The Congressional Budget Office analysis of the American Health Care Act, as amended and passed by the Republican-controlled House of Representatives earlier this month, is finally out.
The macro numbers are not that different from what they were in March, when Republicans couldn’t muster the votes to pass the bill. Now, the CBO says the bill would cut the deficit by $119 billion over 10 years and cause 23 million fewer Americans to have health insurance by 2026. In March, those figures were $150 billion and 24 million.
And as in March, the big driver of both the deficit reduction and the loss of insurance coverage is cuts to Medicaid, the main federal program for insuring poor people. Cutting off access to the Medicaid expansion would cause 14 million people to lose insurance and save $800 billion over a decade, making it possible to finance hundreds of billions of dollars of tax cuts for rich people.
That’s all about the same as last time. The big difference this time is who would pay what: Sick people would pay a lot more, if they could get affordable health insurance at all.
‘Less healthy people would face extremely high premiums’
That’s the key takeaway quote from the CBO score. It describes what would happen in those states that actually decide to use the MacArthur amendment, the May revision to the bill that would allow states to let insurers charge customers based on their health status.
Remember, this is the big change from March: To win over conservative members of the House Republican conference, they had to change the bill to allow states to let insurers charge more to sick people.
House Republicans literally had to change the healthcare FAQ on their website after they passed this bill, since they had promised their bill would “prohibit health insurers from denying coverage or charging more money to patients based on pre-existing conditions,” before they changed their mind and passed a bill that would do exactly that.
Unlike under current law, the tax credits that people would get to help them buy insurance wouldn’t be linked to their income or the premiums they face, meaning these “extremely high” premiums would become unaffordable for those people who need healthcare the most.
“Over time, it would be come more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly,” the CBO warned.
“Out-of-pocket spending… could increase by thousands of dollars”
Of course, premiums are just one component of healthcare costs for consumers. Because the AHCA would permit states to opt out of “essential health benefits” rules governing what insurance plans must cover, in some cases premiums would go down – because insurance would exclude key benefits.
For example, women of childbearing age might be able to get affordable insurance – so long as they bought a plan that didn’t cover pregnancy care.
“Out of pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services,” the CBO said, because states could permit insurers to sell plans that exclude key areas of coverage like pregnancy and substance abuse. They could even sell plans that don’t cover doctor’s visits, if they wanted.
This is the opposite of fixing Obamacare
Common complaints about insurance policies sold under the ACA are that they cost too much and then require patients to pay too much in co-insurance and deductibles.
People are upset that healthcare costs them too much. Instead of addressing their concerns, this law would heap more costs on consumers, especially if they have significant healthcare needs, in order to finance tax cuts for the rich.
If Republicans really wanted to take care of the sick, they have proposed a policy structure that could be transformed into something that would more or less work. But it would cost hundreds of billions of dollars they want to spend on tax cuts for rich people, not on healthcare for people who can’t afford healthcare.
So they lie and say this plan won’t hurt people. But it will, if it becomes law.