Thirty-two million fewer people would have health coverage, health insurance premiums would double and the insurance market would destabilize over the next 10 years under legislation the Senate may take up next week, according to a report the Congressional Budget Office published Wednesday.
This isn’t the Better Care Reconciliation Act, the measure to repeal and “replace” the Affordable Care Act that Senate Majority Leader Mitch McConnell (R-Ky.) shelved Monday because it lacked enough support to pass ― and that President Donald Trump and some Republican senators are trying to revive.
Instead, McConnell said he plans to bring up legislation bluntly entitled the Obamacare Repeal Reconciliation Act, which is based on a bill Congress passed in 2015 and that President Barack Obama vetoed last year.
Both the House-passed American Health Care Act and the Better Care Reconciliation Act sought to erect new health insurance systems and new, less generous forms of financial assistance as well as eliminate many of the Affordable Care Act’s regulations and consumer protections.
The Obamacare Repeal Reconciliation Act, by contrast, would merely eliminate the Affordable Care Act’s tax credits for private insurance, funding for its Medicaid expansion, the individual mandate that most Americans obtain health coverage or face tax penalties, the mandate that large employers offer health benefits to workers, and the taxes on wealthy people and health care corporations.
The result of those policies, the Congressional Budget Office projected in its report Wednesday, would be vastly more uninsured people and an unsustainable health insurance market.
Taking away financial assistance for private insurance and funding for states that expanded Medicaid under the Affordable Care Act would cause millions to lose coverage, including 17 million next year alone.
But the damage to the health care system would go deeper. Absent the individual mandate ― which encourages low-cost healthy people to enroll in coverage ― and the tax credits for insurance policies sold on the exchanges, insurers would be forced to increase premiums to cover the expense of treating those customers who are sick enough that they are motivated to buy coverage.
That’s largely because bill would leave in place guarantees of coverage for people with pre-existing conditions as well as regulations that make coverage more generous. And that mix of policies would create a nightmarish scenario for insurers, according to the Congressional Budget Office.
The outcome, the Congressional Budget Office expects, is health insurance companies would exit the segment of the market for people who buy their insurance directly or through an exchange. About three-quarters of the country’s population would live in geographic areas with no health insurance providers by 2026, the report says.
These consequences would be even more severe than those the Congressional Budget Office projected for the House-passed bill and McConnell’s legislation. Under the American Health Care Act, 23 million fewer people would have health coverage by 2026, and under the Better Care Reconciliation Act, 22 million fewer would be covered.
At times, Trump and GOP congressional leaders have called for a two-step legislative process ― dubbed “repeal and delay” ― that would entail first passing legislation like the Obamacare Repeal Reconciliation Act that undoes major parts of the Affordable Care Act, and then subsequently enacting a “replacement” bill.
That process in and of itself could cause chaos in the health insurance market as insurers and consumers would be left in limbo until the second phase of legislating is concluded. And that’s even assuming the Republicans can come together on a set of health care reforms, which they have been incapable of doing in the seven-plus years the Affordable Care Act became law.
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