All eyes are on the Congressional Budget Office's report, to be released Wednesday evening, on the cost and coverage impact of the American Health Care Act. House Republicans passed the bill May 4 on a 217-214 party-line vote.
With Senate Republicans working on their version of a bill to repeal and replace the ACA, policymakers and healthcare industry leaders will be watching for the CBO's answers to a number of key questions about the AHCA.
The CBO scored an earlier, revised version of the bill on March 23. In that analysis, the nonpartisan agency estimated the bill would reduce the federal deficit by $150 billion over 10 years, result in about 24 million fewer Americans with health insurance, and cut federal Medicaid spending by $839 billion.
The CBO's March 12 analysis of an even earlier version found it would raise premiums in the individual market in 2018 and 2019 by 15% to 20%, but that overall rates would be 10% lower than under current law by 2026. Premiums for 64-year-olds would be 20% to 25% higher, however.
The bill passed by the House included new provisions allowing states to opt out of key Affordable Care Act insurance requirements such as minimum essential benefits, the ban on consideration of pre-existing conditions for setting premiums, and guaranteed issue. It also added extra money for states to set up high-risk pools for people with pre-existing conditions.
The GOP's goal in making the changes was to let insurers offer leaner, more affordable plans and shift people with high medical costs into separate state high-risk pools.
Here are the CBO findings about the AHCA that insiders will be looking at first:
1. Would the bill save at least $2 billion over the first 10 years, as required by budget reconciliation instructions, including $1 billion each from parts overseen by two Senate committees? If not, the House may have to revise the bill and vote again.
2. Would it reduce the federal deficit in the second 10 years, as required by Senate rules allowing the bill to be passed by a simple majority?
3. Would it reduce the original bill's coverage loss of 24 million—which produced widespread criticism—to a less politically toxic number?
4. How many states are likely to seek waivers of ACA insurance rules, and how many Americans would be affected by the loss of those consumer protections?
5. If the waivers of insurance rules reduce premiums, would more Americans buy plans using the AHCA's premium tax credits, and would that significantly increase federal spending, potentially increasing the budget deficit?
6. Does the CBO consider stripped-down plans in states that waive the ACA's rules as insurance for the purpose of scoring the bill's coverage impact?
7. Would the bill's $138 billion in funding over 10 years for high-risk pools and insurance market stabilization measures be adequate to ensure affordable coverage, particularly for older people and those with pre-existing conditions?
8. Would letting states waive the ACA's guaranteed issue rule for people who don't maintain continuous coverage prompt more people to buy and keep coverage? Or would it drive up the number of uninsured?
9. Is the CBO revising its earlier projection that only some of the 31 states that expanded Medicaid to low-income adults would end their expansion, and that 5 million fewer people would be covered by 2026?
10. Would the bill's work requirement for Medicaid expansion beneficiaries significantly reduce the number of people with coverage?