Senate health bill
22 million fewer insured; deficit falls by $321 billion
Congressional Budget Office: Key analysis finds measure would lead to 22 million fewer Americans having health insurance by 2026.
The Senate health care bill introduced last week would lead to 22 million fewer Americans having health insurance by 2026, while reducing the federal deficit by $321 billion, according to an analysis released Monday by the nonpartisan Congressional Budget Office.
The figures present a fresh challenge for Senate Majority Leader Mitch McConnell, R-Ky., who is pushing to bring the bill to a vote on the Senate floor this week before lawmakers head home for the Fourth of July recess.
The projected 22 million uninsured Americans is similar to the 23 million that would be without insurance under the House bill by 2026. The Senate bill, however, would save the federal government $202 billion more than the House bill. The largest savings would come from reduc-
tions in federal Medicaid spending, which would decline by 26 percent by 2026, according to the analysis.
By 2018, 15 million more people would be uninsured under the Senate plan than are uninsured today, primarily because the penalty for not having insurance would be eliminated, the CBO found.
The Senate measure — part of the GOP effort to “repeal and replace” the Affordable Care Act — would end some parts of President Barack Obama’s health care law. Like the House bill, it would eliminate the requirement for individuals to buy insurance and repeal the taxes on corporations and wealthy Americans that paid for the expansion of coverage to millions of people since the law took effect in 2014.
On Monday, GOP Senate leaders added a so-called “continuous coverage” provision that would require people who had gaps in insurance coverage of at least 63 days the previous year to wait six months, after signing up for insurance, before their new coverage kicks in. This was added to help stabilize the individual insurance market by encouraging healthy people to maintain their insurance coverage — while stopping short of imposing an all-out mandate, like the one under the ACA.
The Senate bill, called the Better Care Reconciliation Act, would end the increased federal funding to state Medicaid programs that began under the ACA. That funding allowed California to enroll 5 million new poor residents in the program. And it would change the way Medicaid — called Medi-Cal in California — gets funded in the long run by capping the amount of money the federal government provides states each year, and tying that number to a growth rate that is slower than the growth rate of health care costs.
But the proposed legislation would keep in place the general structure of the ACA subsidies that, in California, go to about 1.5 million residents who buy insurance on Covered California. However, the Senate bill would change the eligibility requirements to receive this assistance, making it no longer available for tens of thousands of low-income people who earn between roughly $42,000 and $48,000 a year. The subsidies under the Senate proposal would be linked to a less generous insurance plan with a higher deductible — meaning even those who would continue to receive assistance would probably shoulder higher out-ofpocket costs.
Older Americans, regardless of whether they receive subsidies, could pay much higher premiums under the GOP plan because both the House and Senate bills would allow insurance companies to charge older people up to five times more than what they charge younger people. Under current law, they cannot charge more than three times more.
These changes would mean that among the low-income population that buys subsidized insurance on the exchange, older people in their 60s would see large spikes in premiums, while some younger people in their 20s would see modest decreases in premiums. Under the Senate plan, generally, the poorer and older you are, the more your premiums would rise.
California consumers’ monthly premiums would more than double under the Senate plan, from $190 to $386, according to data compiled by the Kaiser Family Foundation. This figure applies to low-income Californians across all age levels who receive federal subsidies to buy plans on Covered California insurance exchange.
In San Francisco, premiums for 60-year-olds who earn $20,000 a year would increase by 552 percent, according to data from Kaiser. The same group of people in Alameda County would see premiums rise 491 percent.
In contrast, some higher-earning consumers in their 20s who buy on the exchange would see their premiums drop — by 12 percent in San Francisco and by 15 percent in Alameda County for a 27year-old earning $40,000 a year, according to Kaiser.
“The American people deserve better care, which is exactly what we’re working to bring them,” McConnell tweeted after the CBO report was released.
“If your idea of better care is charging people more for care and kicking 22 million off coverage, we need to talk,” House Minority Leader Nancy Pelosi, D-San Francisco, tweeted in response.
There are some differences between the House and Senate versions of the bill. If the Senate passes its measure, the two houses would have to reconcile the differences before sending the legislation to the president’s desk. Changes to the Senate bill are anticipated this week, as several GOP senators — from both the moderate and conservative wings of the party — have expressed reservations about the measure and could lobby for amendments.