Yesterday, the nonpartisan Congressional Budget Office (CBO) issued its latest analysis of the GOP-proposed American Health Care Act (AHCA) adopted by House Republicans earlier this month. First, what some see as the upside: the proposed bill would reduce the federal deficit by approximately $119 billion over 10 years, and would result in a reduction in health insurance premiums for some Americans. Now for the bad news: those projected benefits come at a significant cost—an additional 23 million uninsured Americans by 2026, and the potential destabilization of individual insurance markets in certain states, which would leave some Americans unable to buy insurance at all.
These sobering facts and numbers have straightforward explanations. The AHCA eliminates the current Affordable Care Act provision that requires coverage of essential health benefits, including basic mental health services and prescription drugs, and prohibits insurers from charging more for pre-existing conditions. Before the Affordable Care Act went into effect, insurance companies routinely lined their pockets by refused to cover people with existing medical conditions, and sold policies that excluded coverage for essential medical care, including prenatal care, childbirth, and mental health care. Under the AHCA, coverage for this care could become prohibitively expensive. The CBO report also notes that passage of the AHCA in its current form could result in some Americans purchasing policies that do not cover “major medical risks.” Individuals with these policies, useless as they are when needed most, are considered uninsured in the CBO’s final 2026 count.
The bill will now move on to the Senate, which is likely to write its own version of the legislation. Many believe that the AHCA’s proposal to cut spending on Medicaid by $834 billion over the next decade is the most difficult political issue facing the Senate. Medicaid currently covers roughly 69 million low-income Americans, and more than half of the CBO’s projected increase in the uninsured—14 million people—would come from reduced Medicaid enrollment.
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