Updated Trumpcare Bill Will See 41 Million Americans Be Health Care Losers

Sick people would probably have to pay more under the health bill passed by the House, the Congressional Budget Office reports. Credit Ozier Muhammad/The New York Times

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.

Read the complete articles in the New York Times here and here.

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House May Need to Vote Again on GOP Obamacare Repeal Bill

House Republicans barely managed to pass their Obamacare repeal bill earlier this month, and they now face the possibility of having to vote again on their controversial health measure.

House Speaker Paul Ryan hasn’t yet sent the bill to the Senate because there’s a chance that parts of it may need to be redone, depending on how the Congressional Budget Office estimates its effects. House leaders want to make sure the bill conforms with Senate rules for reconciliation, a mechanism that allows Senate Republicans to pass the bill with a simple majority.

Republicans had rushed to vote on the health bill so the Senate could get a quick start on it, even before the CBO had finished analyzing a series of last-minute changes. The CBO is expected to release an updated estimate next week.

“Unaware,” said Representative Jeff Denham of California, with noticeable surprise Thursday, when advised that his party leaders still hadn’t sent the bill over to the Senate. Denham was one of the House Republicans who ended up voting for the measure, after earlier in the week opposing it.

“I am on the whip team and we have a lot of conversations, but we have not had that one. So I am going to look into it,” said Denham, a member of the party’s vote-counting team.

In the Senate, the bill must hit separate $1 billion deficit reduction targets in the jurisdiction of the Finance Committee and the chamber’s health committee. Republican aides said failing to meet those numbers would force the House to fix the bill even if the legislation meets the overall cost-savings target.

If Republican leaders hold onto the bill until the CBO report is released, then Ryan and his team could still redo it if necessary. That would require at least one more House vote of some sort.

Ryan told conservative radio host Hugh Hewitt on Friday that he doesn’t think the House will need to vote again on the health law. “We just want to, out of an abundance of caution, wait to send the bill over to the Senate when we get the final score,” Ryan said.

It’s unclear what assumptions the CBO will make about what states will do with that newly created flexibility. If millions of people sign up for much cheaper, minimal insurance, that could trigger billions — and potentially even hundreds of billions — in costs over a decade because of the House bill’s health insurance tax credits.

Read the complete article on Bloomberg web site.