CMS Analysts Say AHCA Will Leave 13 Million More Uninsured

Alicia Ault

June 13, 2017

Analysts at the Centers for Medicare and Medicaid Services (CMS) say that if approved as passed by the US House of Representatives, the American Health Care Act (AHCA), which would repeal and replace the Affordable Care Act (ACA), would lead to 13 million more people being uninsured by 2026.

That's 10 million fewer uninsured than anticipated by the Congressional Budget Office (CBO) in its analysis of the AHCA, released in May. The numbers in the latest review — conducted by the CMS' Office of the Actuary, an independent group within CMS — will add to the debate over how to overhaul the ACA. The AHCA is currently being considered by the US Senate.

Four million will lose coverage in 2018, rising to "roughly" 13 million in 2026, driven by the AHCA's repeal of the individual mandate, "the net reduction to the subsidies available for the purchase of individual insurance," and Medicaid reductions, according to the CMS report.

Overall, with the AHCA in place, the federal government would spend $328 billion less on healthcare from 2017 to 2026 (compared with $119 billion estimated by the CBO), mostly because of lower Medicaid spending, according to the CMS report.

The CMS economists estimated that Medicaid spending would be 11% — or $105 billion — lower in 2026 than called for under the Affordable Care Act, compared with some $800 billion in reductions estimated by the CBO.

Eight million fewer people will be enrolled in Medicaid because of per capita caps, frequent eligibility redeterminations, repeal of retroactive eligibility, and optional requirements for work that might be imposed by states, according to the report.

Individual premiums would also increase — they would be about 5% higher than under current law, after federal and state subsidies are accounted for, according to the report. Average cost-sharing will be 61% higher in 2026 under the AHCA than under current law. The impact of cost-sharing will vary by age, income, and whether an individual lives in a state that opts out of covering essential health benefits or declines to use community rating.

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