The Senate version of the Republican health care bill would allow some Americans to pay less for skinnier plans but result in 22 million fewer people holding coverage a decade from now, the Congressional Budget Office said Monday in estimates that could make it harder for the GOP to scrap Obamacare.
The new “score” is only slightly less daunting than CBO’s analysis of an Obamacare replacement that squeaked through the House and is projected to knock 23 million out of coverage.
That could spook centrists Republicans who aren’t sure if they can back the draft plan Majority Leader Mitch McConnell released on Thursday.
Scorekeepers said the Senate GOP bill will reduce federal deficits by $321 billion over the next decade. It’s far more than the $119 billion in savings from a House version of the bill, largely driven by changes to Medicaid that take effect in 2026.
Savings could have been even greater, though senators made tax credits more generous for certain people who buy insurance on their own.
The CBO said average premiums for popular health plans should drop by 30 percent by 2020 and 20 percent a decade from now, in part because states could waive certain benefits and insurance would pay for a smaller average share of benefits.
The analysts’ findings could significantly influence Republican senators who are trying to decide whether to back the plan.
Sens. Susan Collins of Maine and Dean Heller of Nevada have both said they cannot support a bill that knocks tens of million of Americans out of coverage, though it’s unclear if they have a cutoff in mind.
Budget analysts estimated that 15 million more people would be uninsured in 2018, mostly because the bill would scrap penalties tied to Obamacare’s individual mandate. In later years, tax credits that are less generous than Obamacare, on average, and phased-in cuts to Medicaid spending would result in many more people without coverage.
All told, an estimated 49 million people would be uninsured by 2026 compared to 28 million who would lack it under the Obamacare framework.
Mr. McConnell can afford only two defections from his 52-seat majority and still pass a bill under fast-track budget rules that allow Senate Republicans to avoid a Democratic filibuster.
Yet five Senate Republicans have said they cannot vote for the bill in its current form — four conservatives who say the legislation doesn’t fix Obamacare’s flaws and drive down premiums, and Mr. Heller, who is vulnerable in the 2018 election cycle and says the bill is too tough on Medicaid coverage for the poor.
One GOP holdout, Sen. Ron Johnson of Wisconsin, openly criticized GOP leaders on Monday, saying they were trying to “jam this thing through.” He wants more time to improve the bill so that it slashes premiums further.
Though many Americans could see lower premiums under the Senate plan, the CBO said customers would likely pay more out of pocket in some cases, and those who actually need one of Obamacare’s “essential benefits” would pay significantly more in states that loosen the regulations.
Both sides of the Obamacare fight spotlighted the parts they liked about the report.
Senior Republicans said they were slashing costs, though they’ve also heaped doubt on the CBO’s ability to guess how many people might lose coverage, saying it depends on future behavior once Obamacare’s heavy mandates are lifted.
As expected, Democrats pounced on the CBO’s estimate of coverage losses.
“Today’s CBO report further confirms that the Senate Trumpcare bill is just as devastating as the House bill,” said Rep. Frank Pallone, New Jersey Democrat.
As written, the Senate GOP bill repeals most of Obamacare’s taxes, replaces its generous subsidies with refundable, age-based tax credits and reins in and caps spending on the Medicaid program for the poor. It also strips Planned Parenthood of federal funding as punishment for its abortion practice.
Unlike the House bill, the Senate plan scales down funding for states that embraced President Obama’s vast expansion of Medicaid for the poor through 2024, rather than freezing it in 2020. It also provided more generous tax credits to poorer and older Americans who could struggle to afford coverage under the House plan.
Senate Republicans revised the plan Monday to replace Obamacare’s individual mandate with a provision designed to prevent Americans from dropping coverage and then signing up again once they get sick.
The updated draft says consumers who had a more than two-month lapse in coverage during the prior year must wait six months until their insurance takes effect. It’s a twist on the House bill, which would have allowed insurers to tack a surcharge on consumers who sign up after a long lapse in coverage.
The CBO said the provision would slightly increase the number of people with insurance in later years, though not in 2019, when premiums would be relatively high and deter people from retaining coverage.