(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)
WASHINGTON — A bill to dismantle the Affordable Care Act that narrowly passed the House this month would increase the projected number of people without health insurance by 14 million next year and by 23 million in 2026, the Congressional Budget Office said Wednesday. That 10-year figure is slightly less than originally estimated.
It would reduce the federal deficit by $119 billion over a decade, less than the $150 billion in savings projected in late March for an earlier version of the bill. And in states that seek waivers from rules mandating essential health coverage, the new law could make insurance economically out of reach for some sick consumers.
“Premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums,” the budget office concluded.
The new forecast of the nonpartisan Congressional Budget Office, Capitol Hill’s official scorekeeper, is another blow to Republican efforts to undo President Barack Obama’s signature domestic achievement. The Senate has already said it will make substantial changes to the measure passed by the House, but even Senator Mitch McConnell of Kentucky, the majority leader, is sounding uncertain about his chances of finding a majority to repeal and replace the health law.
“I don’t know how we get to 50 at the moment,” Mr. McConnell told Reuters on Wednesday. “But that’s the goal.”
The new report from the budget office is sure to influence Republican senators, who are writing their own version of the legislation behind closed doors. The report provided fresh ammunition for Democrats trying to kill the repeal bill, which they have derided as “Trumpcare.”
Republicans in Congress generally focus more on reducing health costs than on expanding coverage. Their proposals will inevitably cover fewer people than the Affordable Care Act, they say, because they will not compel people to buy insurance.
Republicans have been trying to repeal Mr. Obama’s health law since the day he signed it in March 2010. But the task is proving more difficult than they expected. Many parts of the law have become embedded in the nation’s health care system, and consumers have risen up to defend it, now that they fear losing its protection. At the same time, other consumers, upset about the mandate to buy insurance they can barely afford, are demanding changes in the law.
The budget office issued two reports on earlier versions of the House bill in March. Both said that the legislation would increase the number of uninsured by 14 million next year and by 24 million within a decade, compared with the current law.
Republican senators appear as determined as ever to replace the health law.
“The status quo under Obamacare is completely unacceptable and totally unsustainable,” Mr. McConnell said Wednesday, a few hours before the budget office issued its report. “Prices are skyrocketing, choice is plummeting, the marketplace is collapsing and countless more Americans will get hurt if we don’t act.”
“Beyond likely reiterating things we already know — like that fewer people will buy a product they don’t want when the government stops forcing them to — the updated report will allow the Senate procedurally to move forward in working to draft its own health care legislation,” he added.
The instability of the health law’s insurance marketplaces was underscored again on Wednesday when Blue Cross and Blue Shield of Kansas City, a nonprofit insurer, announced that it would not offer coverage under the law for 2018. The insurer lost more than $100 million in 2016 selling individual policies under the law, said Danette Wilson, the company’s chief executive.
CreditAl Drago/The New York Times
“This is unsustainable,” she said in a statement. “We have a responsibility to our members and the greater community to remain stable and secure, and the uncertain direction of the market is a barrier to our continued participation.”
While the vast majority of people the company covers get insurance through an employer or a private Medicare plan, Blue Cross of Kansas City covers about 67,000 people in Kansas City and western Missouri under the federal health care law. The company’s departure could leave 25 counties in western Missouri without an insurer, said Cynthia Cox, a researcher at the Kaiser Family Foundation.
Democrats say much of that instability stems from Republican efforts to repeal and undermine the Affordable Care Act. The Senate minority leader, Chuck Schumer of New York, harshly criticized House Republicans for voting on their revised repeal measure without an updated analysis from the budget office.
“Republicans were haunted by the ghost of C.B.O. scores past, so they went ahead without one,” Mr. Schumer said. That action, he said, was reckless — “like test-driving a brand-new car three weeks after you’ve already signed on the dotted line and paid the dealer in full.”
The House repeal bill was approved on May 4 by a vote of 217 to 213, without support from any Democrats. It would eliminate tax penalties for people who go without health insurance and would roll back state-by-state expansions of Medicaid, which have provided coverage to millions of low-income people. And in place of government-subsidized insurance policies offered exclusively on the Affordable Care Act’s marketplaces, the bill would offer tax credits of $2,000 to $4,000 a year, depending on age.
A family could receive up to $14,000 a year in credits. The credits would be reduced for individuals making more than $75,000 a year and families making more than $150,000.
Senior Republican senators say they want to reconfigure the tax credits to provide more financial assistance to lower-income people and to older Americans, who could face much higher premiums under the House bill.
The House bill would roll back a number of insurance requirements in the Affordable Care Act, which Republicans say have driven up the cost of coverage.
In the weeks leading up to passage of the House bill, Republican leaders revised it to win support from some of the most conservative members of their party.
Under the House bill, states could opt out of certain provisions of the health care law, including one that requires insurers to provide a minimum set of health benefits and another that prohibits them from charging higher premiums based on a person’s health status.
Insurers would not be allowed to charge higher premiums to sick people unless a state had an alternative mechanism, like a high-risk pool or a reinsurance program, to help provide coverage for people with serious illnesses.
Senate Republican have been meeting several days a week, trying to thrash out their differences on complex questions of health policy and politics, like the future of Medicaid.
Asked why Democrats had been excluded, Mr. McConnell said, “We’re not going to waste our time talking to people that have no interest in fixing the problem.”
Democrats have said they would gladly work with Republicans if the Republicans would renounce their goal of repealing Mr. Obama’s health care law.