WASHINGTON -- A House-passed bill to dismantle the Patient Protection and Affordable Care Act would increase the projected number of people without health insurance by 14 million next year and by 23 million in 2026, the Congressional Budget Office said Wednesday. That 10-year figure is slightly less than estimated in an earlier bill.
It would reduce the federal deficit by $119 billion over a decade, less than the $150 billion in savings projected in late March for an earlier version of the bill. And in states that seek waivers from rules mandating essential health coverage, the new proposal could make insurance economically out of reach for some sick people.
"Premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums," the budget office concluded.
In some areas of the country, people with pre-existing medical conditions and others who are seriously ill "would ultimately be unable to purchase" robust coverage at premiums comparable to today's prices, "if they could purchase at all," the report said.
[INTERACTIVE: Compare new health care bill with Affordable Care Act]
Democrats jumped on the report as further evidence that the GOP effort to repeal former President Barack Obama's 2010 law -- a staple of Donald Trump's presidential campaign and those of numerous GOP congressional candidates for years -- would be destructive.
The report comes three weeks after the House passed the legislation with only Republican votes, and as Senate Republicans try crafting their own version of the bill, which they say will be different.
"The report makes clear that Trumpcare would be a cancer on the American health care system," said Senate Minority Leader Charles Schumer, D-N.Y., using the nickname that Democrats have pinned to the bill. Schumer said the legislation would end up "causing costs to skyrocket, making coverage unaffordable for those with pre-existing conditions and many seniors, and kicking millions off of their health insurance."
Trump's Health and Human Services Secretary Tom Price dismissed the new analysis.
"The CBO was wrong when they analyzed Obamacare's effect on cost and coverage," he said of the agency's report on former President Barack Obama's law, "and they are wrong again."
That was sharply different from Republican House Speaker Paul Ryan's take.
"This CBO report again confirms that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit. It is another positive step toward keeping our promise to repeal and replace Obamacare."
The new forecast of the nonpartisan Congressional Budget Office, Capitol Hill's official scorekeeper, is viewed by others as another blow to Republican efforts to undo Obama's signature domestic achievement.
The Senate has already said it will make substantial changes to the measure passed by the House, but even Sen. Mitch McConnell of Kentucky, the majority leader, is sounding uncertain about his chances of finding a majority to repeal and replace Obama's health care law.
"I don't know how we get to 50 at the moment," McConnell told Reuters on Wednesday regarding votes in the Senate. "But that's the goal."
Republicans have been trying to repeal the 2010 health care law since the day Obama signed it in March 2010. But the task is proving more difficult than they expected. Many parts of the law have become embedded in the nation's health care system, and consumers have risen up to defend it, now that they fear losing its protections. At the same time, other consumers, upset about the mandate to buy insurance that they can barely afford, are demanding changes in the law.
The budget office issued two reports on earlier versions of the House bill in March. Both said the legislation would increase the number of uninsured Americans by 14 million next year and by 24 million within a decade, compared with the current law.
GOP senators determined
Republican senators appear as determined as ever to replace the health law.
"The status quo under Obamacare [the Affordable Care Act] is completely unacceptable and totally unsustainable," McConnell said Wednesday, a few hours before the budget office issued its report. "Prices are skyrocketing, choice is plummeting, the marketplace is collapsing, and countless more Americans will get hurt if we don't act."
"Beyond likely reiterating things we already know -- like that fewer people will buy a product they don't want when the government stops forcing them to -- the updated report will allow the Senate procedurally to move forward in working to draft its own health care legislation," he added.
The instability of the health law's insurance marketplaces was underscored Wednesday when Blue Cross and Blue Shield of Kansas City, a nonprofit insurer, announced that it would not offer coverage under the law for 2018. The insurer lost more than $100 million in 2016 selling individual policies under the law, said Danette Wilson, the company's chief executive.
"This is unsustainable," she said in a statement. "We have a responsibility to our members and the greater community to remain stable and secure, and the uncertain direction of the market is a barrier to our continued participation."
While the vast majority of people the company covers get insurance through employers or private Medicare plans, Blue Cross of Kansas City covers about 67,000 people in western Missouri under the federal health care law. The company's departure could leave 25 counties without an insurer, said Cynthia Cox, a researcher at the Kaiser Family Foundation.
Democrats say much of that instability stems from Republican efforts to repeal and undermine the Affordable Care Act. Schumer harshly criticized House Republicans for voting on their revised repeal measure without first receiving an updated analysis about it from the budget office.
"Republicans were haunted by the ghost of CBO scores past, so they went ahead without one," Schumer said. That action, he said, was reckless -- "like test-driving a brand-new car three weeks after you've already signed on the dotted line and paid the dealer in full."
The House repeal bill was approved May 4 by a vote of 217-213, without support from any Democrats. It would eliminate tax penalties for people who go without health insurance and would roll back state-by-state expansions of Medicaid, which have provided coverage to millions of low-income people. And in place of government-subsidized insurance policies offered exclusively on the Affordable Care Act's marketplaces, the bill would offer tax credits of $2,000 to $4,000 a year, depending on age.
In the weeks leading up to passage of the House bill, Republican leaders revised it to win support from some of the most conservative members of their party.
Under the House bill, states could opt out of certain provisions of the health care law, including one that requires insurers to provide a minimum set of health benefits and another that prohibits them from charging higher premiums based on a person's health status.
Insurers would not be allowed to charge higher premiums to sick people unless a state had an alternative mechanism, like a high-risk pool or a reinsurance program, to help provide coverage for people with serious illnesses.
Senate Republicans have been meeting several days a week, trying to thrash out their differences on complex questions of health policy and politics, like the future of Medicaid.
Asked why Democrats had been excluded, McConnell said, "We're not going to waste our time talking to people that have no interest in fixing the problem."
Democrats have said they would gladly work with Republicans if the Republicans would renounce their goal of repealing Obama's health care law.
Information for this article was contributed by Robert Pear and Reed Abelson of The New York Times; and by Alan Fram and Ricardo Alonso-Zaldivar of The Associated Press.
A Section on 05/25/2017
