CBO: 22 million would lose health coverage under Senate bill

Nonpartisan office says bill would cut deficit by $321B over a decade.

A Senate Republican plan to replace Obamacare would increase the number of Americans without health insurance by 22 million while reducing the deficit by $321 billion over the next decade, the nonpartisan Congressional Budget Office said in a report released Monday.

The CBO, tasked with determining the economic impact of bills, found that the debt would decrease far more under the Senate bill than the earlier passed House bill, which would trim the deficit by $119 billion over a decade, according to the CBO.

Still, the number of uninsured under both the House and Senate bills would appear to provide a roadblock for Republicans who want to fulfill a key promise of the 2016 election cycle: to repeal and replace the 2010 health care law known as the Affordable Care Act.

In May, the House passed a bill that the CBO estimated would increase the number of uninsured by 23 million. The Senate version knocks that down by just 1 million.

Much of the savings from the Senate bill would be spurred by the gradual scale-back of the 2010 law’s expansion of Medicaid. Thirty–one states and the District of Columbia chose to expand Medicaid under Obamacare; that decision led to 700,000 more being insured in Ohio, where Ohio Gov. John Kasich opted to accept the expansion.

The House called for ending the Medicaid expansion by 2020. The Senate bill would more gradually phase out that expansion, ultimately ending it in 2024. The speed of the Medicaid rollback is perhaps the key difference between the House and Senate approaches.

The CBO also found that under the Senate bill, premiums would initially increase but then begin to decline after 2020.

Republican leaders in the Senate appeared to have an uphill battle even before the CBO report. The bill was met with immediate criticism by a group of four conservatives that included 2016 GOP presidential aspirants Ted Cruz of Texas and Rand Paul of Kentucky.

Last weekend, Sen. Dean Heller, R-Nevada, became the fifth Republican to publicly denounce the bill as it stands. In order for the bill to pass, Senate Majority Leader Mitch McConnell must convince at least 50 of the Senate’s Republicans to support the bill. Vice President Mike Pence would cast the tie-breaking 51st vote.

McConnell has said he wants to get a bill approved before a planned recess for the Fourth of July.

Speaking on CNBC’s “Squawk Box” Monday, Ohio Republican Sen. Rob Portman said “the way the bill changes Medicaid concerns me.” He has yet to say how he’ll vote on the bill, saying the cuts would make it “very difficult” for the people now getting Medicaid “to continue to have it.”

Democrats, including Ohio Sen. Sherrod Brown, oppose the bill, saying that ending the Medicaid expansion would be disastrous to the poor, the elderly and the mentally ill.

“The report only underscores what we already know: this bill hurts working families and raises prices on Ohioans,” Brown said. “Instead of jamming through a bill written in secret by insurance company CEOs, we should be working together to lower costs and make health care work better for everyone.”

Said AFL-CIO President Richard Trumka: “Saying the Senate health care bill is less mean than the House bill is like saying you prefer smallpox over the bubonic plague.”

Ohio Rep. Tim Ryan, D–Niles, meanwhile, said the bill would “throw the elderly, sick and poor under the bus in order to finance massive tax cuts for the wealthiest among us.”

Portman, who is one of the key votes Republicans need to pass the health-care bill, earlier this month backed a plan to slowly phase out Medicaid expansion by 2027. It was unclear whether the faster phase out would cause Portman to oppose the bill.

The Senate GOP bill also dramatically alters Obamacare’s requirement that people without insurance be required to buy a plan or face a fine. Obamacare provided tax credits for families of four earning between $34,000 and $98,400 a year to buy individual plans through federal and state marketplaces known as exchanges.

The bill also allows states to seek federal permission to allow insurance companies to offer individual plans that do not include Obamacare’s 10 essential benefits, such as hospitalization, maternity and newborn care, prescription drugs and laboratory services.

The Senate bill, however, differs from the House on pre-existing conditions. The Senate’s bill would maintain Obamacare protections for those with pre-existing conditions, while the House allowed states to remove such protections and give insurers more pricing flexibility.

Like the House bill, the Senate bill would sweep away most of the tax increases approved in 2010 to finance the expansion of health care. Because most of those taxes are paid for by the wealthy or pharmaceutical companies, Republicans have been criticized for cutting taxes on the rich as they take away health coverage from the poor.

Although health care amounts to about one-sixth of the nation’s gross domestic product, neither the House nor Senate bill directly impacts employer-based health care, which is how most Americans receive health care. But should the Republicans pass a bill, some argue that it will become a model for future employer health care plans, with employer plans offering benefits that mirror what are offered under the bill.

About 155 million Americans are insured by their employers, another 55 million by Medicare, which pays health costs for the elderly; and 74 million by Medicaid, the joint federal and state program that provides health care for low-income people and the disabled.

Outcry against the bill is not just limited to a handful of Republicans and basically every Democrat in the Senate. On Monday, James Madara, CEO of the American Medical Association, sent a letter to McConnell and Senate Minority Leader Chuck Schumer opposing the bill.

“Medicine has long operated under the precept of Primum non nocere, or “first, do no harm,” he wrote. “The draft legislation violates that standard on many levels.”

The insurer Anthem, on the other hand, offered some positive words about the bill, saying in a statement that it believed the Senate legislation would ‘‘markedly improve the stability of the individual market.’’

Earlier Monday, Senate Republican leaders altered their bill to penalize people who go without health insurance by requiring them to wait six months before their coverage would begin. Insurers would generally be required to impose the waiting period on people who lacked coverage for more than about two months in the prior year.

Information from The New York Times was included in this story.

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