School of Law. Under the Senate replacement bill, average premiums could start to fall in 2020 after an initial rise pegged at 20 percent in 2018, but deductibles — the medical and drug costs consumers pay before benefits kick in — could jump to more than $10,000 a year, half the annual income of some people.
“The CBO projects that few lower-income people would buy coverage with this little value,” Jost said.
Senate Majority Leader Mitch McConnell tweeted Thursday that “Americans deserve better” than Obamacare, but Consumers Union called the revised bill “just as harmful as before.”
Florida Gov. Rick Scott said Wednesday in Boca Raton he continues to support outright repeal because Obamacare has been a “disaster.”
Florida leads all states with about 1.5 million people buying policies on healthcare.gov and it has an additional 4 million children, disabled people and seniors in nursing homes on Medicaid, the source for most of the budget savings.
The tweaked Better Care Reconciliation Act contributes $420 billion to budget savings over a decade, up from $321 billion in a previous version, largely by reducing Medicaid spending by $772 billion while keeping some Affordable Care Act taxes in place, CBO found.
Under the Senate bill, about 15 million people will lose or choose not to buy insurance in 2018 compared to leaving the current law, analysts projected.
By 2026, 82 percent of U.S. residents under age 65 would be insured, compared with 90 percent under current law, CBO said.
Why? CBO expects fewer people will have coverage from Medicaid as its expansion is wound down and spending is capped, lower-income earners lose subsidies to make insurance affordable on marketplace plans and people don’t face a financial penalty if they don’t want insurance or figure they cannot afford it anyway.
The revised Senate bill would keep some ACA taxes in place to give more money to the states to do things like lower consumer premiums and fight opioid addiction.
Consumer effects would vary depending on how states apply various pots of money, but generally premiums could fall over time for younger, healthier and higher-income customers and rise for older, sicker and low-income people.
People ages 50 to 64 would face much higher costs, as the plan would let insurers charge them five times more than younger ones, up from three times now. AARP opposes that as an “age tax.”
The CBO scored a version that does not include an amendment to allow insurers to offer cheaper “skinny” plans if they offer at least one plan compliant with the Affordable Care Act. Sen. Ted Cruz, R-Texas, has advocated that concept to bring down premium costs for healthy people.
Critics say a big problem with that idea is if healthy people flock to cheaper plans, it could segregate sick people into what amount to high-risk pools with spiraling costs.
The parade of revisions and CBO scores can be hard to follow and might not matter if no bill gets traction, but Senate leaders have said they still plan to push for a vote next week. Still, several GOP senators have already publicly balked at the replacement plan or a revived proposal to repeal Obamacare effective in two years and work on a replacement in the meantime.