The nonpartisan Congressional Budget Office estimated late Monday that 24 million Americans would lose insurance coverage under the American Health Care Act. The long-awaited score is terrible news for Republicans and shows way more Americans losing coverage than most experts had expected.
To put that in context: 24 million people is close to the entire population of Australia.
This is no good, very bad news for congressional Republicans, who will now field endless questions about why so many people would lose coverage under AHCA — and what they're actually trying to accomplish with this plan.
But the CBO wasn't bad news for every American. Here are the winners and losers from the new report:
Loser: The Republican Party. Republicans in Congress and in the Trump administration are now going to face a barrage of questions about why their health care bill leaves so many Americans uninsured. Trump in particular has promised repeatedly that he'd write a bill that covers everyone. His top advisers said as recently as this weekend that nobody would lose coverage under AHCA. The CBO report tells us that isn't true — and you can bet this is exactly what reporters are going to want to talk about.
Loser: Medicaid. CBO estimates that the Republican plan would make especially steep cuts to Medicaid, the health program that covers millions of low-income Americans. The GOP plan would spend $880 billion less on the entitlement over the next decade. Much of this change comes from halting enrollment in the Medicaid expansion, which covers millions of low-income adults, on January 1, 2020. By 2026, CBO estimates that Medicaid enrollment will have declined by 14 million people.
Trump repeatedly promised that he would not cut Medicaid. In May 2015 when he was preparing his campaign, he said, “I’m not going to cut Medicare or Medicaid. Every other Republican is going to cut.” The CBO report shows that this is absolutely false, and Trump supports a plan that would include very deep Medicaid cuts.
Winner: Middle-income, young Americans. If there is anyone who does well under AHCA, it is mostly Americans who are younger and middle-income. This chart from CBO demonstrates how a 21-year-old who earns $68,200 stands to benefit from AHCA.
Under Obamacare, this 21-year-old earns too much money to qualify for financial help to purchase insurance. The GOP plan, however, gives tax credits to anyone who earns less than $75,000 — meaning this person would receive $2,450 to help buy coverage. The plan would be a bit skimpier than those offered under Obamacare, but it would also be a whole lot cheaper.
Loser: Poor, older Americans. The chart above also shows that the GOP plan would be bad for aging Americans with low incomes. CBO expects that a 64-year-old who earns $20,000 would see her premiums rise from $1,700 to $14,600 under the Republican plan — a 758 percent increase.She'd be expected to spend more than half her annual income on health insurance.
The CBO report shows that AHCA is fundamentally a redistribution from the poor to the middle class and wealthy.
The people who need more help affording coverage will get less — and those who need less help will get more. The bill will cut programs such as Medicaid and substantially reduce financial help for the lowest-earning Americans who purchase their own coverage. Those funds will go towards higher insurance subsidies for the middle class and tax cuts that almost exclusively benefit the ultra-wealthy.
Winner: The individual mandate. Obamacare's requirement that nearly all Americans carry coverage or pay a fine regularly polls as Obamacare's most-hated provision. But the CBO seems to think the individual mandate is working as intended to get healthy people to sign up for insurance — and that getting rid of it would be partially responsible for the huge coverage drop.
“Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums,” the report concludes.
Loser: Obamacare enrollees. The CBO report is all about big numbers: millions of Americans and billions of dollars in spending. At the end of the day, though, health insurance is about individual people. This report suggests that the vast majority of people who gained coverage through Obamacare would lose that coverage if this Republican health care plan passed.
These are real people with real lives who made real decisions around the health law's promise of coverage. Now millions of those people are facing the possibility that all that will change.
Read more from Vox
- "No legislation enacted in recent decades cut low-income programs this much — or even comes close,” Robert Greenstein, the founder and president of the Center on Budget and Policy Priorities and Washington’s leading advocate for poor and low-income Americans, tells my colleague Dylan Matthews of the GOP plan.
- Julia Belluz notices something important in the CBO score: a $9 billion cut to public health funding.
- Ezra Klein's take on the GOP plan: "The AHCA would increase the uninsured population by about 24 million people — which is more people than live in New York state. But the raw numbers obscure the cruelty of the choices. The policy is particularly bad for the old, the sick, and the poor. It is particularly good for the rich, the young, and the healthy."
Chart of the Day
My colleague Alvin Chang charts what CBO expects the uninsured rate to look like under Obamacare and the Republican replacement plan.
With research help from Caitlin Davis
- "4 Key Problems That Could Kill The Tax Credits In The Obamacare Repeal": “In recent days, House leaders have made numerous comments highlighting the procedural limitations of the budget reconciliation process in the Senate. However, those statements do not necessarily mean the legislation released last week comports with all of those Senate strictures. Indeed, my conversations with more than half a dozen current and former senior Senate staff, all of whom have years of expertise in the minutiae of Senate rules and procedure, have revealed at least four significant procedural issues—one regarding abortion, two regarding immigration, and one regarding a structural “firewall”—surrounding the bill’s tax credit regime.” —Christopher Jacobs, the Federalist
- "Another key Republican senator knocks GOP Obamacare plan": “Sen. Dean Heller panned House Speaker Paul Ryan's bill to repeal and replace Obamacare during a closed meeting with constituents on Saturday, according to audio obtained by POLITICO. The remarks by Heller, the most vulnerable GOP senator on the ballot next year, are another sign of the difficult prospects the House bill faces in the other chamber. Already, more than a half-dozen senators have criticized the bill, and Republicans can afford to lose only two votes.” —Burgess Everett, Politico
- "Trump supporters in the heartland fear being left behind by GOP health plan": “In a rural corner of Indiana where Trump won 40,000 votes to comfortably beat Hillary Clinton by 10,000, many low-income people are covered by a program Pence put in place only two years ago and which Republican proposals would severely cut. Pence’s program, called HIP 2.0, is part of Medicaid. It is funded by the ACA, the law that Pence continues to lobby against. Including Medicaid, more than one in three people use government health coverage in Indiana.” —Jessica Glenza, the Guardian