What did the me­dia miss in the CBO re­port?

Modern Healthcare - - NEWS - —Har­ris Meyer

Ev­ery­one re­ported the top-line num­bers from the anal­y­sis of the House Repub­li­cans' Amer­i­can Health Care Act, a bill to re­peal and re­place the Af­ford­able Care Act. The non­par­ti­san Con­gres­sional Bud­get Of­fice and the Joint Com­mit­tee on Tax­a­tion es­ti­mated the bill would drive up the num­ber of unin­sured Amer­i­cans by 24 mil­lion over the next decade and re­duce the fed­eral deficit by $337 bil­lion.

Here are 13 other find­ings that should be of high in­ter­est to health­care in­dus­try groups

1 Medi­care spend­ing on dis­pro­por­tion­ate-share pay­ments to hos­pi­tals would in­crease by $43 bil­lion from 2018 to 2026 due to a sig­nif­i­cant rise in the unin­sured pop­u­la­tion.

2 Med­i­caid dis­pro­por­tion­ate­share pay­ments to hos­pi­tals would in­crease by $31 bil­lion over 10 years.

3 To­tal fed­eral Med­i­caid pay­ments to states would de­cline by $880 bil­lion, 25%, or by 2026.

4 Un­der the AHCA’s per-en­rollee cap on fed­eral Med­i­caid pay­ments, states’ ac­tual per-capita costs would grow 0.7 per­cent­age points an­nu­ally faster than fed­eral pay­ments from 2017 to 2026. States have the op­tion of spend­ing more of their own money to main­tain spend­ing lev­els or cut­ting ben­e­fits or provider pay­ments.

5 Five mil­lion fewer low-in­come adults would be en­rolled in the ACA’s Med­i­caid ex­pan­sion pro­grams by 2026.

6 By 2026, Med­i­caid ex­pan­sion states would have only 5% of ex­pan­sion en­rollees left for whom they would re­ceive en­hanced fed­eral match­ing pay­ments.

7 Con­sumers would have a harder time com­par­i­son-shop­ping for health plans be­cause the ACA’s min­i­mum ac­tu­ar­ial-value re­quire­ment would be re­pealed and in­sur­ers could sell sub­si­dized plans out­side the ACA ex­changes.

8 The re­peal of the ac­tu­ar­ial-value re­quire­ment would prompt many in­sur­ers to of­fer plans with higher de­ductibles and cost-shar­ing.

That and the loss of ACA cost-shar­ing sub­si­dies in 2020 would sig­nif­i­cantly in­crease out-of-pocket costs for lower-in­come en­rollees.

9 About 7 mil­lion fewer peo­ple would have em­ployer-based cov­er­age by 2026. With the em­ployer and in­di­vid­ual man­date penal­ties gone, fewer em­ploy­ers would of­fer ben­e­fits and fewer em­ploy­ees would take it up. And the new pre­mium tax cred­its for higher-in­come work­ers would prompt some em­ploy­ers to send their work­ers to buy cov­er­age in the in­di­vid­ual mar­ket.

10 By 2026, in­di­vid­ual-mar­ket pre­mi­ums would be 20% to 25% lower for a 21-year-old, 8% to 10% lower for a 40-year-old and 20% to 25% higher for a 64-year-old.

11 The one-year, 30% pre­mium penalty for buy­ing in­sur­ance after a cov­er­age gap would lead to about 2 mil­lion fewer peo­ple buy­ing cov­er­age after 2018. Those who pay the penalty would likely be sicker peo­ple.

12 By 2026, the av­er­age pre­mium tax credit to help peo­ple buy cov­er­age would 50% be about less than un­der the ACA.

13 About 52 mil­lion Amer­i­cans, or 19% of the non-el­derly pop­u­la­tion, would be unin­sured in 2026, up from 10% un­der the ACA. Peo­ple ages 50-64 with in­comes un­der 200% of the fed­eral poverty level would make up a larger share of the unin­sured.

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