CBO: 22 million would lose coverage under Senate ObamaCare replacement

The most recent version of the Senate Republican bill to repeal and replace ObamaCare would result in 22 million additional people without insurance over the next decade, the Congressional Budget Office (CBO) reported Thursday.

The number of uninsured is essentially unchanged from the original draft of the legislation released last month, generating more negative headlines for Republicans as they struggle to revise the legislation ahead of a possible vote next week.

Because the legislation retains two of ObamaCare’s taxes, the CBO estimated the new bill would reduce the deficit by about $420 billion by 2026. That’s an increase from the $321 billion the initial draft saved, and gives Majority Leader Mitch McConnellAddison (Mitch) Mitchell McConnellGOP strategist donates to Alabama Democrat McConnell names Senate GOP tax conferees Brent Budowsky: A plea to Alabama voters MORE (R-Ky.) more money he can use to try to sway holdout senators.

One move being considered would be to give $200 billion in assistance to states that expanded Medicaid. That may convince more moderates to vote for the bill, but could risk alienating conservatives. 

Notably, the CBO did not score an amendment added to the bill by Sen. Ted CruzRafael (Ted) Edward CruzDebbie Wasserman Schultz marks 10 years as breast cancer survivor Foreign agent registration is no magical shield against Russian propaganda Let Trump be Trump and he'll sail through 2020 MORE (R-Texas) that would let insurers opt out of ObamaCare regulations as long as they also sell ObamaCare-compliant plans.

Experts say the new CBO score won’t truly measure the impact of the legislation until the Cruz amendment is included.

Senators have said it could take weeks for the CBO to score the Cruz amendment, raising the likelihood those numbers will not be available when the Senate votes next week. CBO officials said Thursday they are working on scoring the proposal, but wouldn’t speculate on when it might be finished. 

Republicans could instead use a Department of Health and Human Services analysis of the amendment, which would be a controversial break from tradition. 

The HHS score found that the Cruz amendment would lower premiums, but has been widely criticized by outside experts for a range of assumptions it made, as well as for a lack of transparency.

Critics of the Cruz language worry it would lead to a massive spike in premiums for sicker and older people because it would also allow insurers to offer cheaper, basic plans for people who are younger and healthier.

Insurers have railed against the amendment, saying it would undermine insurance markets and end protections for people with pre-existing conditions. 

Yet the amendment appears to be key to securing the support of Cruz and other conservatives, and GOP leaders have showed no signs of turning away from it. 

Overall, the CBO’s latest analysis lays out the challenges facing Senate Republican leaders as they seek to bridge the gap between moderates and conservatives to craft legislation that can win 50 votes. 

Congressional Republicans have long argued their healthcare legislation would be better than ObamaCare because it would substantially lower premiums and deductibles.

The CBO delivered some good news on that front, finding that premiums would rise under the legislation until 2020, when they would be about 30 percent lower than under the current law.  

But the office also found that patients on the standard-level plan would have a $13,000 deductible before insurance would cover the cost of care. For the poorest individuals, the deductibles required under the Senate bill could exceed their income, CBO said.

Under ObamaCare, someone in a standard plan pays about $5,000 in deductibles.

In addition, older people would generally face higher premiums than younger people under the Republican bill, in part because the legislation allows insurers to charge them more.

Senate Republicans are barreling toward a vote early next week on healthcare despite confusion on Capitol Hill about what they will be voting on.

On Monday, the Senate Republican repeal-and-replace bill appeared stalled, and McConnell said the chamber would vote on a motion to begin debate on the House’s ObamaCare repeal bill. That would set up a vote on a clean repeal bill with a two-year delay in order to craft a separate replacement plan. 

But opposition quickly mounted to that approach, prompting senators to return to negotiations over the repeal-and-replace bill.

The non-partisan CBO has been an obstacle for Republicans throughout the healthcare debate, with the agency consistently finding that the legislation would lead to millions of people becoming uninsured.

The first score of the Senate bill estimated that 22 million more Americans would be uninsured in the next decade, with 15 million fewer people on the Medicaid rolls by 2026. Since that initial score, GOP leaders added $45 billion to help states deal with the opioid epidemic, as well as additional money for a state insurance stabilization fund.

The Trump administration and some Republican lawmakers have attacked the credibility of the CBO, saying the agency’s projections for enrollment under ObamaCare were wrong. 

The White House preemptively attacked the agency’s score earlier this week, saying the estimate would be “little more than fake news.”

"The reason: The CBO’s methodology, which favors mandates over choice and competition, is fundamentally flawed," wrote White House legislative affairs director Marc Short and Brian Blase, a special assistant to the president for healthcare policy at the National Economic Council.

- This story was updated at 4:57 p.m.