What did the media miss in the CBO report?
What did the media miss in the CBO report?
Everyone reported the top-line numbers from Monday's analysis of the House Republicans' American Health Care Act, a bill to repeal and replace the Affordable Care Act. The nonpartisan Congressional Budget Office and the Joint Committee on Taxation estimated the bill would drive up the number of uninsured Americans by 24 million over the next decade and reduce the federal deficit by $337 billion.
But here are 13 other findings that should be of high interest to healthcare industry groups.
Medicare spending on disproportionate-share payments to hospitals would increase by $43 billion from 2018 to 2026 due to a significant rise in the uninsured population.
Medicaid disproportionate-share payments to hospitals would increase by $31 billion over 10 years.
Total federal Medicaid payments to states would decline by $880 billion, or 25%, by 2026.
Five million fewer low-income adults would be enrolled in the ACA's Medicaid expansion programs by 2026.
Under the AHCA's per-enrollee cap on federal Medicaid payments, states' actual per-capita costs would grow annually 0.7 percentage points faster than federal payments from 2017 to 2026. States have the option of spending more of their own money to maintain spending levels or cutting benefits or provider payments.
Consumers would have a harder time comparison-shopping for health plans because the ACA's minimum actuarial-value requirement would be repealed and insurers could sell subsidized plans outside the ACA exchanges.
The repeal of the actuarial-value requirement would prompt many insurers to offer plans with higher deductibles and cost-sharing. That and the loss of ACA cost-sharing subsidies in 2020 would significantly increase out-of-pocket costs for lower-income enrollees.
About 7 million fewer people would have employer-based coverage by 2026. With the employer and individual mandate penalties gone, fewer employers would offer benefits and fewer employees would take it up. And the new premium tax credits for higher-income workers would prompt some employers to send their workers to buy coverage in the individual market.
By 2026, Medicaid expansion states would have only 5% of expansion enrollees left for whom they would receive enhanced federal matching payments.
By 2026, individual-market premiums would be 20% to 25% lower for a 21-year-old, 8% to 10% lower for a 40-year-old and 20% to 25% higher for a 64-year-old.
By 2026, the average premium tax credit to help people buy coverage would be about 50% less than under the ACA.
The one-year, 30% premium penalty for buying insurance after a coverage gap would lead to about 2 million fewer people buying coverage after 2018. Those who pay the penalty would likely be sicker people.
About 52 million Americans, or 19% of the non-elderly population, would be uninsured in 2026, up from 10% under the ACA. People ages 50-64 with incomes under 200% of the federal poverty level would make up a larger share of the uninsured.
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