Thread: CBO: Senate GOP health-care bill would leave 22 million more people uninsured by 2026

CBO: Senate GOP health-care bill would leave 22 million more people uninsured by 2026

By Amy Goldstein and Kelsey Snell
June 26 at 5:39 PM

Senate Republicans’ bill to erase major parts of the Affordable Care Act would cause an estimated 22 million more Americans to be uninsured by the end of the coming decade — only about a million fewer than similar legislation recently passed by the House, according to the Congressional Budget Office.

The forecast issued Monday by Congress’s nonpartisan budget scorekeepers also estimates that the Senate measure, drafted in secret mainly by Majority Leader Mitch McConnell and aides, would reduce federal spending by $321 billion by 2026 — compared with $119 billion for the House’s version.

The CBO’s analysis has been awaited as a crucial piece of evidence as McConnell (Ky.) and other Republican leaders try to hurry a vote on the bill this week. But they are navigating an expanding minefield of resistance from their own party’s moderate and conservative wings, while Democrats are united against it.

The additional deficit savings gives those leaders plenty of room to add more spending to win votes from skeptical moderate Republicans like Sens. Dean Heller (Nev.), Rob Portman (Ohio) and Bill Cassidy (La.), who want more money and a dedicated fund to help treat opioid abuse. Senate budget rules require that the final legislation save at least $133 billion, more than was saved in the House bill, giving senators $188 billion to make the bill more palatable.

Any extra spending risks alienating conservatives, however, and could threaten a delicate balance McConnell must strike to win votes from at least 50 of the 52 Senate Republicans. And some moderates have said they will decide whether they can support the Better Care Reconciliation Act based on how it will affect Americans who have gained coverage under the ACA during the past few years.

McConnell said Monday that the legislation is an attempt at finding consensus among Republicans on how to fix health care. He urged a quick timeline for action but said the bill is still a draft that can still be changed ahead of a final vote.

“The American people need better care right now,” McConnell said in a speech on the Senate floor. “This legislation includes the necessary tools to provide it.”

Yet Cassidy, who wants to add better protections for people covered under Medicaid, said that the latest changes to the bill have not gone far enough to win his support.

“It makes me more concerned,” Cassidy said in an interview on CNN. “I remain uncommitted.”

The fresh figures come as President Trump, in a sharp pivot from the praise he initially lavished on the House bill, is urging the Senate to provide Americans more generous help with health insurance. On Sunday, the president repeated during a “Fox and Friends” TV appearance a word he had used in a private White House lunch earlier this month with a group of GOP senators: that the House’s version is “mean.”

According to the 49-page report, the immediate increase in the ranks of the uninsured would be slightly larger than under the House version, with an estimated 15 million fewer Americans likely to have coverage in 2018, compared to 14 million in the House bill.

The Senate’s bill also would reduce federal spending on subsidies for people who buy individual health insurance policies significantly more than the House’s version, cutting spending for tax credits by $408 billion by 2026.

Despite uncertainties about how the bill’s moving parts would play out, the report says: “The amount of federal revenues collected and the amount of spending on Medicaid would almost surely both be lower than under current law. And the number of uninsured people under this legislation would almost surely be greater than under current law.”

Democrats immediately seized on the estimates to criticize Republicans for planning a vote on a bill that would force millions to lose insurance coverage and drive up premiums for seniors. Senate Minority Leader Charles E. Schumer (D-NY) said the bill cannot be fixed despite McConnell’s plan to allow senators to make changes before a final vote.

“Republicans would be wise to read it as a giant stop sign,” Schumer told reporters late Monday afternoon. “No matter how the bill changes around the edges, it is fundamentally rotten at the center.”

Though the ACA’s expansion of Medicaid would be phased out over a longer period of time than in the House legislation, cuts to the public insurance program for the poor still would account for by far the largest share of the reduction in federal spending under the Senate bill — $772 billion over the coming decade.

The CBO has been regarded over its four-decade history as a source of neutral analyses devoid of political agenda. Its current director, Keith Hall, is a conservative economist who served in the administration of President George W. Bush and was appointed to his current role two years ago by a Republican Congress.

Nevertheless, senior Trump aides have repeatedly sought to cast doubt on the budget office’s credibility. “If you’re looking at the CBO for accuracy, you’re looking in the wrong place,” White House press secretary Sean Spicer said on the March day that the budget office issued its cost estimate of a preliminary version of the House GOP’s health-care legislation.

While they differ in important details, both the Senate GOP’s plan and the American Health Care Act narrowly passed by House Republicans in May share the goal of undoing central aspects of the sprawling health-care law enacted by a Democratic Congress seven years ago.

Both bills would eliminate enforcement of the ACA’s mandate that most Americans carry health insurance, relying on subtler deterrents to keep people from dropping coverage. The House version would let insurers temporarily charge higher rates, while the Senate added a provision Monday that would let health plans freeze out customers for six months if they let their coverage lapse.

In different ways, both would replace federal subsidies that help the vast majority of consumers buying coverage through ACA marketplaces, instead creating smaller tax credits that would provide greater assistance to younger adults while making insurance more expensive for people from middle age into their 60s.

After two years, both also would end subsidies that now help about 7 million lower-income people with ACA health plans afford deductibles and copays. And both would repeal an array of taxes that have helped to pay for the ACA’s benefits, including levies on health insurers and on wealthy Americans’ investment income.

For the Senate bill, the CBO’s estimates of insurance coverage and federal spending are influenced by the fact that its forecast covers a 10-year window and the legislation’s most profound changes for the nation’s health-care system are tilted toward the latter part of that period.

The bill would, for instance, leave in place the ACA’s expansion of Medicaid through 2020. After that, it would begin a three-year phaseout of the federal money that under the ACA has paid almost the entire cost of adding 11 million Americans to the program’s rolls in 31 states.

That means the extra funding wouldn’t disappear until the mid-2020s — roughly when sharp new restrictions on federal payments for the entire Medicaid program would take effect.

Over the weekend, the senior Democrat on the Senate subcommittee that oversees the CBO said in a tweet that he had asked the budget office to estimate the Senate bill’s effect on insurance coverage over a longer time horizon. “GOP is hiding the worst Medicaid cuts in years 11, 12, 13 and hoping CBO stays quiet,” wrote Sen. Chris Murphy (D-Conn.)

https://www.washingtonpost.com/natio...=.8b15161893ea

Fox News reported that the CBO reports says insurance premiums would reduce by 30% within a few years. This important fact wasn't in the above article.

So:

We have 22 million more uninsured than the 23 million in the House bill. GOOD!!

We reduce premiums by 30%. GOOD!!

We save $328 billion over 10 years. GOOD!!

And that's all before we "erase the lines" and repeal McCarran which the House has already passed and is waiting on action in the US Senate as well as before all the regulatory changes Secretary Price will make to get in the weeds and clear up the details to make it all run efficiently and more cost effectively.

Listen up, Senate Republicans. You pass this bill on Thursday. It isn't ever going to get any better than this. And you pass that repeal of McCarran bill. I think it's HR 372. It's in the Judiciary Committee. Get it out of committee and on to the floor for a vote. That's where the reduction in premiums will come from, the multi-state and national competition that is currently disabled because of the McCarran-Ferguson Act of 1945.

PASS THE BILL!! By 2026, we won't need "Expanded Medicaid", because everyone in that group will have a great job with good wages, affordable plans or employer paid health insurance offered as a company benefit.

Where was all the out-rage and concern for the 7.5 million American citizens thrown off their Individual Healthcare Plans when
Obamacare was enacted?

There was no outrage. Those are the ones they TAX for not having health insurance. Disgusting.

Hopefully the 22 MILLION are refugees, illegal aliens and their anchor rats, and asylum liars.

Boot them off first!

VERIFY FIRST all Doctor's offices and Hospitals and notify ICE.

Fast track the pregnant ones out of here.

Senate needs to pass this bill on Thursday. The people on expanded Medicaid need to get off this program, find better jobs, get more hours and try to find work with employers who offer insurance benefits. This bill will help make that happen because it will promote the tax cut and tax reform bill which when that passes, JOBS are going to explode, wages will rise naturally, more benefits will be offered because with this bill and the repeal of McCarran, there will be all types of employer group plans that are much more cost effective than what is offered now.

Older Americans, regardless of whether they receive subsidies, could pay much higher premiums under the GOP plan because both the House and Senate bills would allow insurance companies to charge older people up to five times more than what they charge younger people. Under current law, they cannot charge more than three times more.

These changes would mean that among the low-income population that buys subsidized insurance on the exchange, older people in their 60s would see large spikes in premiums, while some younger people in their 20s would see modest decreases in premiums. Under the Senate plan, generally, the poorer and older you are, the more your premiums would rise.

@ http://www.sfgate.com/business/artic...e-11248348.php

Too many people aren't taking into account the power of a free enterprise multi-state and nationwide market, probably because they either don't understand the free enterprise market or they don't want to see Obamacare repealed for political reasons. No one's premiums are going to go up under this bill, they're all going to go down.

People are getting lost in the weeds. There are 4 crucial characteristics of this bill that matter:

1. removing the mandates
2. removing the penalties
3. phasing out the subsidies for insurance companies and replacing them with tax deductions/tax credits for the insured person/family
4. accounting for companion bill to repeal health insurance from McCarran-Ferguson Act of 1945 (erasing the lines)

Those are the most important aspects of this bill, because they not only repeal what's wrong with Obamacare, they will fix the problem that led to the insurance issue to begin with, lack of competition across state lines and adequate federal trade regulation the same as every other business in the United States.

It also overlooks the timing of the phase out. Most people in their 60's now who are not already on Medicare will be on Medicare by the time this goes into effect. Those on Expanded Medcaid won't be impacted at all until 2026 and at that point the States will handle more of that issue than they are now. Feds still contribute but with a cap. This motivates States to create good jobs in their States, to protect their American Workers, to discourage importing poverty workers and illegal aliens who will now be costing the state instead of being a funnel for more federal dollars into their state by selling out our American Workers.

Too many Democrats and even some Republicans are lost in the weeds of socialism. They think a reduction in the COLA for Medicaid Expansion is a "cut". No it isn't. It's an adjustment to reduce the growth of a socialist program that feeds the beast. They think changing the Medicaid Expansion program to a more state-oriented program is abandoning low income Americans. No it isn't. It's changing who pays for some of it and giving States more options and flexibility to solve the needs of their low income population. If Medicaid is bankrupting states, it's not because of the federal government, it's because the state hasn't addressed its unemployed and underemployed situation.

I find it humorous that Ron Johnson would be opposing this bill while at the same time proposing his own bill that would increase foreign low cost labor flowing into Wisconsin. You can't solve problems with this type of Confused Senator.

So GOP, set 'em straight, get 'em all on board, and demand they pass this bill on Thursday, so we can move on to tax cuts and tax reform that will kick this economy into an historic run for the money and create tens of millions of good jobs for American Workers who won't need or want Expanded Medicaid by the time the lower COLA adjustments take effect.

Personally, I don't understand why there's any COLA adjustment for Medicaid to begin with. If you're trying to reduce or control costs of medical care why would you feed it with automatic COLAs for Medicaid that are higher than CPI? It's outrageous. No wonder the "Nurses Associations" and "Hospital Associations", hate the bill. This feeds their own paychecks and earnings statements, not poor and low-income patient services.

Also, remember, there are thousands and thousands of pages of "regulations" that are part and parcel to this Obamacare mess. Price and DHHS will fix all that crap and make the system much more stream-lined and effective. There's no way at this point to evaluate what those cost savings and result benefits will be, other than to know they will be ..... HUUUGE!!!

So just pass the damn bill on Thursday and get this show on the road. It's time to play ball and start winning the game on health insurance, tax cuts, good jobs with good benefits. We need an end to phony political grand-standing, and that's all it is, just grand-standing for special interest donors by a few Confused Senators.

Premiums under the Senate Better Care Reconciliation Act

Jun 26, 2017 | Gary Claxton, Anthony Damico, Larry Levitt Follow @larry_levitt on Twitter, and Cynthia Cox Follow @cynthiaccox on Twitter
Issue Brief
Appendix
Endnotes


The Senate Better Care Reconciliation Act (BCRA) would make significant changes to the amounts that people pay for nongroup coverage and for the care they receive under the Affordable Care Act (ACA). The tables below provide estimates of how premiums after taking into account tax credits would change for people currently enrolled in the federal and state marketplaces.
Under current law, people with incomes between 100 percent and 400 percent of the federal poverty level are eligible for premium tax credits to help them pay the premium for nongroup coverage purchased through the federal or a state marketplace if they do not have access to other affordable coverage. People are responsible for paying a specified percent of their income (“required income percentage”) toward the cost of the benchmark plan (the second-lowest cost silver plan in their area), and the federal government pays the remainder of the premium to their insurer; this amount is the person’s premium tax credit. The required income percentages people are responsible to pay vary with income: In 2017, people with incomes between 100 percent and 133 percent of poverty contribute 2.04 percent of income, while people with incomes between 300 percent and 400 percent of poverty contribute 9.69 percent of their income.1 Because premiums vary with age but the share of income people are responsible to pay does not, older people receive larger premium tax credits than younger people with the same income but pay the same amount for the benchmark plan.
Beginning in 2020, the BCRA would make several significant revisions that affect the premium tax credits that people receive when they purchase nongroup coverage. First, the bill would revise income eligibility for premium tax credits, extending eligibility to people with incomes below poverty but capping eligibility at 350 percent of poverty. Second, the bill amends the way that premium tax credits are calculated so that the required income percentages vary with age and with income. Our estimates of the required income percentages under current law and the BCRA for 2020 are shown in the Appendix. The result is that on average people at younger ages would pay a lower share of their income to purchase a benchmark plan than they today while people at older ages would pay a higher share. Third, the bill reduces the value of the benchmark plans that are used to determine premium tax credits. The result is that a person who used their premium tax credit to purchase a benchmark plan would get a plan that on average would pay 58 percent of expected covered costs (a bronze plan), compared to 70 percent (a silver plan) under current law. A plan paying 58 percent of expected covered costs would have much higher cost sharing (e.g., deductibles) than a plan covering 70 percent of costs. This change is particularly important because the BCRA also would eliminate the cost sharing subsidies available under current law that reduce cost sharing and out-of-pocket limits for marketplace enrollees with incomes at or below 250 of poverty.
The bill also authorizes states to change the amount that premiums for adults can vary due to age, from 3:1 under current law to 5:1 (or a different ratio at state discretion). This would lower premiums for younger adults and raise them for older adults in states that made the change.2
Results

We estimated the average premiums that current marketplace enrollees would pay, after receiving any premium tax credit, for a benchmark silver plan in 2020 under current law and under the BCRA. Most current marketplace enrollees purchase silver plans, so we used those as the basis for a comparison of how much people would pay for equivalent coverage under the ACA versus the BCRA. The methods we used in making our estimates are described in more detail below.
Overall, marketplace enrollees would pay on average 74 percent more towards the premium for a benchmark silver plan in 2020 under the BCRA than under current law (Table 1). Younger enrollees would see modest increases on average (10 percent for those under age 18; 17 percent for those ages 18 to 34), while average premiums would more than double for enrollees ages 55 to 64. State-level results are in Appendix Table 2.

Table 1: Monthly Premium for a Silver Plan Among Exchange Enrollees (By Age), 2020
Age	ACA Premium After Tax Credit	BCRA Premium After Tax Credit	% Change
Under 18	$110	$120	10%
18-34	$145	$169	17%
35-44	$194	$271	39%
45-54	$208	$403	94%
55-64	$271	$583	115%
65 and Older	$310	$660	113%
Overall (All Ages)	$197	$342	74%
Source: Kaiser Family Foundation

These results vary significantly by income as well (Table 2). Marketplace enrollees with incomes below 200 percent of poverty would see an average increase in their premium costs of 177 percent, while higher income enrollees would see an increase of 57 percent.

Table 2: Monthly Premium for a Silver Plan Among Exchange Enrollees (By Income and Age), 2020
	Income Below 200% of Poverty			Income 200% of Poverty or Above
Age	ACA Premium After Tax Credit	BCRA Premium After Tax Credit	% Change	ACA Premium After Tax Credit	BCRA Premium After Tax Credit	% Change
< 18	$26	$58	121%	$176	$170	-4%
18-34	$57	$103	82%	$247	$247	0%
35-44	$69	$149	117%	$296	$369	25%
45-54	$67	$215	223%	$323	$556	72%
55-64	$69	$272	294%	$399	$782	96%
65 +	$76	$296	288%	$439	$862	96%
Overall	$61	$168	177%	$311	$489	57%
Source: Kaiser Family Foundation

There are important differences by age within these income groups: among enrollees with incomes below 200 percent of poverty, those in 18 to 34 age group would see an average increase of 82 percent while those in the 55 to 64 age group would see an average increase of 288 percent. Among enrollees with incomes 200 percent of poverty and above, enrollees in the 18 to 34 age group would not see an increase while those age 55 to 64 would see their premium costs almost double.
Discussion

The vast majority of marketplace enrollees would pay higher premiums in 2020 for a silver plan. Older and lower income enrollees see the biggest increases. These results are driven by several provisions in the BCRA. First, the BCRA reduces the value of the benchmark plan used to calculate the premium tax credits (from a plan that, on average, pays 70 percent of expected costs to a plan that pays 58 percent of expected costs). Lowering the benchmark means that marketplace enrollees could enroll in what is roughly a bronze plan by paying their required income percentage, but that they would need to pay the entire difference in premium to enroll in the silver level plans that are most prevalent today.

The second factor is the change in the required income percentages under the BCRA, which generally would reduce what younger adults would be required to pay but increases the amounts paid by older adults, particularly those at higher incomes. Among people with higher incomes, reducing the maximum income eligibility for premium tax credits from 400 percent of poverty to 350 percent of poverty increases costs for some marketplace enrollees, particularly people at higher ages who face relatively high premiums. Increasing the permitted premium variation due to age also would increase premiums for older adults not eligible for premium tax credits.
These significant increases in the costs for silver plans may cause some or many marketplace enrollees to look to lower-value bronze-level plans, which they could purchase by paying their required income percentage. For younger marketplace enrollees, they generally would pay less under the BCRA to purchase a bronze level plan than they would pay for a silver plan under current law; older enrollees, however, generally would pay more for a bronze level plan under the BCRA than they would pay for a silver plan under current law. Moving down to bronze level plans, however, would expose enrollees to much higher cost sharing than in silver plans, and for many enrollees who now receive cost-sharing subsidies, the increases would be very large. The BCRA would eliminate the cost sharing subsidies provided under current law beginning in 2020.
The reduction in the value of the benchmark plan, along with the elimination of cost sharing subsidies, raises questions about whether lower income people would continue their coverage under the BCRA. While premiums after premium tax credits might be somewhat lower for younger enrollees purchasing bronze plans, their cost sharing would likely be thousands of dollars higher; the average deductible for bronze plans in 2017 with a combined deductible for medical and prescription expenses is $6,105; this compares to an average deductible of $809 for plans with cost sharing reductions for people with incomes between 150 and 200 percent of poverty and $255 for people with incomes between 100 and 150 percent of poverty. Many people with low incomes would have a difficult time paying the cost sharing under the benchmark plans in the BCRA, and may decide they do not want to pay even a relatively small premium for a plan that they would struggle to use.
Because of the short time between the release of the discussion draft and the planned debate and vote in the Senate, we were unable to address all of the provisions that might affect premiums under the BCRA. Our analysis assumes that unsubsidized premiums for a 40-year-old would ultimately be the same under the ACA and BCRA. In the score released today (June 26), the Congressional Budget Office expects the difference in unsubsidized premiums for a 40-year-old between the ACA and BCRA to be quite small in 2026, which is consistent with our assumption; however, they expect BCRA premiums to be relatively lower in 2020, due in part to larger federal funding available in 2020 to reduce premiums. While these changes would have some impact on our results, the impact would be muted because we have focused on the amount that people pay after tax credits, and for most marketplace enrollees, those amounts are determined by their required income percentage and not the actual plan premium.

For these people, the actual premium affects the amount of their tax credit, but not what they would pay for a benchmark plan. Generally lower premiums would affect our results primarily for those marketplace enrollees who would pay the full premium with no premium tax credit under the BCRA.

These generally would be people with higher incomes or younger people facing very low premiums such that the full premium would be less than their required income percentage.
Methods

We used data from the March 2016 Current Population Survey, the 2016 National Health Interview Survey and administrative data about the income and demographic distribution of the population enrolled in the federal and state marketplaces to construct a model of nongroup enrollees.
To impute marketplace enrollment status for each individual reporting directly purchased private health insurance to the March 2016 Current Population Survey, we applied a series of modeling techniques to the health insurance units (HIUs) described here in order to model the division of individuals holding nongroup coverage between those enrolled in a marketplace and those enrolled outside of a marketplace. Using the same multiply-imputed technique described here, we repeated our draw of each state’s nongroup population ten times to accurately account for sampling error.
We revised our Uninsured Calibration described in here to more closely align with the insurance coverage movements shown by the recent CDC publication of full-year 2016 National Health Interview Survey (NHIS) estimates.3 This CDC document shows continued gains in public coverage during the year and a leveling-off of private insurance coverage gains after the early 2016 Marketplace enrollment surge that mirrors administrative data sources. Our previous publications on this topic were calibrated to NHIS 2016 first quarter estimates; however, both HHS-published effectuated enrollment in the Exchanges at the end of March 2016 and also the insurer rate filings used to estimate the size of the off-marketplace population more closely align with the trends exhibited by NHIS 2016 full-year statistics.4 Calibrating to national CDC estimates allowed for on- and off-marketplace sampling targets consistent with administrative enrollment at the state level.
For each state’s on-marketplace and off-marketpace nongroup population, we drew purchasing units across five strata, each informed by federal data. For each state and the District of Columbia, we sampled subsidy-eligible marketplace enrollees both above and below 250% FPL, followed by a small group of ACA subsidy-eligibles forgoing help in the off-exchange market.5 Consistent with this administrative data, we also sampled a small group of wealthier nongroup enrollees (those not eligible for subsidies) into the Exchanges, and moved the remaining nongroup individuals into the off-exchange market. For non-immigrants with incomes below 100% of poverty, we calculate the amount of their required premium contribution as though their income were 138% of poverty. To most accurately reflect the age and income distribution of the Exchanges, each marketplace-purchasing unit received a sampling probability proportional to the average monthly subsidy per person within the state. At the conclusion of these ten repeated state sample draws, our average advanced premium tax credit (APTC) per month landed at $284 nationwide (compared to the $291 reported by HHS) and within $30 of the actual amounts displayed on table two of the HHS effectuated enrollment report for every geography except for the state of Connecticut.6 This close match of estimated APTC dollars for forty-nine states and the District of Columbia reflected a high degree of accuracy of the demographic (primarily age and income) distribution of our sampled exchange population.
To compare the effect of the Senate’s proposed Better Care Reconciliation Act (BCRA) against current law under the Affordable Care Act (ACA), we attached both the second lowest cost silver and the lowest cost bronze plan premiums to each individual in each local market. These 2017 premiums from the Kaiser Family Foundation’s Subsidy Calculator matched CPS respondents at the state and metropolitan area-level, with smaller areas not disclosed by the U.S. Census Bureau computed using a population-weighted average premium across the aggregation of non-metro areas. Matching our prior eligibility analyses, we computed ACA eligibility and subsidy receipt using the second lowest cost silver plan available to the HIU as the benchmark plan. To reflect the 58% Actuarial Value (AV) level stated by the BCRA, we used each geographic area’s lowest cost bronze plan as the benchmark plan for each HIU. In a small number of geographies without a bronze plan option for purchase on the 2017 exchanges, we used 85% of the silver plan as that local area’s benchmark plan premium. For each individual’s premium calculations under the BCRA, we relaxed the ACA’s 3:1 age rating to a 5:1 age band in all states that did not have community rating requirements in place prior to 2014. We followed CBO and HHS inflation factors to project all dollar values and thresholds to calendar year 2020. Using CBO’s economic projections,7 we inflated the 2015 income amounts in the 2016 CPS for each HIU to 2020 dollars. We increased premium dollars from 2017 to 2020 and both ACA and BCRA premium caps from 2014 to 2020 using Centers for Medicare & Medicaid Services Office of the Actuary projections.8 Our analysis assumes that states do not take up a waiver under the BCRA.

http://www.kff.org/health-reform/iss...ciliation-act/

NPR‏Verified account @NPR 14m14 minutes ago More



#BREAKING: Senate Majority Leader Mitch McConnell will delay a vote on the Republican health care bill until after the July 4 recess.

46 replies213 retweets344 likes
Reply

46
Retweet

213

Like
344