Earlier this week, the nonpartisan Congressional Budget Office
(CBO) released its highly anticipated analysis of the House
Republican healthcare reform bill (HR 277). In a potential
blow to the legislation, the CBO projects that the measure –
entitled the American Health Care Reform Act (AHCA) – would shift
significant health care costs to states and counties and
dramatically reduce the number of individuals with health
insurance.
According to CBO, the AHCA would reduce by 25 percent the federal
contribution to the Medicaid program by the year 2026, amounting
to an $880 billion cut over the next ten years. Combined
with other changes proposed in the bill, the CBO estimates that
there would be roughly 17 percent fewer Medicaid enrollees by
2026 – amounting to 14 million individuals. All told, the
bill would result in 24 million individuals joining the ranks of
the uninsured over the course of the ensuing decade.
In response to the analysis, congressional Republicans, along
with the Trump White House, sought to discredit the CBO estimate
by questioning the accuracy of the results. Specifically,
GOP leaders pointed to the congressional scorekeeper’s failure to
correctly predict the number of uninsured individuals who would
gain coverage under the Affordable Care Act (ACA). At the
same time, supporters of the Republican proposal scrambled to put
a positive spin on the CBO analysis, with a number of members
praising the AHCA for reducing the federal deficit by $337
billion over the next decade.
It should be noted that the budgetary savings under the GOP
measure would be primarily derived from a combination of Medicaid
cuts and a reduction in the size and scope of healthcare-related
tax credits. Incidentally, although nearly all of the taxes
that support the ACA would be repealed by HR 277, the legislation
would retain the ACA’s so-called “Cadillac tax” on high value
insurance plans. Pursuant to the bill, implementation of
the tax – which would impact a number of health insurance plans
provided by counties – would be delayed from 2020 to 2025.
Despite the considerable concerns identified in the CBO report,
the House Budget Committee earlier today advanced the AHCA by a
vote of 19 to 17. Three members of the conservative House
Freedom Caucus joined every Democrat in opposing the bill.
While today’s action marks the third time a House committee has
voted to clear the legislation, the GOP defections represent the
first official Republican opposition to the effort. The
vote may signal additional trouble ahead for Republican leaders
who cannot afford more than 21 defections on the House floor.
