The non-partisan Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) reported on Monday that 14 million more people would be without health coverage next year under the GOP replacement for Obamacare, the American Health Care Act. Because the bill caps states’ per-enrollee spending on Medicaid, the CBO predicts that by 2026, an estimated 52 million people would be uninsured, compared with 28 million likely uninsured under current law.
The CBO also found that the Republican health care plan would reduce federal spending by $337 billion over 10 years, with much of the savings achieved through drastic cuts to Obamacare’s massive Medicaid expansion, though these savings would be offset somewhat by state grants and new tax credits. (This overall deficit reduction is key to passing the bill, since, under the sometimes arcane rules of the Senate, if a bill reduces the deficit, it can be passed on a simple majority vote.)
The Trump administration was quick to “disagree strenuously with the report,” according to Health and Human Services Secretary Tom Price on Monday, who argued that those aforementioned and yet-unreleased plans for regulatory changes and state grants would actually expand insurance coverage.
Meanwhile, House Speaker Paul Ryan highlighted that the reason more people will be off the insurance rolls is because the bill does not mandate coverage. “The one thing I’m certain will happen is CBO will say, ‘Well, gosh, not as many people will get coverage.’ You know why? Because this isn’t a government mandate,” Ryan said on CBS over the weekend. “So there’s no way we can compete with, on paper, a government mandate with coverage.”
But the bill does have a mandate of a sort, a lifetime penalty if one foregoes insurance – but instead of the government collecting the revenue, the 30 percent fine goes to the insurance companies.
Meanwhile, in 2018, when many in Congress are up for reelection, premiums in the individual market are expected to rise 20 percent, according to the CBO.
It’s hard to see how the GOP, which made an Obamacare repeal the centerpiece of its opposition to Democrats for the better part of a decade, could retain its majority in 2018 if this bill passes. If somehow they did, after that, the CBO sees premiums decreasing and by 2026, average premiums would be roughly 10 percent lower than under the current system. The reason the premiums eventually become less expensive is because the bill allows older people to be charged five times more than younger people, compared to a ratio of 3 to 1 under Obamacare.
Still, try selling that to the American public: “Your premiums just went up, but wait – it will get better!”
Tom Price at least tried on “Meet the Press” last Sunday: “I firmly believe that nobody will be worse off financially in the process that we’re going through.” But that sounds an awful lot like President Obama circa June 2009: “If you like the plan you have, you can keep it. If you like the doctor you have, you can keep your doctor, too. The only change you’ll see are falling costs as our reforms take hold.”
The House has held over 60 votes to repeal Obamacare. Less than 15 months ago, they sent a full repeal bill to President Obama’s desk. When he predictably vetoed it, Republicans promised that if elected to the presidency and majorities in both congressional chambers, they would immediately repeal and replace the law.
Now, as the liberal site Vox.com notes, “A curious thing has happened to the Republican replacement plan as it has evolved through multiple drafts: it has begun to look more and more like Obamacare itself.”