GOP Health Plan Would Leave 23 Million More Uninsured, Budget Office Says 
 
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 The revised Republican bill to repeal and replace the Affordable Care Act will leave 23 million more people uninsured in 2026 than if that act, also known as Obamacare, were to remain in place. The GOP bill would also reduce the deficit by $119 billion over 10 years. 
 
 That's what the nonpartisan Congressional Budget Office reported Wednesday in its latest score of the American Health Care Act. The CBO's assessment shows that the deficit would fall and premiums would fall for some Americans, but the report also raises potential concerns about the bill. The agency reports that the bill could destabilize individual insurance markets in some states, leaving unhealthy Americans unable to buy insurance. 
 
 The bill will now move on to the Senate, and should it pass that chamber, it will not look like this current AHCA version. As NPR's Susan Davis reported Wednesday, the Senate is likely to write its own version of the bill. Senate Majority Leader Mitch McConnell also told Reuters he doesn't know what that path to passing the bill will look like. 
 
 "I don't know how we get to 50 [votes] at the moment. But that's the goal," he said. 
 
 A smaller deficit, but a far higher uninsured rate 
 
 The $119 billion deficit reduction represents a decline from previous versions. When the CBO first scored the AHCA, it said the plan would save $337 billion over 10 years. Later revisions reduced those savings to $150 billion. 
 
 By far the biggest savings would come from Medicaid, which serves low-income Americans. That program would face $834 billion in cuts. Cutbacks in subsidies for individual health insurance would likewise help cut $276 billion. But those are offset in large part by bigger costs, including the repeal of many of Obamacare's taxes. 
 
 Those tax cuts would overwhelmingly benefit the highest-income Americans, the Tax Policy Center, a Washington think tank, reported on Wednesday. 
 
 The increase in the number of uninsured is also slightly lower than in the CBO's initial estimate. That report estimated that 24 million fewer would be insured in 2026 if this bill were to become law, putting the uninsured rate at around 18.6 percent. This revised bill would reduce that by around 1 million — a difference of less than half a percentage point. 
 
 In contrast, the uninsured rate in 2026 would be around 10 percent under Obamacare, the CBO reports. 
 
 More than half of that increase in the uninsured — 14 million — would come from reduced Medicaid enrollment. 
 
 The CBO also notes that the AHCA could mean some Americans would buy policies that don't cover "major medical risks." Because of those policies' skimpy coverage, the CBO doesn't count those people as insured in this report. 
 
 The Trump administration responded by saying it believes the CBO's numbers are unreliable. 
 
 "History has proven the CBO to be totally incapable of accurately predicting how healthcare legislation will impact health insurance coverage," the White House said in a statement. 
 
 The CBO did indeed far overestimate the number of people who would sign up for the Obamacare exchanges, as FactCheck.org's Brooks Jackson wrote in March. Likewise, it undershot on the number of Medicaid enrollees. (That said, Jackson added, the CBO predicted the uninsured rate relatively closely.) 
 
 Difficulties for some addicted, pregnant or sick Americans 
 
 The act could make obtaining health care coverage prohibitively expensive for some sicker Americans, the CBO found. 
 
 That's because under the AHCA, states could get waivers exempting them from some Obamacare provisions, including what are called essential health benefits — a list of basics like mental health and prescription drugs that the Affordable Care Act required plans to cover. States could also get waivers that allow insurers to charge more for people with pre-existing conditions. 
 
 One challenge the CBO faced in creating these estimates was figuring out how many states would get those waivers, and the report acknowledges that this creates some uncertainty in the estimates. In the end, it estimated that around one-sixth of the population lives in states that would seek both of those waivers. Around half of Americans live in states that would seek no waivers, meanwhile, and the remainder live in states that would make "moderate" changes. 
 
 In states that obtained both of those waivers, it would mean lower premiums for people buying individual insurance. But less healthy Americans in those states could face "extremely high premiums," the report said. 
 
 "Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly," the CBO wrote. 
 
 Waiving essential health benefits could also make medical care much more expensive for people who are pregnant, addicted or have other mental health issues and who live in those states that waive those benefits. 
 
 "In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services," the report says of people living in those states. 
 
 Under current law, the CBO wrote, the markets will be "stable in most areas" because lower-income Americans buying individual insurance will be shielded from rising Obamacare premiums, thanks to subsidies. 
 
 However, the report acknowledges that insurers have reduced their participation in the exchanges, leaving some Americans with no options for buying insurance. "The Affordable Care Act doesn't have a back-up plan for this situation," as Vox's Sarah Kliff and Sarah Frostenson reported Wednesday, so it's not clear how this could play out. 
 
 Cuts to Medicaid 
 
 Medicaid accounts for by far the biggest spending reductions under the American Health Care Act. The bill would roll back the Medicaid expansion instituted under the Affordable Care Act, which extended the program to cover some Americans with incomes up to 133 percent of the poverty line. That expansion increased enrollment by 10 million, as NPR's Alison Kodjak previously reported. Rolling back that expansion would limit future enrollments. 
 
 The AHCA would also give states a choice: Receive Medicaid funding via either a block grant or a per capita amount per enrollee. 
 
 Together, these changes would create major cuts in enrollment for the program: 14 million fewer people by 2026, and $834 billion in spending cuts over a decade. 
 
 Older, lower-income Americans get higher premiums 
 
 Average premiums would be lower in 2026 than they would be under Obamacare, both in states that do and that don't seek waivers. But it's impossible to make a meaningful blanket statement about how premiums would change under this bill, as those changes differ vastly for different groups of people. 
 
 For example, older Americans who make little money and buy individual insurance would see their premiums climb far beyond what they would be under Obamacare. A 64-year-old making $26,500 would pay $1,700 in premiums annually under Obamacare. In a state making those "moderate" changes to its market, that 64-year-old would pay $13,600, and in a state with no waivers, the cost would be $16,100. That's more than nine times that person's premium under the Affordable Care Act. 
 
 However, younger Americans would see little change in their premiums, or even declines. Likewise, some people with higher incomes could see substantially lower premiums under this bill. For example, a 40-year-old paying $6,500 a year under current law could pay an estimated $2,100 in a state with "moderate changes" to its market. 
 
 The bill moves on to the Senate 
 
 The CBO's newly estimated deficit savings mean the bill can safely move on to the Senate. 
 
 The future of the bill hinged upon this report, as House Republicans passed their most recent version of the bill without waiting for the CBO to report its estimated price tag. Three weeks after passing the bill, however, they have not sent the bill on to the Senate yet, because they were waiting on this score. Budget rules dictate that if the bill's deficit savings had not reached $2 billion (and that $2 billion had to come from particular spending categories), the bill would be dead upon arrival. ||||| Republicans’ American Health Care Act would be devastating to older Americans who rely on the individual insurance market, according to an analysis by the Congressional Budget Office. 
 
 The CBO found that the revised Republican bill does bring down overall premiums in the individual market by anywhere from 4 to 20 percent by 2026 compared with what they would be under current law. 
 
 The variation depends on whether a state accepts waivers under the American Health Care Act, which would allow insurers to offer much skimpier health plans at lower premiums. States that take up such waivers would see lower premiums, although the health plans would provide fewer benefits. States that don’t adopt such waivers would have higher premiums, but their health plans would offer more benefits — a trade-off. 
 
 But the CBO’s analysis includes a big caveat: Premiums would differ greatly based on age and income. In general, the older and poorer you are, the higher your premiums would be under the American Health Care Act compared with current law. 
 
 The CBO offers an example of a single individual with an annual income of $26,500. 
 
 If that person is 21 years old, he could benefit from the Republican health care bill. Under the Affordable Care Act (also known as Obamacare), he would on average pay $1,700 in premiums for insurance. Under the Republican plan, he would pay $1,250 if he’s in a state that accepts regulatory waivers and makes moderate changes to market rules — although, again, this also means his health plan would likely be skimpier. If his state doesn’t take up a waiver, his premium would actually increase by $50 to $1,750. 
 
 But if that person is 64 years old, he would be hurt by the Republican bill. Under Obamacare, he would also pay $1,700 in premiums for insurance. But under the Republican bill, he would pay $16,100 (about 60 percent of his annual income) if he lives in a state that doesn’t accept regulatory waivers, and $13,600 — still more than half his annual income — if he lives in a state that does adopt waivers to make moderate rule changes. That amounts to as much as an 850 percent increase in premiums from Obamacare to the Republican bill. 
 
 A 64-year-old who’s making $68,200 a year could fare a bit better. Under Obamacare, he’s expected to pay $15,300 in premiums for insurance, because his income would be too high to receive the law’s tax credits. Under the Republican bill, the tax credit, which is now based on age instead of income, begins phasing out at $75,000. So his premium would drop to $13,600 — a bit below Obamacare levels — in a state that gets a regulatory waiver but would actually increase to $16,100 in a state that doesn’t get a waiver. 
 
 Here’s how all of that looks in chart form: 
 
 Older people with an annual income of $75,000 or more would get fewer to no subsidies under the Republican bill. So they would likely face higher premiums than they did under Obamacare, much like the lower-income consumer. 
 
 The Republican bill accomplishes all of this in two ways. 
 
 First, it abandons Obamacare’s income-based tax credits (which give more money to people with lower incomes) to instead give anyone with an annual salary below $75,000 a tax credit based on age, with older people getting more money and a phaseout for higher incomes. 
 
 But it also peels back an Obamacare rule that protects older people from higher premiums. Under Obamacare, insurers are generally only allowed to charge an older person about three times what they would charge a younger person — under the theory that older people are often sicker and therefore need to use more insurance. But under the Republican bill, the limit of three times would go up to five times, effectively letting insurers charge older people 66 percent more than they would under Obamacare. 
 
 Republicans argue this is necessary because it would also let insurers charge younger people less, which would encourage younger and generally healthier people to come into the insurance pool — and therefore bring down the overall cost of health care by making it so more younger, healthier people are effectively subsidizing everyone’s care. 
 
 The CBO found that’s broadly true: It would bring insurance premiums down in general, and it would cost at least some young people less to get signed up for a health plan. But it would do all of that at a very high cost to older, particularly poorer Americans. ||||| (Daron Taylor/The Washington Post) 
 
 Health-care legislation adopted by House Republicans earlier this month would leave 23 million more Americans uninsured by 2026 than under current law, the Congressional Budget Office projected Wednesday — only a million fewer than the estimate for the House’s previous bill. 
 
 The nonpartisan agency’s finding, which drew immediate fire from Democrats, patient advocates, health industry officials and some business groups, is likely to complicate Republicans’ push to pass a companion bill in the Senate. 
 
 The new score, which reflects last-minute revisions that Republicans made to win over several conservative lawmakers and a handful of moderates, calculates that the American Health Care Act would reduce the federal deficit by $119 billion between 2017 and 2026. That represents a smaller reduction than the $150 billion CBO estimated in late March, largely because House leaders provided more money in their final bill to offset costs for consumers with expensive medical conditions and included language that could translate to greater federal spending on health insurance subsidies. 
 
 [What is in the Republican health-care bill? Questions and answers on preexisting conditions, Medicaid and more.] 
 
 As GOP senators quickly distanced themselves from the updated numbers, what became apparent is the difficult balancing act congressional leaders face as they seek to rewrite large portions of the Affordable Care Act. Some senators are eager to soften portions of the House bill, including cuts to entitlement programs and provisions that would allow insurers in individual states to offer fewer benefits in their health plans or to charge consumers with costly medical conditions higher premiums. 
 
 
 
 
 
 Senate Majority Leader Mitch McConnell (R-Ky.), who did not issue a statement in response to the new budget score, suggested in an interview with Reuters that he still harbored doubts over whether his party could muster enough votes to pass any kind of health-care bill this year. 
 
 “I don’t know how we get to 50 [votes] at the moment,” he said, referring to a situation in which Vice President Pence would cast the deciding vote. “But that’s the goal.” 
 
 To avoid a filibuster by Democrats, Senate Republicans plan to take the bill up under budget reconciliation rules — which only require a majority vote but mean the legislation cannot increase the federal deficit within a 10-year window. The Republicans have been working for weeks on their own health-care bill and emphasize that they do not intend to simply follow the House’s lead. 
 
 “Exactly what the composition of [our legislation] is, I’m not going to speculate about because it serves no purpose,” McConnell told Reuters. 
 
 Some, like Sen. David Perdue (R-Ga.), said the CBO score would have no impact on his chamber’s efforts to write its own bill. 
 
 [The three numbers you need to understand the CBO report on Republicans’ health-care bill] 
 
 “Regardless of any CBO score, it’s no secret Obamacare is collapsing under its own weight,” Perdue said in a statement. “Doing nothing is not an option.” 
 
 Instead of addressing the future number of uninsured Americans under the Republican plan — projected to immediately jump in 2018 by 14 million — House Speaker Paul D. Ryan (R-Wis.) on Wednesday chose to focus on the CBO’s estimate that premiums overall would fall under the AHCA. 
 
 “This CBO report again confirms that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit,” Ryan said in a statement. “It is another positive step toward keeping our promise to repeal and replace Obamacare.” 
 
 Congressional analysts concluded that one change to the House bill aimed at lowering premiums, by allowing states to opt out of some current insurance requirements, would encourage some employers to maintain coverage for their workers and get younger, healthier people to buy plans on their own. But those gains would be largely offset by consumers with preexisting conditions, who would face higher premiums than they do now. 
 
 “Their premiums would continue to increase rapidly,” the report found. 
 
 The CBO estimated that states seeking waivers to strip the ACA’s “essential health benefits” would affect roughly one-sixth of the population and that obtaining maternity coverage outside a basic plan, for example, “could be more than $1,000 per month.” 
 
 But Rep. John Faso (R-N.Y.), who supported the House bill, called the CBO’s assumption that waivers would affect that many Americans “grossly wrong.” 
 
 “Frankly I doubt any state would try to take advantage of that provision,” he said. “I think that is completely out of the ballpark.” 
 
 Asked why the House included the provision if no state would seek such waivers, he replied, “I’m sure it will be stripped out in the Senate.” 
 
 The administration’s reaction came from Health and Human Services Secretary Tom Price, who questioned the congressional analysts’ latest numbers while noting that many Americans on the individual insurance market are paying more than double the premiums they were before the ACA was passed in 2010. 
 
 “The CBO was wrong when they analyzed Obamacare’s effect on cost and coverage, and they are wrong again,” Price said. 
 
 [Trump, House GOP ask appeals court to again delay decision on health-care law provision] 
 
 Joseph Antos, a resident scholar at the conservative American Enterprise Institute who specializes in health-care policy, said the new estimate “is the same signal repeated,” conveying that the changes congressional Republicans envision would cut the price of premiums and trim the deficit while leaving more Americans without insurance. 
 
 The AHCA’s proposal to cut spending on Medicaid — a federal program that covers roughly 69 million Americans — by $834 billion over the next decade is the thorniest political issue facing the Senate, Antos said. 
 
 “They’re going to have to do something on Medicaid, and that something is a real question,” he said. 
 
 Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus, said he was confident the Senate would be able to craft a bill that could pass muster in the House — even in light of the CBO’s analysis. 
 
 He said that he expected senators to address the situation of the roughly 10 million Americans who now enjoy Medicaid coverage under the ACA “in a less conservative way” than the House and that the measure “would still have conservative support in the House when it came back.” 
 
 Senate Democrats seized on the new budget estimate, arguing that their GOP counterparts would be foolhardy to press ahead along the same lines as the House’s final legislation. The bill was passed May 4 with no support from Democrats. 
 
 “These were cosmetic changes. They thought they could put lipstick on a pig,” said Sen. Ron Wyden (D-Ore.), adding that it’s now obvious “we’re going to have well over 20 million people uninsured.” 
 
 Several key outside groups, including those representing physicians, hospitals and patients, said in statements that the updated projections underscored the need for the Senate to shift course. 
 
 The president of the American Medical Association urged the Senate to take a different approach. The CBO estimates “show that last-minute changes to the AHCA made by the House offered no real improvements,” Andrew Gurman said. 
 
 And Rick Pollack, president and chief executive of the American Hospital Association, said the new numbers “only reinforce our deep concerns about the importance of maintaining coverage for those vulnerable patients who need it.” 
 
 Mike DeBonis and Sean Sullivan contributed to this report.
– The American Health Care Act passed by House Republicans earlier this month will reduce the deficit by $119 billion over the next decade—while leaving 23 million more Americans without insurance than if ObamaCare remains in place, according to the Congressional Budget Office's score of the bill released Wednesday. NPR reports that while premiums could go down for some people under the AHCA, the CBO warns of "extremely high premiums" for people with preexisting conditions. Insurance could also be thousands of dollars more expensive for people who are pregnant or have issues with addiction or mental health. The AHCA would reduce the deficit by cutting Medicaid by $884 billion and subsidies for individual health insurance by $276 billion. Whether or not insurance premiums go up for Americans under the AHCA depends partly on what state they live in. The AHCA allows for states to get waivers that would lower premiums by allowing cheaper plans that don't cover "major medical risks." But it also largely depends on age, as Vox explains. A 64-year-old making $26,500 a year would pay between $13,600 and $16,100 for insurance under the AHCA, depending on if their state gets waivers. That's up from $1,700 under ObamaCare. A 64-year-old making $68,200 would also see their premiums increase if they live in a state that doesn't get the waivers. That's because the AHCA allows insurers to charge older people up to five times as much as younger people. The Washington Post reports the Senate is unlikely to pass the AHCA as it stands and is working on its own bill.