Republicans are speeding their health care bill through the Senate, releasing the text last week and preparing to vote as soon as this week. When asked why the rush, one of the first answers GOP leaders often give is that Congress must take action now to save individual insurance exchanges set up under the Affordable Care Act, which Sen. John Cornyn (R-TX) told reporters this weekend are in “full meltdown mode.”
One piece of evidence for that meltdown is the scattered — but growing — number of rural counties, in states such as Missouri and Ohio, where no insurer will offer a plan on the individual market. Republicans must repeal and replace the ACA, the argument goes, in order to give residents of those areas choices for insurance.
But the Congressional Budget Office just said the Senate bill will not, in fact, solve that problem. From its assessment of the bill, released Monday afternoon:
In the agencies’ assessment, a small fraction of the population resides in areas in which — because of this legislation, at least for some of the years after 2019 — no insurers would participate in the nongroup market or insurance would be offered only with very high premiums. Some sparsely populated areas might have no nongroup insurance offered because the reductions in subsidies would lead fewer people to decide to purchase insurance — and markets with few purchasers are less profitable for insurers. Insurance covering certain services would become more expensive — in some cases, extremely expensive — in some areas because the scope of the EHBs would be narrowed through waivers affecting close to half the population, CBO and JCT expect. In addition, the agencies anticipate that all insurance in the nongroup market would become very expensive for at least a short period of time for a small fraction of the population residing in areas in which states’ implementation of waivers with major changes caused market disruption.
To repeat: “Some sparsely populated areas might have no nongroup insurance offered.” That seems like a messaging challenge for Republicans selling the speedy process, and the bill.