The Better Care Reconciliation Act would cause 22 million Americans to lose health coverage by 2026, according a Congressional Budget Office review of the draft legislation. Modern Healthcare earlier highlighted 13 key findings from the CBO's analysis. Here are 12 more takeaways from the CBO.
1. Medicare would spend $42 billion more over 10 years in disproportionate-share payments to hospitals due to an increase in uncompensated care for low-income patients.
2. Medicaid DSH payments to hospitals in Medicaid non-expansion states would increase by $19 billion over 10 years due to elimination of the Affordable Care Act's DSH cuts in those states.
3. Providers in Medicaid non-expansion states would receive $10 billion in additional funding from 2018 to 2022 for delivering safety-net services.
4. Federal spending on premium tax credits and cost-sharing subsidies would be reduced by $424 billion over 10 years compared with current law.
5. The percentage of non-elderly adults with incomes below 200% of poverty who would be uninsured in 2026 would nearly double compared with current law.
6. About 9 million fewer people would buy coverage in the individual market in 2020, with about 7 million fewer buyers in 2026, due to elimination of the individual mandate penalty and smaller premium tax credits on average.
7. Federal Medicaid per capita payments to states would grow substantially slower than actual costs in 2025 and beyond, when federal spending growth would be capped at the rate of general inflation; states likely would restrict eligibility, cut rates to providers and plans, and eliminate optional benefits.
8. The phase-out of enhanced federal payments for Medicaid expansion would prompt some states to end expanded coverage, reducing the share of eligible people living in expansion states from 80% to 30% in 2026.
9. States would use work requirements to reduce Medicaid enrollment due to declining federal payments under per capita caps.
10. Terminating enhanced federal Medicaid funding for the Community First Choice, which allows states to provide home and community-based attendant services, would cost states $19 billion over 10 years.
11. Eliminating the ACA's Prevention and Public Health Fund would cut federal spending by $9 billion over 10 years.
12. Medicaid enrollment would fall by 15 million by 2026 among people under age 65.
Source: Congressional Budget Office/Joint Committee on Taxation cost estimate of the Better Care Reconciliation Act of 2017.
