Congressional Budget Office Releases Update on American Health Care Act - American Society of Anesthesiologists (ASA)

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Congressional Budget Office (CBO) Releases Update on American Health Care Act

A report released by the Congressional Budget Office (CBO) has found that the House of Representatives-passed health care reform bill, H.R. 1628, the American Health Care Act (AHCA), as amended, would leave 23 million Americans uninsured by 2026. The report also found that the AHCA would reduce the federal deficit by $119 billion over the next decade.  This is 1 million less American uninsured and $32 billion less in deficit reduction than indicated in a previous CBO analysis of an earlier version of the House bill. 

CBO, a nonpartisan entity that analyzes the financial impact of legislation, and the Joint Committee on Taxation (JCT) estimated that 14 million more people would be uninsured under H.R. 1628 than under current law, with the estimate of uninsured people increasing to 19 million in 2020 and 23 million in 2026.  Assuming that state waivers would allow people to purchase insurance plans that do not include a comprehensive major medical policy to cover high-cost medical events, the CBO and JCT estimated that in 2026, 51 million people under the age of 65 would be uninsured; contrasted with 28 million estimated uninsured that year under current law, the Affordable Care Act.

With regard to premiums, the AHCA would tend to increase premiums in the non-group market before 2020, relative to those under current law— by an average of about 20 percent in 2018 and 5 percent in 2019, as the funding provided by the act to reduce premiums had a larger effect on pricing. Starting in 2020, however, average premiums would depend in part on any waivers granted to states and on 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.

CBO and JCT also indicate that the stability of the health insurance market would vary throughout the country depending upon the proportion of people living in areas with participating insurers and whether premiums rise in those areas. This would in part be influenced on the waivers states take from the market regulations.

These reported numbers on uninsured are updated from a previous CBO report, with adjustments made based on several amendments that were added to the legislation before it was voted in the House of Representatives.  With the analysis of the deficit reduction, Republicans passed a critical test of budget reconciliation. As part of reconciliation, the legislation needed to reduce the deficit by at least $2 billion over 10 years, under the rules set out through the budget resolution passed by the House and Senate in January.

Republicans have previously criticized the CBO report saying they disagree with the CBO analysis.  It is not yet clear whether this analysis will impact the legislation’s ability to pass in the Senate or become law.  Next, the Senate must vote on a proposal before it is reconciled with the House-passed legislation.

During the week of May 14, over 600 ASA-member physician anesthesiologists traveled to Washington, DC for LEGISLATIVE CONFERENCE 2017.  After a formal two-day session, ASA members blanketed Capitol Hill for meetings with House and Senate lawmakers and staff to discuss the AHCA and issues related to the Medicaid program, Essential Health Benefits, tax credits to purchase insurance in the non-group market, and coverage for individuals with preexisting conditions.      

ASA, through its Ad Hoc Committee on Health Care Reform, is working to determine the impacts of the legislation on physician anesthesiologists and their patients.  You can find more information on the proposed health care legislation at

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