Senate Majority Leader Mitch McConnell is pushing for a vote this week on Senate Republican health care plan.
Twenty-two million Americans would lose health care coverage in the next 10 years under a Senate Republican health care draft plan released last week, the Congressional Budget Office said in a long-awaited report released late Monday.
“Next year, 15 million more people would be uninsured compared with current law,” said the CBO’s analysis.
The budget analysis predicts, however, that the federal deficit would be cut by $321 billion in the next decade, mainly due to cuts in Medicaid and a shifting of responsibility from the federal government to the states.
After unveiling the original replacement bill for the Affordable Care Act, Senate Republicans have adjusted their strategy to stabilize the individual insurance market. In the original draft, insurance companies were required to offer everyone coverage, including individuals living with pre-existing conditions. But people were not required to purchase insurance, meaning healthy people go without having to pay monthly insurance premiums. Critics refer to this as a ‘death spiral’ because without healthy customers making those regular payments, the companies would have to drive up prices and risk losing customers. Senate Republicans decided to implement penalties on people who refuse to maintain their insurance within lapses of 63 days a year. Those people will be locked out of purchasing insurance for a six-month period the following year.
The report is expected to make it more difficult for Senate Majority Leader Mitch McConnell to “sell” the plan and come up with 50 or 51 Senate votes needed to pass it. A half-dozen of the Senate’s 52 Republicans, from both ends of the GOPSenate caucus, have voiced reservations.
At the same time, the CBO report does give McConnell room to “tweak” the bill, as he courts senators ranging from the far-right Ted Cruz of Texas to the moderate Susan Collins of Maine.
But, the CBO is merciless in its description of what the Republican plan would do to those aged 55 to 64.
It would “increase the number of uninsured substantially,” the CBO found. “The increase would be disproportionately larger among older people with lower income — particularly between 50 and 64 years old — with income of less than 200 percent of the federal poverty level.”
The CBO looked at the GOP plan’s high premiums and deductibles, concluding that “despite tax credits, few low-income people would purchase any plan.”
It also made a prediction of post-2026 health care, saying: “The agencies expect that after ’26, enrollment in Medicaid would continue to fall relative to what would happen under the present system.”
The CBO predicted a quandary for states, such as Washington, which have expanded Medicaid under provisions of the 2010 Affordable Care Act (aka “Obamacare”). Its analysis:
“With less reimbursement for Medicaid, states would need to decide whether to commit more of their own resources to finance the program at current law levels, or to reduce spending by cutting payments to health care providers and health plans.”
This could mean “eliminating optional services, restricting eligibility through work requirements and other changes, or (to the extent possible) arriving at more efficient methods for delivering services.”
U.S. Rep. Suzan DelBene, D-Wash., a former Microsoft executive, predicted wider consequences, “skyrocketing deductibles, widespread hospital closures, and the return of annual and lifetime caps on care.” Such caps were eliminated by the Affordable Care Act.
Sen. Jeff Merkley, D-Oregon, the first Northwest senator to comment, said the CBO study confirms that the Republican health care bill is “diabolical.”
“The cruelty of this plan is breathtaking,” said Merkley. “Senators are supposed to come here to make our constituents’ lives better, not destroy them.
“Here’s my advice to Republican colleagues. Take this last chance to put a stake through the heart of this horrific bill, before it destroys health care for millions of America’s children, seniors, and working and struggling families.”
Sen. Maria Cantwell, D-Wash., worried about a range of impacts, saying:
“So many in our state struggling with opioid addiction will lose support and services needed to recover, and face dire options. The vast majority of our rural hospital patients use Medicaid. Many of these hospitals and clinics are now concerned they won’t be able to survive. This heartless plan will drive up costs for all Americans.”
(Medicaid pays 26 percent of opioid medication-assisted treatments in Washington. In Kentucky and West Virginia, Trumpstates hard hit by the addition crisis, Medicaid bears 44 and 45 percent of the opioid cost burden.)
How will the numbers speak to members of the Senate. Last week, Collins said she would have great difficulty voting for any plan that adds 20 million or more to ranks of Americans with no health insurance. Late Monday, she tweeted: “The Senate bill won’t do it.”
While lower than CBO’s prediction of coverage loss under a House-passed plan — 23 million — the Senate plan would carry sharp, immediate losses. Maine is also a state hard hit by the opioid epidemic.
Sen. McConnell and Senate Majority Whip, John Cornyn, R-Texas, want a vote on the Republican plan this week.
Or as conservative GOP Sen. Ron Johnson, R-Wisconsin, said over the weekend: “They’re trying to jam this thing through.”
The CBO report has lengthened the odds of that happening.