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The Congressional Budget Office estimates that 22 million Americans would lose coverage under the Senate health bill. This would mean the uninsured rate would rise significantly over the next decade.
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The CBO report is a dense 49-page document that you can read here. But you can find its clearest explanation of the Senate bill on page 48. This is where the CBO report explains how premiums would change for low- and middle-income Americans — and what type of health insurance they would get for those monthly payments.
This page shows, in no uncertain terms, that low-income Americans would be asked to pay higher premiums for worse health insurance coverage.
Look at what happens to people who earn $26,500 (175 percent of the poverty line). I've circled the most relevant numbers below.
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You can see that across the board, premiums go up for Americans with low to moderate incomes. People who purchased bronze-level plans would see their premiums go up a little. People who purchased silver-level plans would see their premiums go up a lot.
What is harder to see is that the premiums are up while the quality of the health insurance is going down. Those numbers in the gray boxes represent actuarial value, which measures how much a health plan, on average, covers of its members' costs. You can see that the actuarial value drops as premiums rise.
This, in simple terms, means enrollees will be asked to pay higher premiums and in return get coverage with higher deductibles and copayments.
The reality, of course, is that many of these people just wouldn't buy coverage. They would find the plans prohibitively expensive and the coverage not worth the price. This is what the CBO concludes in one especially devastating paragraph (bolding mine):
Under this legislation, starting in 2020, the premium for a silver plan would typically be a relatively high percentage of income for low-income people. The deductible for a plan with an actuarial value of 58 percent would be a significantly higher percentage of income — also making such a plan unattractive, but for a different reason. As a result, despite being eligible for premium tax credits, few low-income people would purchase any plan, CBO and JCT estimate.
One problem this Senate bill does solve is helping some especially low-income Americans who didn't qualify for tax subsidies under the Affordable Care Act. This was an odd drafting quirk: The law presumed these people would enroll in Medicaid expansion before the Supreme Court gave states the ability to opt out of the program.
Those people would qualify for subsidies under the Senate bill, lowering the premiums of a 40-year-old who earns $11,000 significantly. You can see that in the first lines of the chart above.
But it's not clear that this would matter that much: At that income level, any level of subsidy (again, for a plan with a high deductible) may not be an attractive option. The CBO makes this clear in one other chart that is worth pausing on:
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This chart shows that the people who lose badly in the Senate bill are Americans with lower incomes. They would see the steepest rise in uninsured rates, just as this group saw the biggest gains under the Affordable Care Act.
The Senate bill provides current Affordable Care Act enrollees with a stark choice: You can pay more and get less, or you can decide to drop coverage. The CBO estimates that millions of Americans will, understandably, make the latter decision.
Defector of the Day: Ron Johnson
Each day leading up to the Senate vote, we'll take a closer look at a Republican senator who seems to be on the fence on the Better Care Reconciliation Act, what they want, and what role they're likely to play in the debate. On Friday, we kicked off with Nevada Sen. Dean Heller. Today we move eastward with some news from Wisconsin Sen. Ron Johnson.
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Johnson already made waves last week when he joined a trio of the Senate's most conservative Republicans (Sens. Ted Cruz, Mike Lee, and Rand Paul) Thursday to announce they could not endorse the Senate health bill in its current form.
Since then, however, Johnson has somewhat surprisingly emerged as one of the most outspoken critics of the BCRA. He wrote Monday in a New York Times op-ed that the current bill from Senate Majority Leader Mitch McConnell (R-KY) “leaves in place the pre-existing-condition rules that drive up the cost of insurance for everyone.”
Johnson also appeared on Meet the Press this past Sunday, where he criticized the health care process too. “We don't have enough information,” he said. “I don't have the feedback from constituencies who will not have had enough time to review the Senate bill. We should not be voting on this next week.”
What will get Johnson to yes: Johnson seems to be angling for relaxing some of the Affordable Care Act's insurance market regulations and wants a bit more time to consider the bill.
Stat of the Day
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The House bill's tax cuts for the wealthiest 400 families are equivalent to ending federal funding for Medicaid expansion in four states. This would end coverage for an estimated 725,800 Medicaid enrollees. Read more here.
Kliff’s Notes
Your daily top health care reads, with research help from Caitlin Davis
Today's top news
- "The Senate just released a new draft of its health bill. Here’s what changed." "The new bill includes a six-month waiting period for those who want to purchase individual market coverage but have had a more than two-month break in coverage at some point in the past year." —Sarah Kliff and Dylan Scott, Vox
- "Insurers' losses on ACA plans narrow in 2016": "Health insurers lost less money on individual insurance plans in 2016 than they did the year before, but those losses still totaled billions of dollars. Insurers selling plans in the individual insurance market on and off the exchanges lost between 7% and 9% of premiums, compared with 10.1% of premiums in 2015, according to a report released Friday morning by consultancy McKinsey & Co. That's because enrollment increased in individual plans last year, so insurers made more in revenue." —Shelby Livingston, Modern Healthcare
- "Health Bill Provision Favors States That Didn’t Expand Medicaid": “As health-care companies parse Senate Republicans’ bill to undo the Affordable Care Act, a rift is emerging in the hospital industry over a provision that would award additional funds in states that didn’t expand Medicaid. The split centers around cuts the Affordable Care Act made to Medicaid subsidies known as 'disproportionate share' payments, for hospitals that care for a large share of uninsured patients.” —Melanie Evans, Wall Street Journal
- "GOP's Obamacare repeal bills threaten huge disruptions across the healthcare system": “In physicians’ offices and medical centers, in state capitols and corporate offices, there are growing fears that the unprecedented cuts proposed in the GOP legislation would create even larger problems in the U.S. healthcare system. 'These reductions are going to wreak havoc,' warned Tom Priselac, chief executive of Cedars Sinai Health System in Los Angeles, one of the country’s leading medical centers. 'It will be a tragic step backward not just for the people most affected, but for the country as a whole.'” —Noam N. Levey, Los Angeles Times
- "In the End, Even the Middle Class Would Feel GOP Cuts to Nursing Home Care": "A combination of longer life spans and spiraling health care costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation." —Jordan Rau, Kaiser Health News
Longer reads and analysis
- "The defenses of the Senate health care plan are pathetically dishonest": "There is one solid, coherent argument for the Senate health-care bill: If you believe the government redistributes too much money from the medically and financially fortunate to the unfortunate, then Trumpcare is a huge step forward." —Jonathan Chait, New York magazine
- "51 percent of opioid prescriptions go to people with depression and other mood disorders": "More than half of all opioid prescriptions in the United States are written for people with anxiety, depression, and other mood disorders, according to a new study that questions how pain is treated in this vulnerable population." —Catherine Caruso, Stat
- "How the Senate health care bill threatens the nation's health": "Conservatives also dismiss Medicaid by arguing that it provides inadequate or unsatisfactory coverage. The opposite is true, according to the evidence. Compared with private coverage, Medicaid produces at least as much improvement in access to care, measures of health, and mortality reduction." —Atul Gawande, New Yorker
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