CBO scores House-approved AHCA: 5 things to know

The Congressional Budget Office released its score on the American Health Care Act Wednesday, finding it would reduce the federal deficit significantly but increase the projected number of uninsured Americans by about 82 percent over the next 10 years.

The CBO previously scored the AHCA in March, but that was before changes were made to the bill that ultimately passed the House. The latest projections include the following modifications to the bill:

  • A delay in repealing the increase to the payroll tax
  • State waivers for essential health benefits and community rating rules
  • $8 billion in funding to offset increased premiums for people with preexisting conditions in waiver states
  • $15 billion in funding for the Federal Invisible Risk Sharing Program
  • $15 billion in state funding for maternity care and mental health services

Here are five things to know about the CBO's findings.

1. The AHCA would reduce the federal deficit by $119 billion from 2017 to 2026. This is $32 billion less than the projected reduction for the previous version of the bill. The CBO found the greatest savings would come from reduced funding for the Medicaid program and restructuring tax credits for the individual market. These savings are partially offset by other provisions, such as a reduction in revenue from repealing the individual and employer mandates.

2. Under the latest version of the AHCA, 14 million more Americans would be uninsured in 2018 and up to 23 million more Americans would be uninsured by 2026. This is a slight improvement over previous versions of the bill, which the CBO estimated would increase the number of uninsured by 24 million by 2026. It is important to note these estimates are an increase in the number of uninsured over what is already expected under the ACA. Under current law, a projected 28 million Americans will be uninsured by 2026. The AHCA would increase this count by 23 million, leaving an estimated 51 million Americans under age 65 uninsured by 2026.

3. Individual markets would be stable in most regions — except in states that file waivers. The CBO believes the AHCA subsidies are sufficient to ensure enough healthy people buy insurance and that state grants to help offset costs for covering sick people are enough to stabilize the individual markets in most areas of the U.S. However, the CBO estimates about one-sixth of the population will reside in areas with individual markets that will be unstable by 2020. This will occur in states that choose to waive both the essential health benefits and community rating requirements, according to the CBO. The CBO estimates these waivers will increase premiums for sick enrollees so much that insurance becomes unaffordable, despite funding to help reduce premiums.

4. Premiums are expected to increase initially, but could start to decrease beginning in 2020. The CBO estimates premiums would jump about 20 percent under the AHCA in the first year and increase an additional 5 percent in the second year of implementation. Beginning in 2020, the CBO estimates premiums would likely begin to decrease again, but by how much depends on which options states choose. For example, if states do not request waivers, the CBO estimates premiums would be 4 percent lower in 2026 than they are projected to be under current law. If states make moderate changes to essential health benefits via the waiver program, premiums could be about 20 percent lower in 2026, according to the CBO. However, benefits would be skimpier, and reductions would likely be smaller for older Americans. Due to potentially high variation in premiums in states that waive both the essential health benefits and the community rating rule, the CBO was unable to provide an estimate for that scenario.

5. The estimates are uncertain. The CBO notes the estimates provided are uncertain because it is unable to predict how many of the affected parties would act in response to the law. It also noted due to the limited time available, it was unable to provide projections of the macroeconomic budgetary impact of the AHCA.


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