The Republican healthcare bill that passed the House earlier this month would nearly double the number of people in the U.S. without health insurance over the next decade, according to a new analysis by the nonpartisan Congressional Budget Office.
The much-anticipated report cast a new shadow over the controversial legislation and is expected to complicate Republican efforts to get the bill through the Senate, where it already faces difficult prospects.
According to the budget office, which both parties in Congress look to for estimates on the impact of complex legislation, the bill would cause 23 million fewer people to have health insurance by 2026. Many additional consumers would see skimpier health coverage and higher deductibles, the budget office projected.
The report further undermines claims by President Trump and House Republicans that their campaign to repeal and replace the current healthcare law — often called Obamacare — will protect all Americans' access to healthcare.
The House bill would be particularly harmful to older, sicker residents of states that waive key consumer protections in the current law, including the ban on insurers charging sick consumers more. The budget office estimates that about one-sixth of the U.S. population live in states that would seek such waivers, which would be allowed under the House bill.
"Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance," the report notes.
Insurance markets in states that dropped Obamacare's protections would become unstable after 2020, the budget office warned.
Healthcare advocates seized on the report to sharply criticize the House bill.
"The Congressional Budget Office today confirmed what we knew all along: The House plan to dismantle the Affordable Care Act is dangerous, deadly and deeply flawed," said Dr. Georges Benjamin, executive director of the American Public Health Assn.
"The Senate must heed CBO's analysis, reject the House bill and start over on a bipartisan plan," he said.
The report updates an analysis the budget office did in March of the original version of the legislation developed by House GOP leaders.
Since then, Republicans made a series of modifications tailored to win enough votes from conservative and centrist GOP lawmakers to pass the bill. It cleared the House on May 4 without any Democratic votes.
But the revisions did not fundamentally change the structure of the bill or its impact, budget analysts concluded.
The American Health Care Act, as it is called, cuts more than $1 trillion from the assistance the government gives low- and moderate-income Americans, primarily through a historic retrenchment in Medicaid, the half-century-old government health plan for the poor.
The bill also fundamentally restructures the system of insurance marketplaces created by Obamacare to guarantee health coverage to Americans, even if they are sick.
Obamacare extended coverage to more than 20 million previously uninsured Americans. The law drove the nation's uninsured rate to the lowest levels ever recorded.
The Republican measure would reverse many of the changes Obamacare brought about.
It would scale back the subsidies that the current law makes available to help people afford insurance if they don't get coverage through an employer.
And under a series of changes made at the last minute to win the final votes in the House, states would be given new flexibility to scrap protections in the current law. Those include the ban on insurers charging sick people more and the requirements that all health plans cover a basic set of benefits, including mental healthcare, prescription drugs and maternity care.
GOP leaders have argued the changes would make health insurance more affordable.
The budget office projected that average premiums for those who buy their own coverage would be lower in some states after 2020 than under Obamacare, an estimate quickly hailed by Republicans.
"It is another positive step toward keeping our promise to repeal and replace Obamacare," House Speaker Paul D. Ryan (R-Wis.) said Wednesday.
But the decrease would be driven largely driven by the fact that more people would have plans that cover fewer benefits and shift more costs to consumers, budget analysts wrote.
Healthier consumers "would be able to purchase nongroup insurance with relatively low premiums," the budget office said.
But skimpier plans with high deductibles would be particularly problematic for Americans facing high medical needs.
"Some people enrolled in nongroup insurance would experience substantial increases in what they would spend on healthcare," the report notes.
Out-of-pocket costs for pregnancy, mental health and substance abuse would likely "increase by thousands of dollars" for people in some states, the budget office said.
Older and poorer Americans would also see higher premiums or lose coverage altogether.
For example, under the House bill, a 64-year-old single American with an income of $26,500 a year would see his or her annual insurance bill jump from $1,700 to $13,600 in states that waive protections now mandated by Obamacare, according to the budget office.
By contrast, a similar consumer who is 21 would see his or her premiums decrease from $1,700 to $1,250, budget analysts projected.
The changes made to get the bill through the House also include additional aid to states to soften some of the blows to low-income consumers. But that means the bill would reduce the deficit by slightly less than the earlier version.
It is now projected to generate $119 billion in budget savings over the next decade.
Meanwhile, wealthy Americans and the medical device and insurance industries still fare best in the House bill.
They stand to benefit from $663 billion in tax cuts over the next decade as the House legislation gradually eliminates taxes that were included in the Affordable Care Act to pay for the law's coverage expansion.
In the first nine months of 2016, just 8.8% of U.S. residents lacked health coverage, data from the Centers for Disease Control and Prevention show. That was down from 16% in 2010, when President Obama signed the healthcare law.
Under the House GOP plan, almost 1 in 5 people under age 65 would be uninsured by 2026, compared with 1 in 10 under Obamacare, according to the CBO. That is in part because consumers would no longer be required to have insurance and in part because millions of Americans would lose assistance that allows them to afford coverage.
The scale of those coverage losses has troubled some Senate Republicans, who have argued that their legislation rolling back the current law should protect more Americans who are vulnerable.
The new CBO report may strengthen this position, largely held by Republican lawmakers from states that have expanded Medicaid under Obamacare, including Ohio, West Virginia, Louisiana and Arizona.
What effect the report will have on the Senate Republican discussions remains unclear, however: All the debate is taking place behind closed doors.
Senate Majority Leader Mitch McConnell (R-Ky.), who is leading the effort, has elected not to develop healthcare legislation through the traditional process of holding public hearings and debating amendments in committee.
The House bill leaves Senate Republicans without many options as they try to follow through on their promises to both cut taxes and preserve coverage for millions of Americans.
In an interview Wednesday with Reuters, before the budget office report was released, McConnell offered a downbeat assessment of the health bill's chances of winning a majority in the Senate.
"I don't know how we get to 50 [votes] at the moment," he said. "But that's the goal."
MORE ON POLITICS
2:40 p.m.: This article was updated with additional details from the CBO report and reaction.