The Congressional Budget Office has released its score of Zombie Trumpcare, slightly revising the number the bill would make uninsured by 2026 as compared to current law—Obamacare—from 24 million to 23 million, which adds up to 51 million total uninsured by that year including those who would remain uninsured even under current law. They estimate it would reduce the federal deficit over the next 10 years by $119 billion, $32 billion less than the savings estimated for the original Trumpcare bill. That savings means that the House won’t have to revote and can send the bill on to the Senate, which is doing its own thing anyway.
As far as the stability of the insurance markets and premium increases, they predict prices would come down for healthy people because the sick people would be driven out of the individual market.
CBO and JCT expect that, as a consequence, the waivers in those states would have another effect: Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all—despite the additional funding that would be available under H.R. 1628 to help reduce premiums. As a result, the nongroup markets in those states would become unstable for people with higher-than-average expected health care costs. That instability would cause some people who would have been insured in the nongroup market under current law to be uninsured. Others would obtain coverage through a family member’s employer or through their own employer.
Those state waivers could reduce premiums compared to the original Trumpcare: a 64-year-old making $26500 in a waiver state could see the annual go from $16100 to $13600. Which would seem like a lot of money saved, unless you looked at current law—Obamacare—where the annual premium is $1,700. So, yeah.
And more not so good news about those waivers. They estimate that about one-sixth of the population lives in states where markets would start to become unstable in just three years, in 2020, because those states “would obtain waivers involving both the EHBs and community rating and that would allow premiums to be set on the basis of an individual’s health status in a substantial portion of the nongroup market.” Meaning, again, those with pre-existing conditions could be out of luck.
The CBO also points out that it’s not just the individual market or Obamacare customers who could see the quality of their coverage reduced, or be subject once again to annual and lifetime benefit caps: having employer-based insurance will not spare you if you live in a state that waives essential health benefit requirements.
Services or benefits likely to be excluded from the EHBs in some states include maternity care, mental health and substance abuse benefits, rehabilitative and habilitative services, and pediatric dental benefits. In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services. Moreover, the ACA’s ban on annual and lifetime limits on covered benefits would no longer apply to health benefits not defined as essential in a state. As a result, for some benefits that might be removed from a state’s definition of EHBs but that might not be excluded from insurance coverage altogether, some enrollees could see large increases in out-of-pocket spending because annual or lifetime limits would be allowed. That could happen, for example, to some people who use expensive prescription drugs. Out-of-pocket payments for people who have relatively high health care spending would increase most in the states that obtained waivers from the requirements for both the EHBs and community rating.
The Joint Tax Commission also released its assessment today: this is a $663 billion tax cut over the next 10 years. That’s a good reminder that this isn’t a healthcare bill. It’s a tax cut bill.