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May 30, 2017

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Budget Office Releases Score of ACA Repeal Bill

On May 24, 2017, the Congressional Budget Office (CBO) released its “score” (or, cost and coverage impact) of the House Republicans’ bill to repeal and replace the Affordable Care Act (ACA). The House passed the legislation earlier this month by a vote of 217-213 (read more in Advocacy Now online here).

“CBO and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of H.R. 1628, the American Health Care Act (AHCA) of 2017, as passed by the House of Representatives,” the report starts. “CBO and JCT estimate that enacting that version of H.R. 1628 would reduce the cumulative federal deficit over the 2017-2026 period by $119 billion… In comparison with the estimates for the previous version of the act, under the House-passed act, the number of people with health insurance would, by CBO and JCT’s estimates, be slightly higher and average premiums for insurance purchased individually—that is, nongroup insurance—would be lower, in part because the insurance, on average, would pay for a smaller proportion of health care costs.”

CBO score on the AHCA

Most importantly, the report predicts that about 23 million more people would be uninsured over a decade as compared to current law. The previous version of the AHCA would have raised the number of uninsured by 24 million (read more about the previous version of the AHCA in Advocacy Now online here). Republicans in the House and the Trump administration have criticized the CBO score and pointed to the lowered premiums and deficit reduction.

“The CBO was wrong when they analyzed Obamacare’s effect on cost and coverage, and they are wrong again,” Health and Human Services Secretary Tom Price said in a statement. “In reality, Americans are paying more for fewer healthcare choices because of Obamacare, and that’s why the Trump Administration is committed to reforming healthcare.”

“It improves the number of people who would be covered and premiums continue to come down even more,” House Energy and Commerce Committee Chair Greg Walden (R-OR) told reporters. “This is the first big plan out there that really brings premiums down, or has the potential to bring premiums down.”

However, Senate Republicans, who are now starting their work on the repeal effort, have indicated they will either scrap the House bill entirely and write their own legislation or make significant changes.

“While I am in favor of repealing Obamacare, I am opposed to the American Health Care Act (AHCA) in its current form,” Sen. Dean Heller (R-NV) said in a statement. “This bill does not do enough to address Nevada’s Medicaid population or protect Nevadans with pre-existing conditions.” Sen. Bill Cassidy (R-LA) also criticized the House bill for failing to adequately protect Americans with pre-existing medical conditions.

Senate Republicans have formed a working group to focus their efforts and hopefully find improvements over the House version. A major issue remains how to wind down Medicaid expansion so that it won’t hurt constituents in states that expanded under the ACA. With a 52-48 majority, Republicans can only afford to lose two votes under the fast-track budget maneuver (“reconciliation”) they are using to pass the bill.