CBO: Amended ACA Replacement Bill Doesn't Improve Coverage

March 23, 2017

Amendments to a House bill replacing the Affordable Care Act (ACA) do not improve insurance coverage, with the estimated increase in the uninsured remaining at 24 million by 2026, the Congressional Budget Office (CBO) announced today.

However, one number important to House Republicans did change significantly in the CBO's updated "score" of the American Health Care Act (AHCA). The measure as amended would reduce the federal deficit by $150 billion over 10 years, compared with $337 billion under the original bill.

The CBO report came out shortly after House Republican leaders delayed a vote on the AHCA that was scheduled for today in an attempt to round up enough ayes to pass it. Despite pressure from President Donald Trump, members of the staunchly conservative House Freedom Caucus in the GOP are withholding their needed support of the bill unless it undergoes more amendments so that it looks less like the ACA itself.

One point of negotiation is the ACA's requirement that private health plans in the individual and group market have essential benefits such as mental health and maternity care. The Freedom Caucus wants to eliminate that provision, arguing that it boosts the cost of coverage and makes it unaffordable for many Americans. Congressional Democrats counter that without the essential benefits requirement, insurers will offer stripped-down, albeit less expensive, health plans that leave enrollees stuck with higher out-of-pocket costs.

The House Freedom Caucus already has won one concession from House Speaker Paul Ryan (R-WI) — a proposed amendment that lets states attach a work requirement for able-bodied adults to receive Medicaid. This amendment was one of several that the CBO analyzed in its report today. Another major amendment it examined would allow the Senate to give older Americans more generous tax credits to purchase health plans.

According to published reports, the House could vote on the AHCA tomorrow. However, further amendments that might win the votes of Freedom Caucus members could cost the votes of moderate Republicans who don't want to lose healthcare coverage and benefits gained under the ACA.

In essence, the AHCA eliminates the ACA's individual mandate penalty for not obtaining insurance coverage, ends Medicaid expansion in 31 states and the extra federal funding that comes with it, replaces income-based tax credits for purchasing coverage under the ACA with generally less generous tax credits based on age, and erases taxes imposed by the 2010 law.

The American Medical Association and several other major medical societies oppose passage of the AHCA, and public opinion is running against it, too. According to a recent Reuters/Ipsos poll, only 33% of Americans think the AHCA improves on the ACA, while 48% say it doesn't.

Follow Robert Lowes on Twitter @LowesRobert


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