Congressional Budget Office (CBO) Finds Loss of Insurance Coverage under American Health Care Act

A report released by the Congressional Budget Office (CBO) finds that the Republican bill to repeal and replace the Affordable Care Act (ACA) would leave 24 million Americans uninsured while reducing the federal deficit by $337 billion over ten years.

CBO, a nonpartisan entity that analyzes the financial impact of legislation, predicts that 14 million more people would be uninsured in 2018 under the House GOP’s American Health Care Act (AHCA) than under the ACA. Yet, this number would rise to 24 million by 2026. If the AHCA became law, the coverage gains under the ACA would be vastly impacted.

The reported numbers on those uninsured would stem from repeal of the individual mandate, the provision within the ACA that requires all Americans to be insured or face tax penalties, and a reduction in Medicaid— the AHCA rolls back some of the ACA’s Medicaid expansion. Under the new law, some individuals would choose not to have insurance because they only chose to be covered under current law, to avoid paying the mandate’s tax penalties. Others would choose to forego insurance to avoid higher premiums. CBO also projected that the Medicaid program would be cut by $880 billion over a decade, which amounts to about a 20 percent reduction.

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. CBO reported that the largest savings would come from reductions in Medicaid spending and from the elimination of the ACA’s subsidies for non-group health insurance.

Republicans have criticized the report saying they disagree with the CBO analysis, while the Trump Administration has addressed the insurance issue, stating, “You're not going to have one-size-fits-all. Instead, we're going to be working to unleash the power of the private marketplace to let insurers come in and compete for your business…you'll have a lot of choices.”

Speculation has been made about whether or not the CBO analysis will impact the legislation’s ability to progress and eventually become law, but it’s unclear. For next steps, the House must vote on the bill and reconcile its legislation with an anticipated Senate proposal.

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.