Senators looking to repeal and replace Obamacare were already facing a breakneck timetable, mounting public disapproval, opposition from Democrats, and a growing number of Republican holdouts. A new analysis of the effects of the current Senate bill under discussion, the Better Care Reconciliation Act, won’t help matters.
Under the Senate bill, about 22 million more Americans would be left without health insurance by 2026, according to the nonpartisan Congressional Budget Office. That is slight improvement over the 23 million who would drop or lose insurance under the House bill passed last month, but it remains a staggering number, from both a human and political perspective. Approximately 15 million people would lose health-care coverage within the first year of implementation alone, relative to current law, ensuring that any blowback would affect dozens of vulnerable Republican lawmakers up for re-election next year. Because the B.C.R.A. eliminates the penalty for employers of a certain size that don’t provide insurance to workers, the C.B.O. predicts that 4 million people would lose employer-sponsored coverage by 2018. By 2026, with a 16 percent drop in Medicaid enrollment, according to the C.B.O., the number of people under age 65 without coverage would reach 49 million, compared with 28 million under Obamacare.
Changes to premiums, too, would practically guarantee a reckoning at the ballot box. According to the C.B.O., average premiums for benchmark plans would surge 20 percent in the first year, based on the expectation that fewer health people would purchase insurance coverage. By 2020, the federal scorekeeper anticipates that premiums would ultimately be about 30 percent lower than under the current law—primarily because the bill’s tax credits would go toward stingier plans with higher deductibles.
The numbers will likely weigh heavily on senators who were already hesitant to throw their support behind the legislation, which Senate majority leader Mitch McConnell has been pushing to pass by week’s end, before lawmakers return home for the July 4 recess. With no votes from Democrats expected, McConnell can only afford to lose two votes from his side of the aisle. Before the C.B.O. estimates came out, he was already facing reluctance from about a half-dozen senators within his ranks.
While the Senate bill’s impact on Medicaid was already largely known, based on the draft text of the B.C.R.A., the numbers included within the C.B.O. analysis are still stunning. About $772 billion would be cut from Medicaid over a 10-year period, as a result of the reduction or termination of federal matching funds and the implementation of per capita limits on payments. Tax credits and subsidies would be reduced by $408 billion for non-group health insurance, making coverage dramatically more expensive for vulnerable populations, including the poor and the elderly. The overall net effect of the bill would be to reduce the budget deficit by $321 billion, while providing a cumulative tax cut of some $541 billion over the next decade alone, the vast majority of which would go to a small number of high-income households.
