Latest Senate ACA repeal bill would lead to 22 million more uninsured

There would be 22 million fewer Americans with health insurance in 2026 under the latest version of the Senate Republican bill to repeal and replace the Affordable Care Act, the same coverage loss as under the previous version, the Congressional Budget Office said Thursday.

The CBO projected that 15 million more Americans would be uninsured in 2018 compared with current law, largely because the bill would repeal the ACA's tax penalties for individuals to buy insurance and larger employers to offer it.

Because the latest version of the Better Care Reconciliation Act keeps two ACA taxes on higher-income people, it would reduce the federal deficit by a greater amount over 10 years than the previous version did—$420 billion versus $321 billion.

That gives Senate Majority Leader Mitch McConnell an additional $99 billion to dole out in funding sweeteners to entice balky Senate moderates to support the bill when McConnell hopes to hold a vote on the legislation next week.

As with the previous bill version, federal Medicaid spending would decline by 26% from 2017 through 2026. About three-quarters of that reduction would come from rolling back the ACA's expansion of Medicaid coverage to low-income adults.

The version of the bill scored by the CBO Thursday did not include the controversial Cruz amendment, which would allow individual market insurers to offer plans that do not comply with ACA requirements for minimum essential benefits, guaranteed issue regardless of pre-existing conditions, and the setting of premiums without regard to pre-existing conditions.

The CBO found that under the bill's formula for calculating federal tax credits, deductibles would climb to the point where enrollees would face out-of-pocket costs that exceed the ACA's limits on maximum out-of-pocket costs in 2026.

The bill pegs the tax credits to plans that cover only 58% of enrollees' medical costs, compared with 70% under the ACA. That means insurers would likely offer skimpier plans with higher cost-sharing. But the Senate bill does not change the ACA's cap on out-of-pocket costs.