WASHINGTON (AP) – The health care bill Republicans have pushed through the House would leave 23 million additional people uninsured in 2026 compared to President Barack Obama’s health care law, the Congressional Budget Office said Wednesday.

The GOP bill would lower average premiums, but in part that would be because coverage would typically be skimpier.

The nonpartisan analysts were also critical of 11th-hour provisions that GOP leaders had added to pick up votes and assure the bill’s passage. Letting states get federal waivers so insurers could charge higher premiums for people with pre-existing medical conditions would mean those consumers would “ultimately be unable to purchase” comprehensive coverage at prices comparable to today’s costs, “if they could purchase at all.”

The report was the budget office’s first analysis of the GOP health care overhaul that the House narrowly approved this month with only Republican votes. Two budget office reports in March on initial versions of the bill projected that 24 million people would lose coverage, and that premiums would rise over the next two years but fall by 2026.

Democrats have said the GOP bill would toss people off their coverage, threaten their benefits and jeopardize coverage for people with serious, costly to treat medical conditions.

Republicans have said they are largely focused on steps that will reduce premiums.

The House bill would also reduce the federal deficit by $119 billion over the next decade, according to the new projection. That’s slightly less than the $150 billion the office estimated in March.

The new estimates will serve as a starting point for GOP senators starting to write their own version of the legislation as they consider changing the House’s Medicaid cuts, tax credits and other policies. </s> The revised Republican bill to repeal and replace the Affordable Care Act will leave 23 million more people uninsured in 2026 than if that act, also known as Obamacare, were to remain in place. The GOP bill would also reduce the deficit by $119 billion over 10 years.

That’s what the nonpartisan Congressional Budget Office reported on Wednesday in its latest score of the American Health Care Act. The CBO’s assessment shows that the deficit would fall and premiums would fall for some Americans, but the report also raises potential concerns about the bill. The agency reports that the bill could destabilize individual insurance markets in some states, leaving unhealthy Americans unable to buy insurance.

The bill will now move on to the Senate, and should it pass that chamber, it will not look like this current AHCA version. As NPR’s Susan Davis reported on Wednesday, the Senate will likely write their own version of the bill. Senate Majority Leader Mitch McConnell also told Reuters he doesn’t know what that path to passing the bill will look like.

“I don’t know how we get to 50 (votes) at the moment. But that’s the goal,” he said.

The $119 billion deficit reduction represents a decline from previous versions. When the CBO first scored the AHCA, it said the plan would save $337 billion over 10 years. Later revisions reduced those savings to $150 billion.

By far the biggest savings would come from Medicaid, which serves low-income Americans. That program would face $884 billion in cuts. Cutbacks in subsidies for individual health insurance would likewise help cut $276 billion. But those are offset in large part by bigger costs, including the repeal of many of Obamacare’s taxes.

Those tax cuts would overwhelmingly benefit the highest-income Americans, the Tax Policy Center, a Washington think tank, reported on Wednesday.

The increase in the number of uninsured is also slightly lower than in the CBO’s initial estimate. That report estimated that 24 million fewer would be insured in 2026 if this bill were to become law, putting the uninsured rate at around 18.6 percent. This revised bill would reduce that by around 1 million — a difference of less than half a percentage point.

In contrast, the uninsured rate in 2026 would be around 10 percent under Obamacare, the CBO reports.

More than half of that increase in the uninsured — 14 million — would come from reduced Medicaid enrollment.

The CBO also notes that the AHCA could mean some Americans would buy coverage that doesn’t cover “major medical risks.” Because of those policies’ skimpy coverage, the CBO doesn’t count those people as insured in this report.

The Trump administration responded by saying it believes the CBO’s numbers are unreliable.

“History has proven the CBO to be totally incapable of accurately predicting how healthcare legislation will impact health insurance coverage,” the White House said in a statement.

The CBO did indeed far overestimate the number of people who would sign up for the Obamacare exchanges, as FactCheck.org’s Brooks Jackson wrote in March. Likewise, it undershot on the number of Medicaid enrollees. (That said, Jackson added, the CBO predicted the uninsured rate relatively closely.)

Difficulties for some addicted, pregnant or sick Americans

The act could make obtaining health care coverage prohibitively expensive for some sicker Americans, the CBO found.

That’s because under the AHCA, states could get waivers exempting them from some Obamacare provisions, including what are called “essential health benefits” — a list of basics like mental health and prescription drugs that the Affordable Care Act required plans to cover. States could also get waivers that allow insurers to charge more for people with pre-existing conditions.

One challenge the CBO faced in creating these estimates was figuring out how many states would get those waivers, and the report acknowledges that this creates some uncertainty in the estimates. In the end, they estimated that around one-sixth of the population lives in states that would seek both of those waivers. Around half of Americans live in states that would seek no waivers, meanwhile, and the remainder live in states that would make “moderate” changes.

In states that obtained both of those waivers, it would mean lower premiums for people buying individual insurance. But less healthy Americans in those states could face “extremely high premiums,” the report said.

“Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly,” the CBO wrote.

Waiving essential health benefits could also make medical care much more expensive for people who are pregnant, addicted, or have other mental health issues, and who live in those states that waive those benefits.

“In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services,” the report says of people living in those states.

Under current law, the CBO wrote, the markets will be “stable in most areas” because lower-income Americans buying individual insurance will be shielded from rising Obamacare premiums, thanks to subsidies.

However, the report acknowledges that insurers have reduced their participation in the exchanges, leaving some Americans with no options for buying insurance. “The Affordable Care Act doesn’t have a back-up plan for this situation,” as Vox’s Sarah Kliff and Sarah Frostenson reported Wednesday, so it’s not clear how this could play out.

Medicaid accounts for by far the biggest spending reductions under the American Health Care Act. The bill would roll back the Medicaid expansion instituted under the Affordable Care Act, which extended the program to cover some Americans with incomes up to 133 percent of the poverty line. That expansion grew enrollment by 10 million, as NPR’s Alison Kodjak previously reported. Rolling back that expansion would limit future enrollments.

The AHCA would also give states a choice: Receive Medicaid funding either via a block grant or receive a per capita amount per enrollee.

Together, these changes would create major cuts in enrollment for the program: 14 million fewer people by 2026, and $834 billion in spending cuts over a decade.

Average premiums would be lower in 2026 than they would be under Obamacare, both in states that do and don’t seek waivers. But it’s impossible to make a meaningful blanket statement about how premiums would change under this bill, as those changes differ vastly for different groups of people.

For example, older Americans who make little money and buy individual insurance would see their premiums climb far beyond what they would be under Obamacare. A 64-year-old making $26,500 would pay $1,700 in premiums annually under Obamacare. In a state making those “moderate” changes to its market, that 64-year-old would pay $13,600, and in a state with no waivers, the cost would be $16,100. That’s more than nine times that person’s premium under the Affordable Care Act.

However, younger Americans would see little change in their premiums, or even declines. Likewise, some people with higher incomes could see substantially lower premiums under this bill. For example, a 40-year-old paying $6,500 a year under current law could pay an estimated $2,100 in a state with “moderate changes” to its market.

The bill moves on to the Senate

The CBO’s newly estimated deficit savings mean the bill can safely move on to the Senate.

The future of the bill hinged upon this report, as House Republicans passed their most recent version of the bill without waiting for the CBO to report the bill’s estimated price tag. Three weeks after passing the bill, however, they have not sent the bill on to the Senate yet, because they were waiting on this score. Budget rules dictate that if the bill’s deficit savings had not reached $2 billion (and that $2 billion had to come from particular spending categories), the bill would be dead upon arrival in the upper chamber. </s> There are 2 comments on the The San Diego Union-Tribune story from 11 hrs ago, titled Congressional Budget Office. In it, The San Diego Union-Tribune reports that:

The Congressional Budget Office says the health care bill Republicans pushed through the House this month would leave 23 million additional people uninsured in 2026, compared with former President Barack Obama 's health care law. The nonpartisan office also says that compared with Obama's 2010 overhaul, average premiums for people buying individual policies would be lower.

Join the discussion below, or Read more at The San Diego Union-Tribune. </s> iStock/Thinkstock(WASHINGTON) — Republicans on Capitol Hill are preparing for the release of the Congressional Budget Office’s analysis of the GOP health care bill that passed the House earlier this month.

The estimate of the American Health Care Act impact on the federal deficit could determine whether the Senate will take up the measure, which passed with only one vote to spare in the House.

Senate budget rules require the AHCA to save $2 billion over 10 years in order to be taken up under reconciliation — a process that would allow Senate Republicans to pass the bill with only 51 votes.

If the nonpartisan CBO determines that the bill doesn’t pass muster for reconciliation, Democrats would be able to filibuster the measure, which could send the bill back to House Republicans to amend and hold another vote.

Republican leadership aides say it’s unlikely the bill won’t meet the Senate requirements.

The CBO score will also include an estimate of whether the number of Americans with health insurance would change and by how much.

An earlier analysis of the bill estimated that 24 million Americans would lose health insurance under the GOP’s AHCA, compared to Obamacare. </s> CBO Releases Score For House-Approved American Health Care Act

The Congressional Budget Office gave its projections Wednesday on the costs and impact of the version of the American Health Care Act passed by the House earlier this month.

AUDIE CORNISH, HOST:

We now have a score of the health care bill recently passed by House Republicans. That's what the analysis from the nonpartisan Congressional Budget Office is called. Economists have estimated how much the bill will cost and how many Americans it's expected to cover. NPR congressional correspondent Susan Davis has read the report. She joins us now to talk about those numbers and what they mean as the bill heads to the Senate. And Susan, to start, what does the CBO say the budget impact would be if this House bill actually became law?

SUSAN DAVIS, BYLINE: Well, the first news that I think will be good news for Republicans is that it saves money. It says that it would reduce the federal deficit by about $120 billion over the next 10 years. The original forecast on the bill earlier this year said that it would leave 24 million fewer Americans insured over that same period of time, that 10-year period. This report is slightly better. It estimates only 23 million fewer Americans will be insured over the next decade. And it also forecasts that premiums on the individual market would be lower.

Now, the caveat of course, Audie, is they say premiums would be lower because of the changes Republicans made to the bill that would give states options to get waivers from the current law mandates on what insurance plans have to cover as well as how pre-existing conditions are covered.

CORNISH: Let's talk more about pre-existing conditions. How will they be affected according to this report?

DAVIS: Audie, I think this is one of the most notable parts of this update and something that we're going to be hearing a lot more about. Republicans said the changes they were making to the bill would not hurt people with pre-existing conditions or their access to coverage. Their argument is that their plan would give states more flexibility, and they included more money in what they were calling stability funds to help people buy those premiums if they needed to. CBO says very clearly that's not the case. In this report, it states that premiums for up to one-sixth of the people in the individual market could see their premiums go up, and they wouldn't be able to afford them.

In the very nerdy, wonky CBO language, they say, quote, "instability would cause some people who have been insured under current law to be uninsured." Now, the pre-existing condition protections are arguably the most popular part of Obamacare, and Republicans campaigned on keeping those protections in place. So if this is seen as an effort to weaken them, this is an area where I think we could see a huge backlash, at least politically.

CORNISH: When it comes to the politics, I know the CBO has been a bit of a political football for lawmakers. How are they reacting to the report?

DAVIS: You know, it doesn't really shift the debate. This is, as you know, one of the most partisan debates on Capitol Hill about this health care bill. You know, there's a lot of fodder in here for Democrats to continue to oppose the legislation. Republicans have been largely dismissive of it. They note that in the past, CBO forecasts have been wrong, and many of them think they'll be wrong again. For - that 23 million fewer insured, you know, Republicans will say that's because the repealing the individual mandate. And that is what they promised to do.

Their argument is that fewer people will have to buy something they don't want in the first place. House Speaker Paul Ryan put out a statement on it, and he said that the bill accomplishes their mission. And the mission as he defines it is, quote, "lowering premiums and lowering the deficit." And if that is Republicans' goal this bill does that.

CORNISH: And in the meantime, what does this mean for the Senate? They're still writing their version of the bill.

DAVIS: You know, Senate Majority Leader Mitch McConnell gave an interview to Reuters today in which he said he does not know yet how he's going to get to 50 votes. We don't know a lot about what's happening in the Senate because it's all happening behind closed doors. There's a 13-member Republican working group. They're meeting at least twice a week in private to try and craft a bill that can pass the Senate. We don't know what that bill's going to look like, but the goal is to try and have a bill and to pass it by the August recess. We do know that senators do not see the House bill as where they need to go and are going to write their own very different bill.

CORNISH: NPR congressional correspondent Susan Davis. Thanks so much.

DAVIS: Thank you, Audie.

Copyright © 2017 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record. </s> Mitch McConnell released the Senate's Healthcare Bill Thursday. Dubbed the "Better Care Reconciliation Act of 2017," the 142-page proposal includes massive cuts to Medicaid, cuts to hundreds of millions of dollars in taxes for the wealthy and defunding of Planned Parenthood for at least one year. The Congressional Budget Office has not had a chance to score the Senate's bill yet. Under the House bill, the CBO found found that 23 million Americans would lose their healthcare coverage by 2026. </s> President Donald Trump discusses the federal budget in the Roosevelt Room of the White House on February 22, 2017 in Washington, DC.

A draft bill detailing Republican plans to begin repealing and replacing many facets of the Affordable Care Act would provide expanded tax credits and health savings accounts for individuals while reducing federal spending on tax subsidies and Medicaid and practically eliminating both the current employer and individual mandate to provide and carry health insurance.

The 105-page draft legislation, obtained by NBC News, repeals much of the current law, also known as Obamacare, within the next few years and sets in place a Republican vision of healthcare.

More from NBC News:



Jim Parsons reveals the inspiration behind 'Big Bang Theory' spinoff about young Sheldon

Full McCain interview: 'I worry about the president's understanding' of some issues

Mayor touts plans to make NYC more affordable



The draft, dated February 10, is circulating among health care lobbyists and, while changes are possible, it is believed to be a legitimate effort at health care reform. The legislation, which also cuts funding to Planned Parenthood, still has to be scored by the non-partisan Congressional Budget Office, for a full accounting of how much it would cost, but the largest funding mechanism is a tax on the most expensive employer-provided health insurance plans.

What isn't included is a guarantee that people with pre-existing conditions are able to obtain coverage. Members of the House, however, introduced a bill last week to preserve the pre-existing condition ban, signaling that it would have to be passed separately.

The bill dismantles some major components of the ACA, including the expansion of Medicaid and the subsidies to purchase health insurance.

In its place, Americans who need assistance to purchase health care will receive a tax credit - able to be received in advanced on a monthly basis - based on age. A person under 30 is eligible for a $2000 tax credit while a person over 60 is eligible for a $4000 credit.

As for Medicaid, Republicans propose placing a cap on the number of Medicaid recipients in each state based on population, which would likely largely reduce the 72 million Americans currently receiving Medicaid. The current Medicaid expansion allows coverage for people based on income. The transition begins in 2020.

They have also carved out exceptions for some medicaid recipients with pre-existing conditions to ensure they keep their medicaid coverage, including cervical and breast cancer or are blind, which are specifically noted.

The measure also also creates state-based high risk pools for people who don't have access to insurance. The federal government would start in 2018 providing $15 billion to help fund the high risk pools, but the number decreases to $10 billion by 2020 and beyond.

And the legislation would greatly expands the use of Health Savings Accounts, a tax deductible way to purchase health insurance, which has become a top Republican priority.

The measure does not directly get rid of the individual and employer mandate to purchase and provide health care, but it zeroes out the penalty, making violation of the mandate non-enforceable.

Republicans, struggling to figure out a way to pay for their health insurance plan, puts in place a tax on the most expensive employer-based health insurance plans, which is an expanded version of the so-called Cadillac tax.

The measure repeals unpopular taxes opposed by the business community and health field, including the medical device tax and the tax on health insurance, also known as the HIT tax, that helped to pay for the ACA.

The plan is already being panned by some.

Ron Pollack, head of the Families USA, which advocates for health consumers, said the draft "buys less care — or no coverage at all."

"This leaked Republican proposal, if enacted, would put us on a destructive path that would decimate the safety-net Medicaid program for over 72 million people; drastically reduce premium subsidies for working families; and cause out-of-pocket health costs to soar," Pollack said. </s> FILE PHOTO - A copy of President Trump's Fiscal Year 2018 budget is on display on Capitol Hill in Washington, U.S., May 23, 2017.

WASHINGTON (Reuters) - President Donald Trump's proposed government spending plan would reduce the federal deficit over the next decade but fail to balance the budget, the nonpartisan Congressional Budget Office said on Thursday.

The 2018 fiscal year budget, unveiled in May, put numbers on Trump's vision of a government that would boost military spending while radically cutting assistance to lower-income Americans.

The annual budget deficit in 2027 would be about $720 billion under Trump's proposal, the CBO said in a report, not eliminated as promised by the White House, which has projected a $16 billion surplus.

There was no immediate reaction to the report from the Trump administration. But in a pre-emptive strike on Wednesday, the White House wrote on Twitter: "Faulty Numbers = Faulty Results."

Trump's budget, which slashes funding for the Medicaid healthcare program for the poor and disabled, is unlikely to become law in its current form.

Republicans who control the U.S. Congress - and the federal purse strings - will decide whether to make the politically sensitive cuts.

Senate Republicans unveiled revised healthcare legislation on Thursday as part of their party's long-running effort to scrap the 2010 Affordable Care Act, popularly known as Obamacare..

The Senate legislation retained the previous draft bill's phaseout of Obamacare's expansion of Medicaid and sharp cuts to federal Medicaid spending beginning in 2025. The changes to Medicaid have been a point of political contention among Republican lawmakers.

The CBO estimated that Trump's budget would cause the federal budget deficit to shrink relative to the size of the economy over the next 10 years, ranging between 2.6 percent to 3.3 percent of gross domestic product during that period.

The cumulative federal deficit would be one-third smaller than CBO baseline projections that show deficits rising to 5 percent of GDP by 2027, the CBO said.

The CBO said the Trump budget's deficit reduction over the next decade would be lower than the White House projects due to lower estimated revenues and slower economic growth than assumed by the administration.

The CBO said did not take into account all of Trump's proposals that may affect the economy because "the details on many of the proposed policies are not available at this time." The administration's tax reform proposal, for example, "lacked the specificity necessary to evaluate any effects," the CBO wrote.

The deficit reduction created by Trump's budget proposal would result from lower spending over the next decade, the CBO said.

The White House blueprint would cut $2 trillion in mandatory spending, including $1.9 trillion on healthcare.

About $1.25 trillion of that is linked to a bill already passed by the House or Representatives to repeal and replace Obamacare. Trump's budget also proposes saving $610 billion over the next decade by overhauling the Medicaid program, the CBO said. </s> People who are pregnant, mentally ill or have pre-existing health conditions could face skyrocketing premiums under the Republican health care plan, according to a new Congressional Budget Office report.

The CBO projects that several states will waive the Obamacare rules that prevent insurers from raising prices on people due to their individual health circumstances, and this will lead to rapid cost increases for people facing health problems.

The CBO found that the American Health Care Act, which was passed by the House but still needs to be approved by the Senate, will save $119 billion over the next decade at a cost of 23 million more uninsured people than under Obamacare.

The state waivers allow insurers to offer bare bones insurance plans and charge higher rates to people with pre-existing conditions, all in the hopes of slashing premium costs everyone else.

Republicans were hoping for a boost in the projection of insured people. They did not get it.

The CBO projected the original AHCA to cause 24 million more uninsured people over the next decade. For the amended bill, that number drops by just one million to 23 million new uninsured.

The CBO expects less healthy people to face "extremely high premiums" in states that exercise the waivers.

"Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly," says the report.



The CBO projects about one sixth of the American public to be affected by the waivers. It expects several benefits that currently are mandated to be part of all insurance plans to be dropped. These include maternity care, mental health services, substance abuse treatment, and pediatric dental benefits.

"In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year," says the report.

The CBO says the AHCA will lower premium costs on average, but this is tied to plans covering a smaller percentage of total health care costs.



The CBO projects the amended AHCA to cut $834 million from Medicaid over the next decade, most of which is redirected into tax cuts. The CBO projects Medicaid rolls to shrink by 14 million people over the next decade as the Obamacare Medicaid expansion is rolled back.

Premiums will rise for plans that do not discriminate against people with pre-existing conditions in states that adopt the waivers, according to the report. The theory is that healthier people, who are less expensive to cover, will move into the cheaper health plans that only they are eligible for. This will raise costs on everyone, sick or healthy, in other plans.

This is a developing news story. Check back for updates or follow BuzzFeed News on Twitter.
The Congressional Budget Office predicts that in the next decade, the new health care bill recently approved by the U.S. House of Representatives will reduce the federal deficit by $120 billion and leave 23 million more Americans uninsured, as opposed to current law.