The Senate now has a clearer sense of the 41 million Americans who would lose under the health bill the House sent them by Donald Trump and the Republicans. It also got a startlingly direct message from government analysts about how destabilizing one of the House ideas could be.
The Congressional Budget Office published its assessment of the House health bill on Wednesday, and warned that a last-minute amendment made to win conservative votes would result in deeply dysfunctional markets for about a sixth of the population. In those places, insurance would fail to cover important medical services, and people with pre-existing illnesses could be shut out of coverage, the budget office said.
It found that about half the country would face thinner coverage for people who buy their own insurance, as it would be unlikely to include mental health and addiction treatment services, maternity care or rehabilitation services. Medical deductibles would also increase.
As in the original version of the bill, winners would include people who are young, healthy and earn higher incomes. They would be better off, assuming they didn’t develop serious health problems. The bill makes big cuts to taxes on payroll and investment income for those earning more than $200,000, and provides more subsidies to buy insurance for people earning between about $50,000 and $150,000. On average, premiums for health plans people buy for themselves would decline over the 10-year period, as coverage becomes less generous.
The report was sharply critical of the idea that sicker patients could be protected in a system that allowed insurers to charge them higher premiums. In the minority of states it predicted would pursue broad waivers of Obamacare’s insurance regulations, the office said that sick customers would face far higher prices and many would be priced out of the market altogether.
The bill would save the federal government $119 billion in a decade.
The largest savings would come from cutting Medicaid and reducing tax credits for middle-income insurance buyers.
Projected cumulative change in deficit, in billions
Because Republicans are using a special legislative process to avoid a filibuster in the Senate, the bill had to comply with special rules. They include saving the federal budget at least $2 billion over 10 years.
An initial version of the bill would have saved the federal government $337 billion over a decade, and a subsequent version would have saved half that amount. House Republicans pulled an earlier bill from the floor because they did not have enough votes to pass it.
In the final bill, however, lawmakers added more spending in various areas to get enough votes to pass, including $8 billion over five years to help cover insurance costs for people with pre-existing conditions.
One of the bill’s most expensive items is a provision that would eliminate about $600 billion in taxes imposed under the Affordable Care Act, including taxes on investment income, prescription drugs and indoor tanning.
23 million more Americans will be uninsured in 10 years.
The budget office projected that in 2018, the number of uninsured would increase to 41 million and would continue to grow. In 10 years, it would become closer to what it was before the Affordable Care Act, President Barack Obama’s signature health law, took effect.
Number of uninsured
People with Medicaid coverage would take the largest loss. In a decade, 14 million fewer people would be enrolled in the program.
The C.B.O. estimates that the increase in the number of uninsured would be disproportionately larger among older people with low incomes.
Cost of insurance could rise more than nine-fold for some older people with low incomes.
The House bill included last-minute amendments that let states seek changes to certain insurance regulations.
The C.B.O. estimates that premiums could go down about 10 to 30 percent for people in states that make moderate changes to these regulations. This is largely achieved by offering skimpier plans and pricing out the old and sick from the insurance market.
Senate leaders, aware of the criticism already leveled at the House bill, say they are writing their own bill. This analysis is likely to offer guidance in where they will and won’t want to go.