The latest Senate Republican bill to replace the Affordable Care Act (ACA) would reduce the federal deficit by at least $133 billion over 10 years, but at the cost of increasing the number of uninsured Americans “by millions,” the Congressional Budget Office (CBO) said today.
The CBO said it would need several more weeks to provide more specific estimates on how the bill would affect the federal budget, health insurance coverage, and premiums for plans sold on the marketplaces, or exchanges, created by the ACA. It issued today’s preliminary study at the request of the bill’s chief sponsors, Senators Lindsey Graham (R-SC) and Bill Cassidy, MD (R-LA), who are aiming for a Senate vote this week. Under a budget resolution enacted by the Republican-controlled Congress, their ACA repeal-and-replace legislation can’t be filibustered, and needs only a simple majority for passage, but only through September 30. After that date, the Senate’s 52 Republicans would not have enough votes to overcome a filibuster by their unified Democratic colleagues.
The CBO based its analysis on the first version of the Graham-Cassidy bill, which has been amended since then to make it more fiscally generous for states represented by reluctant Republican Senators. However, today’s report was enough to swing Sen. Susan Collins (R-ME) over to the “no” column, where she joins Sen. John McCain (R-AZ) and Sen. Rand Paul (R-KY). As it stands, bill sponsors don’t have the minimum 50 votes needed for passage (Vice President Mike Pence would supply the tie-breaking 51st vote).
The Graham-Cassidy bill takes money earmarked by the ACA for Medicaid expansion, premium and cost-sharing subsidies for exchange plans, and the Basic Health Plan that states can implement under the law, and distributes it to states in the form of block grants between 2020 and 2026. The CBO said that the bill reduces the deficit mainly because the new block grants would be smaller than the various ACA subsidies for healthcare. The difference is partly offset by the repeal of the penalty for the individual and employer mandates, which would yield about $200 billion in revenue between 2020 and 2026.
The threshold of $133 billion cited by the CBO represents the savings achieved by the ACA repeal-and-replace bill passed by the House earlier this year.
The projected increase in the ranks of the uninsured could vary widely, the CBO said, “depending on how states implemented the legislation, although the direction of the effect is clear.” The agency ticked off three main reasons why the bill would leave more people uninsured:
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Enrollment in Medicaid would decrease because of “large reductions in federal funding” for the program.
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Lower subsidies under the bill would depress enrollment in individual health plans in the exchanges.
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Repeal of the penalties for the individual and employer mandates would erode enrollment in all types of health insurance.
These enrollment dips would be partially offset by people signing up for new insurance programs created by states with block grant money and “somewhat higher enrollment in employment-based insurance,” the CBO said.
The CBO report is available on the agency’s website.
Follow Robert Lowes on Twitter @LowesRobert
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