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32 million fewer people would have health insurance under Senate's repeal-and-delay plan

Senate GOP Health Care Bill Loses More Support  With Republican Ranks Mark Wilson/Getty Images

Senate Majority Leader Mitch McConnell is planning a desperate move after the failure of his party to unite around their latest health care bill. He's prepared to push forward a vote that would repeal huge swaths of Obamacare with no immediate replacement.

But Republicans who worried about coverage losses or high premiums won’t find much to like in that plan.

The Congressional Budget Office estimated its effects earlier this year. The analysts projected that by 2026, 32 million fewer Americans would have health insurance under the 2015 plan compared to Obamacare. That adds another 10 million uninsured to the total from the doomed Better Care Reconciliation Act.

Meanwhile, by 2026, premiums would double.

The bill was written by Rep. Tom Price, now secretary of health and human services, and would have repealed Obamacare’s funding but not its insurance regulations. The bill would have destroyed the Affordable Care Act in three important ways: eliminating tax credits for low-income Americans to buy private health insurance, cutting funding for the law's Medicaid expansion, and removing penalties for people who are uninsured.

It also created a two-year transition period before the cuts would go into effect, which was meant to give lawmakers time to come up with and pass a replacement bill. (Read a full explainer of the repeal-and-delay effort by my colleague Sarah Kliff, here.)

Analysts at the Congressional Budget Office originally believed the repeal bill would leave 22 million fewer Americans without health insurance. But after a more detailed review, the CBO and the Joint Committee on Taxation released a more dire assessment in January. They found:

1) Premiums would skyrocket

Buying health insurance on the individual market would be way more expensive. That's mostly because people would no longer be penalized for not having insurance, but insurers would still be required to cover everyone at the same price, as they are under Obamacare. So many relatively healthy, young Americans would decide that they don't need health insurance. That would leave an older, sicker group of people seeking coverage, and to cover the cost of their care, insurers would mostly like raise premiums — by a lot.

After the first year, premiums on the individual market would rise anywhere from 20 to 25 percent, according to CBO and JCT. By 2026 — after funding for Medicaid expansion and marketplace subsidies are removed — premiums would double.

2) The uninsured rate would soar

Things wouldn't be so bad the first year after repealing Obamacare, because insurers in the individual market would have already set their rates and people would have already made their decisions to enroll —or not — that year. The second year would be different, and that's mainly because the bill would stop penalizing people who didn't have health insurance. About 18 million people would probably end up without coverage after the first year, including about 5 million fewer people with Medicaid.

That would have a ripple effect. With more people choosing not to buy individual insurance, insurers would likely stop selling plans in some state exchanges. That would leave more people in those states without coverage.

The uninsured rate would then keep climbing once funding for the ACA’s Medicaid expansion and subsidies to buy insurance were phased out. That would eventually leave 32 million fewer people without health care coverage than Obamacare.

Passing such a bill still poses a major challenge for McConnell. After all, he still needs to get 50 Republican votes through the budget reconciliation process. That means that no more than two Republican senators can oppose it. And if the fate of the BCRA is any indication, that will be quite a feat to pull off.

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