A report from the nonpartisan Congressional Budget Office says the Republican bill to ‘repeal and replace‘ the Affordable Care Act would reduce the federal deficit by $337 billion over a decade by leaving 24 million more Americans uninsured during that period.
The GOP legislation has drawn opposition from major interest groups, health policy experts and many Republican lawmakers who say it is merely Obamacare with minor revisions.
While supporters are touting lower premiums and deficit cuts that the CBO confirmed, they are also being challenged about what to do with tens of millions added to the ranks of uninsured Americans.
With the current law in place, the CBO estimates if the Affordable Care Act, also known as Obamacare, remained in place the number of uninsured Americans would barely change from around 26 million now to 28 million in 2026.
The uninsured rate would tick up only slightly, from around 9.5 to 10 percent.
However, if the GOP bill were enacted, CBO says the number of uninsured would rise to 31 million this year and by 2026, 52 million would be uninsured under the American Health Care Act, which is the first step in the Republican repeal-and-replace plan.
That Republicans would bring the uninsured rate from 11.4 to 18.6 percent.
Much of the initial spike in uninsured Americans would come from repealing the individual mandate.
“Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums,” the CBO wrote.
But overall, a big chunk of that increase in the uninsured comes from Medicaid, as the Republican bill rolls back the Affordable Care Act’s Medicaid expansion. In 2026, 14 million fewer people would be enrolled in Medicaid under the GOP health care bill, accounting for half the total increase in uninsureds.
In addition, CBO estimates that the Republican bill would reduce the number of employers offering health insurance, in part because it repeals the employer mandate to provide insurance. The CBO also notes that the GOP plan’s tax credits (available only to people who aren’t offered insurance at their jobs) would be available to more people than under Obamacare.
That covers the number of people who would be insured under the legislation, but the type of people covered would also shift: Namely, the people in the individual market would skew younger than they would otherwise. That’s because younger people would have comparatively more financial help, the CBO explained:
“Under the legislation, premiums for older people could be five times larger than those for younger people in many states, but the size of the tax credits for older people would only be twice the size of the credits for younger people,” they wrote.
Obamacare has had difficulty getting enough young and healthy Americans to sign up and help bring premiums down. It appears the GOP plan would shift the balance in the individual insurance market more toward those young, healthy people. But it may not be able to do so while keeping older, less healthy people on board as well.
Premiums would rise, then fall (but not necessarily for everyone)
While the number of uninsured Americans would immediately climb, the trajectory for premiums is more complicated. In the near future, average premiums for single people buying insurance in the individual market would be up to 20 percent higher than they would be under Obamacare.
However, those premiums would eventually settle below where they would be under Obamacare. By 2026, those same premiums would be 10 percent below where they would be under the Affordable Care Act.
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