On May 24th, the Congressional Budget Office (CBO) released its score of H.R. 1628, the American Health Care Act of 2017 (AHCA), as passed by the U.S. House of Representatives. The CBO estimates that the AHCA would reduce the federal deficit by $119 billion over 10 years. The CBO also estimates that if enacted, in 2018 the AHCA would result in 14 million more uninsured people than under current law. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 23 million in 2026. In 2026, an estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law. The CBO also reviewed market stability and premiums under the AHCA. The CBO anticipates that under the AHCA, nongroup insurance markets (people who do not have health insurance through an employer or through the government) would be stable in many parts of the country. However, beginning in 2020 about one-sixth of the population resides in areas in which the nongroup market would start to become unstable as a result of the two waivers permitted under the AHCA: (i) permit states to modify the requirements governing essential health benefits; and (ii) allow insurers to set premiums on the basis of an individual’s health status if the person had not demonstrated continuous coverage. The CBO estimates that the AHCA would tend to increase premiums before 2020 by an average of about 20 percent in 2018 and 5 percent in 2019. Starting in 2020, average premiums would depend in part on any waivers granted to states and how those waivers were implemented and in part on what share of the funding available from the Patient and State Stability Fund was applied to premium reduction. The CBO’s analysis is available at https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr1628aspassed.pdf.
Last week Senate Republicans continued discussions regarding a possible Senate health care bill. Republicans appear divided on several issues: (i) whether the Medicaid expansion under the Affordable Care Act should be rolled back or continued at least in the short term; (ii) how the federal government should grant states more control over setting insurance standards; and (iii) the AHCA’s inclusion of waivers from the federal requirement to provide a minimum set of health benefits (essential health benefits) and a prohibition against charging higher prices to individuals without continuous coverage with pre-existing medical conditions. The Senate is in recess this week.