CBO finds GOP plan lowers costs but also coverage
Senate leaders optimistic for health vote despite holdouts
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.