Actuaries at the Centers for Medicare and Medicaid Services released their own estimate for the healthcare bill passed by House Republicans in May, projecting that 13 million fewer people would be insured by 2026.
The report, from the CMS office of the actuary, differs significantly from an earlier report assembled by the Congressional Budget Office that projected 23 million more people would be uninsured over the same time period. The CMS report from Tuesday also projects the House bill would reduce spending by $328 billion, mostly because of its wind-down of Obamacare’s Medicaid expansion. The House bill, the American Healthcare Act, would make a number of changes to Medicaid that would reduce its funding, including allowing states to implement work requirements and rolling back its expansion under Obamacare beginning in 2020. Not all states would be affected by the rollback, because Obamacare was originally written to cover all low-income people, but under a Supreme Court decision the move became optional for states. Since then, 31 states and the District of Columbia have expanded the program, some of which are already working to reduce their Medicaid rolls.
Republicans in the Senate are working on their version of a bill to repeal and replace Obamacare, saying that they will use portions of the House bill. In their efforts to defend Obamacare, Democrats have seized on the projections from CBO, while some Republicans have worked to discredit its findings.
The two reports mainly differ in how strong they project the individual mandate is as an impetus to getting people to purchase health insurance. The CBO report from last month estimated that 14 million people would otherwise choose not to have health insurance in 2018 while the new CMS report estimates 4 million would make that choice. The individual mandate, an unpopular provision in Obamacare, obligates people to purchase health insurance or pay a fine.
Under the CMS projections, the number of uninsured would rise to 13 million people because fewer people would be eligible for Medicaid and the subsidies to buy health insurance would be less generous for some.
Premiums, the CMS report projects, would go down by 13 percent for people who do not qualify for subsidies under Obamacare, but would be 5 percent higher for those who do qualify. Out-of-pocket medical expenses, like deductibles, are projected to rise by 61 percent. Actuaries warned that differences would vary widely by geography and according to whether states would make use of waivers that allow them to opt out of certain Obamacare protections, which require plans to cover a range of benefits and do not allow insurers to price people of the same age differently if they have serious medical conditions. The American Health Care Act creates a fund instead that would move more expensive patients into high-risk pools.
