Twenty-four million fewer Americans would have health coverage over the next decade under the House Republican plan to replace the Affordable Care Act, the nonpartisan Congressional Budget Office estimated Monday in an analysis that threatens the GOP legislative campaign.
Fourteen million fewer would be insured by next year alone, dramatically reversing the coverage expansion made possible by the 2010 healthcare law, often called Obamacare.
At the same time, millions of consumers would see skimpier health coverage and higher deductibles under the GOP plan, the budget office projected.
And although average premiums for those who buy their own insurance are projected to be lower after 2020 than under Obamacare — partly because plans will cover less — many consumers will pay more over the next few years than they would under current law.
Hardest hit in the long run will be lower-income Americans and those nearing retirement, according to the budget office, which estimates that over the next decade, the GOP legislation would cut about $1 trillion in federal healthcare assistance to low- and moderate-income Americans.
The much-anticipated independent analysis from the budget office, which lawmakers from both parties rely on to gauge the potential impact of legislation, undercuts key promises by President Trump and senior Republican lawmakers that no one would be harmed if Obamacare is repealed and replaced.
And it provides potent ammunition to critics of the House GOP plan, just as Republican leaders are scrambling to get it to a vote next week.
"Coverage matters when it comes to preventing disease and ensuring health and well-being," said Dr. Georges C. Benjamin, executive director of the American Public Health Assn. "Unfortunately, this bill, as written, will result in more people losing coverage they desperately need. … We know that the absence of health insurance translates into premature death for many."
The current law is credited with extending health coverage to more than 20 million previously uninsured Americans and driving the nation's uninsured rate to the lowest levels ever recorded.
In the first nine months of 2016, just 8.8% of U.S. residents lacked health coverage, survey 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, the percentage of uninsured would surge back to 19% by 2026, higher than before 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 financial assistance to get coverage.
Health and Human Services Secretary Tom Price disputed the CBO conclusions, saying they failed to take into account other changes Republicans are planning to make through the regulatory process and in subsequent legislation.
"We strenuously disagree with the report," he told reporters outside the White House. "It's just not believable."
Congressional Republicans meanwhile defended the healthcare legislation and even praised the CBO report, focusing on the estimated savings and the promise of lower premiums, while glossing over the coverage losses.
"Our plan is not about forcing people to buy expensive, one-size-fits-all coverage," said House Speaker Paul D. Ryan (R-Wis.). "It is about giving people more choices and better access to a plan they want and can afford."
The CBO estimates that some Americans may see less expensive health insurance plans under the House Republican bill.
By 2026, budget analysts said, average premiums for consumers who buy health coverage on their own rather than getting it from an employer, would be 10% lower than under the current law.
But that reduction would be driven in part by the increasing prevalence of health plans with high deductibles, which would be made possible by provisions in the GOP legislation that loosen requirements on health plans.
Also making health insurance cheaper on average, according to the CBO, would be the departure from the market of some older consumers who could no longer afford health plans. Older consumers have higher medical costs, which drive up premiums for everyone.
The GOP plan provides less assistance to older, low-income Americans while at the same time allowing insurers to charge older customers up to five times more than younger consumers, compared to three times more under Obamacare. That change is expected to benefit younger, healthier consumers.
At the same time, GOP health legislation would produce a historic retrenchment in Medicaid, the government safety net health program for the poorest Americans.
Obamacare made billions of dollars in federal aid available to states, which allowed a major expansion of coverage to low-income childless adults, a population that traditionally was not covered by Medicaid.
The House GOP plan would scrap that aid and cap future federal support for Medicaid, delivering $880 billion in savings over the next decade, the budget office estimates.
The retrenchment would force states to dramatically scale back their safety nets, the budget office concluded. And it would likely result in 14 million fewer poor people covered by Medicaid by 2026.
The Medicaid cutbacks, coupled with other cutbacks, would help the GOP legislation reduce federal deficits by $337 billion over the next decade, according to the CBO report.
The safety net cuts also allow for a series of major tax cuts, including the elimination of two taxes on high-income Americans that were used to fund Obamacare's coverage expansion.
Democrats seized on the budget report Monday to renew their attacks on the Republican legislation.
"The CBO's estimate makes clear that Trumpcare will cause serious harm to millions of American families," Senate Minority Leader Charles E. Schumer (D-N.Y.) said Monday. "Tens of millions will lose their coverage, and millions more, particularly seniors, will have to pay more for healthcare."
But it was unclear whether the new report would slow down the GOP's push to advance the bill through the House by as soon as next week.
Ryan has warned lawmakers they face a "binary choice" between keeping the Republican promise to end Obamacare or sticking with the status quo.
And a group aligned with his leadership is running TV ads urging 30 of the most conservative House Republicans to join Trump and back the bill.
"This is historic. And it's significant," Ryan said over the weekend. "The beautiful thing about this plan that we're proposing, it is more freedom, it is more choices, it is more markets, it's lower prices, which gets us better access."
Opposition, though, is mounting from almost all sides in Congress, including from Senate Republicans whose support will be needed to send the bill to the president.
Centrist Republicans worry constituents in their state will lose health coverage. A recent Times analysis found those hardest hit by the GOP plan live in counties that voted for Trump.
More conservative members of the House and Senate deride the bill as Obamacare Lite and are furious with Ryan's strong-arm approach.
Trump for now appears to be sending Congress mixed messages, signaling his support for the House bill, but also leaving conservatives with the impression he is open to negotiation.
Members of the conservative House Freedom Caucus have been invited to go bowling Tuesday night at the White House and those lawmakers are increasingly bypassing congressional leadership to talk directly with the administration. Many are expected to join Sen. Rand Paul (R-Ky.) at a Wednesday rally against the bill.
Trump, meanwhile, is planning to travel to Kentucky next week for a rally in support of the Obamacare repeal push.
6 p.m.: This article was updated with additional reaction to and analysis of the GOP healthcare plan.