Bill again said to add 22 million uninsured
WASHINGTON — The nonpartisan Congressional Budget Office said Thursday that the latest version of a Senate bill to repeal and replace the health care law would leave 15 million people without health insurance next year, rising to 22 million in 2026.
The report casts a shadow upon the legislative push that President Donald Trump is trying to revive.
The increase in the number of people who are uninsured was the same as the 22 million more people who would be uninsured in 2026 under an earlier version of the bill that was analyzed in June.
The newest score of a replacement for the Patient Protection and Affordable Care Act came after a marathon bargaining session Wednesday night among senators that ended inconclusively. On Wednesday, the budget office released its analysis of a separate bill that would repeal large parts of President Barack Obama’s signature health care law without a replacement. That analysis concluded that such a move would increase the number of people without health insurance by 32 million in 2026.
Senators were set to leave for the weekend Thursday afternoon after a week of fruitless negotiations, capped by news that one of their most prominent colleagues, Sen. John McCain, R-Ariz., has brain cancer.
The majority leader, Sen. Mitch McConnell, R-Ky., appeared determined to force the Senate to vote next week
on a procedural motion to begin debating health care, but he still is short of the 50 votes he needs.
“Dealing with this issue is what’s right for the country,” McConnell said. He added, “It was certainly never going to be easy, but we’ve come a long way and I look forward to continuing our work together to finally bring relief.”
The latest budget office analysis did not take into account a provision that would allow insurers to offer lowcost, stripped-down insurance plans, an idea that has been pushed by Sen. Ted Cruz, R-Texas, and could be critical to winning the votes of Cruz and another conservative, Mike Lee of Utah.
Cruz’s proposal was included in a version of the bill released last week, but it has been assailed by the insurance industry. While the provision was omitted from the latest version of the bill that was released Thursday, it remains under consideration to be part of the repeal legislation, a Republican congressional aide said.
As leaders tested revisions that might attract GOP votes, one senator compared the process with the trade-offs lawmakers scorned seven years ago as top Democrats pushed Obama’s overhaul.
“It’s almost becoming a bidding process — let’s throw $50 billion here, let’s throw $100 billion there,” said Sen. Bob Corker, R-Tenn. “It’s making me uncomfortable right now. It’s beginning to feel a lot like how Obamacare came together.”
The budget office released its analysis as Senate Republicans are struggling to keep alive their longtime goal of repealing the Affordable Care Act — and to settle on a strategy for achieving that aim. But its conclusions are not likely to help.
The budget office did have good news about the latest version’s fiscal impact: It would reduce federal budget deficits by $420 billion over 10 years, about $100 billion more than an earlier version of the legislation. The change resulted mainly from the fact that Senate leaders decided to keep two taxes on high-income people that would have been eliminated by the previous version of the Senate bill.
The latest version of the Senate bill would increase average insurance premiums by 20 percent next year, the budget office estimates, but it would reduce premiums after 2019, so that in 2026 premiums for a typical “benchmark plan” would be 25 percent lower than under current law.
Still, one of the main reasons for the lower premiums is that the typical insurance plan would, according to the budget office, “pay for a smaller share of the total cost of covered benefits.” In other words, out-of-pocket expenses from deductibles and co-payments would grow.
Moreover, the budget office said, even though average premiums for a standard benchmark plan would decline after 2019, many older people would face substantial increases in premiums.
For example, it said, the net premium — after tax credits — for a midlevel “silver plan” for a 64-year-old person with annual income of $26,500 would be $5,500 a year in 2026, or more than three times the amount projected under current law.
The analysis detailed huge changes that the bill would impose on Medicaid, the health care program for low-income people and the disabled. In 2026, it said, 15 million fewer people would be enrolled in Medicaid, compared with enrollment expected under current law, and federal Medicaid spending would be 26 percent lower.
The Senate bill, like the repeal bill passed by the House in May, would put annual caps on federal Medicaid spending and would roll back the expansion of eligibility authorized by the current health care law.
Senate Republican leaders in June rolled out a bill to repeal and replace the health law, hoping to finally deliver on their promise to dismantle the existing law. But since then, McConnell has come up short in trying to marshal the support to push a version of his legislation through the chamber.
This week, after his latest effort to pass a bill collapsed, McConnell laid out a new approach — repealing the health law without immediately providing a replacement — and pledged to hold a vote to begin debate on health care next week.
But on Wednesday, Trump urged senators to provide a replacement to go with a repeal of the health law, reviving the effort to revise McConnell’s bill that earlier in the week seemed dead as Republican senators renounced their support, sinking their majority.
‘SABOTAGE’ ALLEGED
In a related development, Trump’s administration has ended Affordable Care Act contracts that provided assistance at libraries, businesses and urban neighborhoods in 18 cities, meaning shoppers on the insurance exchanges will have fewer places to turn for help signing up for coverage.
Community groups say the move, announced to them by contractors last week, will make it even more difficult to enroll the uninsured and help people already covered re-enroll or shop for a new policy. That’s already a concern because of consumer confusion stemming from the political wrangling in Washington and a shorter enrollment period. People will have 45 days to shop for 2018 coverage, starting Nov. 1 and ending Dec. 15. In previous years, they had twice that much time.
Some people said they see it as another attempt to undermine the health law’s marketplaces by a president who has suggested he should let the Affordable Care Act fail. The administration earlier this year pulled paid advertising for the sign-up website healthcare.gov, prompting an inquiry by a federal inspector general into that decision and whether it hurt sign-ups.
Now insurers and advocates are concerned that the administration could further destabilize the marketplaces where people shop for coverage by not promoting them or not enforcing the mandate compelling people to get coverage. The administration has already threatened to withhold payments to insurers to help people afford care, which would prompt insurers to sharply increase prices.
“There’s a clear pattern of the administration trying to undermine and sabotage the Affordable Care Act,” said Elizabeth Hagan, associate director of coverage initiatives for the liberal advocacy group Families USA. “It’s not letting the law fail, it’s making the law fail.”
Two companies — McLean, Va.-based Cognosante LLC and Falls Church, Va.based CSRA Inc. — will no longer help with the sign-ups, after Centers for Medicare and Medicaid Services officials decided not to renew a final option year of the vendors’ contracts. The contracts, awarded in 2013, were never meant to be long term, Centers for Medicare and Medicaid Services spokesman Jane Norris said in an email.
“These contracts were intended to help CMS provide temporary, in-person enrollment support during the early years” of the exchanges, Norris said. Other federally funded
help with enrollment will continue, she said, including a year-round call center and grant-funded navigator programs. The existing program is “robust” and “we have the on-the-ground resources necessary” in key cities, Norris said.
But community advocates expected the vendors’ help for at least another year. “It has our heads spinning about how to meet the needs in communities,” said Inna Rubin of United Way of Metro Chicago, who helps run an Illinois health access coalition.
CSRA’s current $12.8 million contract expires Aug. 29. Cognosante’s $9.6 million contract expires the same date.
Together, they assisted 14,500 enrollments, far less than 1 percent of the 9.2 million people who signed up through healthcare.gov, the insurance marketplace serving most states. But some advocates said the groups focused on the healthy, young adults needed to keep the insurance markets stable and prices down.
During the most recent open-enrollment period, they operated in the Texas cities of Dallas, Houston, San Antonio, Austin, McAllen and El Paso; the Florida cities of Miami, Tampa and Orlando; Atlanta; northern New Jersey; Phoenix; Philadelphia; Indianapolis; New Orleans; Charlotte, N.C.; Cleveland; and Chicago.
The insurance exchanges, accessed by customers through the federal healthcare.gov or state-run sites, are a way for people to compare and shop for insurance coverage. The health law included grant money for community organizations to train people to help consumers apply for coverage, answer questions and explain differences between the insurance policies offered.
Information for this article was contributed by Thomas Kaplan and Robert Pear of The New York
Times and by Alan Fram, Erica Werner, Andrew Taylor and Carla K. Johnson of The Associated Press.