CBO report says healthcare law could cause as many as 20M to lose coverage

As many as 20 million Americans could lose their employer-provided coverage because of President Obama's healthcare reform law, the nonpartisan Congressional Budget Office said in a new report Thursday.

The figure represents the worst-case scenario, CBO says, and the law could just as well increase the number of people with employer-based coverage by 3 million in 2019. 

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The best estimate, subject to a "tremendous amount of uncertainty," is that about 3 million to 5 million fewer people will obtain coverage through their employer each year from 2019 through 2022.

The new report adds more detail to this week's update of the law's coverage provisions, which CBO released Tuesday. Compared to a year ago, the law is now anticipated to cover 2 million fewer people but cost $50 billion less over 10 years, after factoring penalties paid by individuals and businesses that don't get or provide healthcare coverage.

Republicans immediately pounced after the new numbers came out because they appear to violate Obama's pledge that people who like their health plans will be able to keep them. Last year, CBO's best estimate was that only 1 million people would lose employer-sponsored coverage.

"President Obama's string of empty promises is quickly becoming a disappointing trail of broken promises," House Budget Committee Chairman Paul Ryan (R-Wis.) said in a statement. "He promised Americans that his overhaul of the health care sector would not jeopardize the health coverage of those who liked what they had. As nonpartisan analysts made clear today, millions of Americans will soon learn the hard way that Washington's overreach into their health care decisions will result in sharp disruptions to their coverage and their care."


The White House for its part argues that the latest projections are in line with what the CBO estimated when it scored the bill at the time of passage two years ago.

"Today's report also does not project major changes in the number of workers who will get coverage through their job," Jeanne Lambrew, the deputy assistant to the president for health policy, wrote on the White House blog. "At the time of passage CBO projected a change of 3 million people; last year CBO projected 1 million; this year 4 million – out of the roughly 150 million people get insurance through their job today. Other respected independent analysts have concluded that the number of Americans who get their health insurance at work will not change in a significant way."


Under CBO's best estimate, 11 million mostly low-wage workers would lose their employer coverage. About 3 million would choose to drop their coverage to go into the new subsidized health exchanges or on Medicaid, while another 9 million would gain employer-sponsored coverage, for a net total of 5 million people losing employer coverage in 2019.

CBO defended its methodology Thursday after Republicans highlighted business surveys that found a bigger number of employers threatening to drop coverage because of the law.

"Some observers have expressed surprise that CBO and [the Joint Committee on Taxation] have not expected a much larger reduction in the number of people receiving employment-based health insurance in light of the expanded availability of subsidized health insurance coverage that will result from the" health law, the report says. 

"CBO and JCT’s estimates take account of that expansion, but they also recognize that the legislation leaves in place some financial incentives and also creates new financial incentives for firms to offer and for many people to obtain health insurance coverage through their employers," the report adds.

Employer surveys, CBO said, "have uncertain value and offer conflicting findings."

"One piece of evidence that may be relevant is the experience in Massachusetts, where employment-based health insurance coverage appears to have increased since that state’s reforms, which are similar but not identical to those in the [federal health law], were implemented," the agency said.

Update: This post was updated at 1 p.m with comment from the White House