CBO finds GOP plan low­ers costs but also cov­er­age

Se­nate lead­ers op­ti­mistic for health vote de­spite hold­outs

The Washington Times Daily - - FRONT PAGE - BY TOM HOW­ELL JR.

Se­nate Repub­li­cans’ Oba­macare re­peal bill would lower most Amer­i­cans’ pre­mi­ums and save the gov­ern­ment more than $300 bil­lion over the next decade but also leave 22 mil­lion fewer peo­ple with health care cov­er­age, the Con­gres­sional Bud­get Of­fice said in an anal­y­sis Mon­day.

The CBO score paved the way for a po­ten­tial floor vote this week. How­ever, at least three Se­nate Repub­li­cans planned to op­pose a mo­tion to pro­ceed to de­bate on the bill, and a fourth said he prob­a­bly would re­ject it, too, mean­ing Re­pub­li­can lead­ers’ hopes for a quick vote could stall.

The CBO’s score is a slight im­prove­ment on the ver­sion the House passed in May, which pro­jected 23 mil­lion fewer peo­ple with in­surance in 10 years. But it was cold com­fort to Repub­li­cans who hoped to meet Pres­i­dent Trump’s chal­lenge to write a bill with “more heart.”

“I think it’s go­ing to be harder to get to 50, not eas­ier,” Sen. Lind­sey Gra­ham, South Carolina Re­pub­li­can, said of the votes needed for pas­sage.

Re­pub­li­can lead­ers, who had been hop­ing for a floor vote by the end of the week, saw some good news in the re­port. The av­er­age pre­mium paid for “bench­mark” plans should drop 20 per­cent a decade from now, largely be­cause states could waive cer­tain ben­e­fit re­quire­ments and in­surance would pay for a smaller av­er­age share of ben­e­fits.

The $320 bil­lion in sav­ings over the next decade is far more than the House bill earned, thanks chiefly to ma­jor Med­i­caid changes that kick in half­way through the next decade.

Re­pub­li­can lead­ers could rein­vest those sav­ings to try to sway po­ten­tial hold­outs, such as Sens. Rob Portman of Ohio and Shel­ley Moore Capito of West Vir­ginia, who want money for treat­ment of opi­oid ad­dic­tion.

Mr. Trump per­son­ally ap­pealed to fence-sit­ting Repub­li­cans, and the White House crit­i­cized the CBO re­port, say­ing the score­keeper “has con­sis­tently proven it can­not ac­cu­rately pre­dict how health care leg­is­la­tion will im­pact in­surance cov­er­age.”

The White House said the CBO orig­i­nally pro­jected that 24 mil­lion peo­ple would be in Oba­macare’s ex­changes by 2016 — when the num­ber turned out to be just 11 mil­lion.

The White House said the choice for the Se­nate is be­tween fail­ing Oba­macare and a bet­ter Re­pub­li­can sys­tem.

“As more and more peo­ple con­tinue to lose cov­er­age and face fewer health care choices, Pres­i­dent Trump is com­mit­ted to re­peal­ing and re­plac­ing Oba­macare, which has failed the Amer­i­can peo­ple for far too long,” the White House said.

Se­nate Ma­jor­ity Leader Mitch McCon­nell, Ken­tucky Re­pub­li­can, said he planned to move for­ward this week.

“The Amer­i­can peo­ple need bet­ter care now, and this leg­is­la­tion in­cludes the nec­es­sary tools to pro­vide it,” Mr. McCon­nell said.

He an­nounced changes that would re­place Oba­macare’s in­di­vid­ual man­date to hold cov­er­age with a pro­vi­sion de­signed to pre­vent Amer­i­cans from drop­ping cov­er­age and then sign­ing up again once they need med­i­cal care.

The up­dated draft says con­sumers who have a more than a two-month lapse in cov­er­age dur­ing the prior year must wait six months un­til their in­surance takes ef­fect. It’s a twist on the House bill, which would have im­posed a sur­charge on con­sumers who sign up af­ter a long lapse in cov­er­age.

Democrats said the Re­pub­li­can bill is fun­da­men­tally flawed. They high­lighted the 22 mil­lion who would forgo in­surance as a po­lit­i­cal night­mare, hop­ing to spook Re­pub­li­can cen­trists into break­ing away from the bill.

“This CBO re­port should be the end of the road for Trump­care,” said Se­nate Mi­nor­ity Leader Charles E. Schumer, New York Demo­crat. “Repub­li­cans would be wise to read it like a giant stop sign, urg­ing them to turn back from this path that would be dis­as­trous for the coun­try, for mid­dle-class Amer­i­cans and for their party.”

Mr. McCon­nell can af­ford two de­fec­tions and still pass a bill un­der fast-track bud­get rules, with Vice Pres­i­dent Mike Pence serv­ing as a tie-break­ing vote.

Yet five Se­nate Repub­li­cans have said they will not vote for the bill in its cur­rent form. Four con­ser­va­tives say the leg­is­la­tion doesn’t fix Oba­macare’s flaws and drive down pre­mi­ums, and Sen. Dean Heller, a Ne­vada Re­pub­li­can who is fac­ing a tough re-elec­tion con­test next year, says the bill is too tough on Med­i­caid cov­er­age for the poor.

One of the hold­outs, Sen. Ron John­son of Wis­con­sin, bluntly crit­i­cized Re­pub­li­can lead­ers for try­ing to “jam this thing through.”

Sen. Rand Paul, Ken­tucky Re­pub­li­can, said only about a quar­ter of Amer­i­cans like the plan. He pointed to Democrats who want to keep Oba­macare and the half of Repub­li­cans who say the plan isn’t full re­peal.

“It’s a ter­ri­ble bill,” he said.

Mr. Paul said he was pre­pared to buck lead­er­ship and vote to thwart the bill, and Mr. John­son said he had a hard time be­liev­ing he would have “enough in­for­ma­tion” to sup­port pro­ceed­ing this week.

Sen. Su­san M. Collins of Maine said she planned to re­ject the mo­tion to pro­ceed, and Mr. Heller had promised to do so ab­sent sweep­ing changes.

On Twit­ter, Ms. Collins said she wanted to work with Repub­li­cans and Democrats to fix Oba­macare’s wob­bly mar­kets.

But “CBO anal­y­sis shows the Se­nate bill won’t do it,” she said.

The CBO said the in­surance mar­kets would be sta­ble un­der the Oba­macare pro­gram and the Repub­li­cans’ model, largely be­cause of fi­nan­cial in­cen­tives to en­roll.

It es­ti­mated that 15 mil­lion more peo­ple would be unin­sured in next year, mostly be­cause the bill would scrap penal­ties tied to Oba­macare’s in­di­vid­ual man­date. In later years, tax cred­its that are less gen­er­ous than Oba­macare, on av­er­age, and phased-in cuts to Med­i­caid spend­ing would re­sult in many more peo­ple with­out cov­er­age.

All told, an es­ti­mated 49 mil­lion peo­ple would be unin­sured by 2026 com­pared with 28 mil­lion who would lack it un­der the Oba­macare frame­work.

The CBO said the in­crease in unin­sured would be dis­pro­por­tion­ate among older, poorer peo­ple who are not el­i­gi­ble for Medi­care, the gov­ern­ment in­surance pro­gram for se­niors, since in­sur­ers could charge older Amer­i­cans up to five times what they charge younger con­sumers.

Though younger Amer­i­cans, par­tic­u­larly those who don’t qual­ify for Oba­macare sub­si­dies, stand to pay lower pre­mi­ums un­der the Se­nate bill, the CBO said, many cus­tomers would likely pay more out of pocket in some cases, and those who need one of Oba­macare’s “es­sen­tial ben­e­fits” would pay sig­nif­i­cantly more in states that loosen the reg­u­la­tions.

Se­nate Ma­jor­ity Whip John Cornyn, Texas Re­pub­li­can, said the re­port had enough good news to pro­ceed.

“I look for­ward to con­tin­u­ing to work with my col­leagues this week as we get closer to fi­nally re­plac­ing this failed law with bet­ter care at a cost that Tex­ans will be able to af­ford,” he said.

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