CBO: Proposal to Repeal ACA Would Push Uninsured to 32 Million

Alicia Ault

July 19, 2017

The Congressional Budget Office (CBO) estimates that at least 17 million more Americans would be uninsured in 2018 and premiums would rise by at least 25% under the Senate Republicans' new proposal to repeal the Affordable Care Act (ACA).

By 2020, some 27 million additional individuals would be uninsured, and by 2026, that would rise to 32 million. That's 10 million more than estimated under the Senate's initial version of the Better Care Reconciliation Act, which was analyzed by the CBO in late June.

The Obamacare Repeal Reconciliation Act of 2017, posted on the Senate Budget Committee website today, was promptly analyzed by the nonpartisan CBO.

Yesterday, it appeared that the Senate might have to give up on holding a vote on the repeal action. But some Senators reportedly said that negotiations were back on after President Donald Trump urged the leadership, during a White House lunch today, to keep working on passage.

The CBO economists estimate in the new report that under the proposal — which eliminates individual and employer mandates to provide insurance, ends federal subsidies to help buy coverage in 2020, and rolls back the ACA's Medicaid expansion — 10 million fewer people would get coverage in the nongroup market, 4 million fewer would have Medicaid coverage, and 2 million fewer people would have employment-based coverage.

Overall, they estimate that in 2018 some 84% of Americans aged less than 65 years would be insured compared with 90% projected under the current law.

The Obamacare Repeal proposal would leave the Essential Health Benefit requirements in place and prohibit denial of coverage or charging higher premiums for preexisting conditions.

Average premiums for individuals buying a "silver" plan through the ACA marketplaces or directly from insurers would increase by 25% more than projected under current law, and 50% more in 2020.

Eliminating the individual mandate would be a major contributor to the rise in premium costs, the CBO said. It would reduce the number of people buying health insurance overall, and change the mix of people with insurance. Healthcare costs for those who had coverage would rise, forcing insurers to increase premiums in the nongroup market.

The CBO essentially predicted a "death spiral," in which fewer insurers would participate in the individual market, putting "further upward pressure on premiums because the market would be less competitive."

The repeal proposal would eliminate most of the taxes imposed by the ACA and zero out funding for the Prevention and Public Health Fund.

It would, however, authorize appropriations of $750 million in fiscal 2018 and 2019 for the US Department of Health and Human Services to award grants to states "to address the substance abuse public health crisis or respond to urgent mental health needs."

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