The Congressional Budget Office (CBO) has released this preliminary analysis of the proposal by Senators Lindsey Graham and Bill Cassidy to repeal and replace the Affordable Care Act (ACA), concluding that millions of Americans would lose their health insurance coverage under the bill. The CBO explains:
“The reduction in the number of insured people relative to the number under current law would result from three main causes. First, enrollment in Medicaid would be substantially lower because of large reductions in federal funding for that program. Second, enrollment in nongroup coverage would be lower because of reductions in subsidies for it. Third, enrollment in all types of health insurance would be lower because penalties for not having insurance would be repealed.”
Since the bill shifts significant responsibility to the states for designing their Medicaid programs through block grants, and for their health insurance marketplaces with much more flexibility to change the current national standards established by the ACA, the CBO has not had the time to analyze or estimate the impacts on these complex, potential state-level decisions. For example, the CBO could project that states that have expanded Medicaid under the ACA are more likely to try to use both their Medicaid programs and their health insurance marketplaces to maintain coverage for those currently insured, including establishing state-based subsidies for premiums and cost-sharing. However, states may be limited in what they can do because the amount of federal funding for Medicaid under the new block grants and for their health insurance marketplaces is capped and limited.
Considering the caps on federal Medicaid funding and the limited amount of federal assistance for the marketplaces, the CBO does preliminarily conclude that the number of uninsured will increase, that the average amount of health insurance premiums will increase, and that the scope of health insurance benefits will decreases (since states can waive the “essential health benefits” required by the ACA).
Here is the text of the proposed bill analyzed by the CBO (at least two other versions of the bill have been circulated):
Since this bill would use the federal budget reconciliation process to repeal and replace the ACA, it must be voted on before the end of this year’s federal fiscal year, or this Saturday September 30. Republican Senators Rand Paul, John McCain, and Susan Collins have announced their opposition to the proposal, which means that whether the Senate even votes on the bill this week remains uncertain.