WASHINGTON – The Senate Republican health care bill would leave 22 million more U.S. citizens uninsured in 2026 than under President Barack Obama’s health care law, the Congressional Budget Office (CBO) estimated Monday, complicating GOP leaders’ hopes of pushing the plan through the chamber this week.
The CBO coverage estimates pose yet another problem for Senate Majority Leader Mitch McConnell, Republican from Kentucky, who unveiled the legislation last Thursday. By Friday afternoon, he was facing public statements of opposition from five GOP senators — three more defections than he can afford and still win approval for the legislation over united Democratic opposition.
Other Republican senators have expressed concerns. But none has ruled out backing the measure if it’s changed, and GOP leaders are looking for ways to win more votes by revising the legislation.
“It’s going to be very close, but we’re working with each one of them in trying to accommodate their concerns without losing other support,” said No. 2 Senate GOP leader John Cornyn of Texas. He added, “When senators tell me they want to get to yes, that means that we have a very good chance to get to yes.”
In good news for the GOP, the budget office said the Senate bill would cut the deficit by $202 billion more than the House measure over the coming decade. Senate leaders could use some of those savings to make Medicaid and other provisions in their measure more generous. That could win over unhappy moderates but risk alienating conservatives eager to curb federal spending.
The 22 million additional people without coverage under the Senate proposal is just a hair better than the 23 million who’d be left without insurance under the measure the House approved last month, the budget office has estimated. President Donald Trump has called the House version “mean” and called on Senate Republicans to approve legislation with more “heart.”
“This bill is every bit as mean as the House bill,” said Senate Minority Leader Chuck Schumer, Democrat from New York.
Of the 22 million without coverage by 2026, 15 million would be without it next year, the nonpartisan budget office said. That could be a particular concern to Sen. Dean Heller, Republican from Nevada , who faces perhaps the toughest 2018 re-election race of any Senate Republican. He’s said he can’t support a health care package that cuts Medicaid like the GOP plan and takes coverage from tens of millions of U.S. citizens.
The budget office report said the Senate bill “would increase the number of uninsured people substantially.” It said that would especially apply to people between 50 and 64 and with incomes below 200 percent of the poverty level, or around $30,300 for a single person. Those ages are just shy of when people begin qualifying for Medicare coverage.
Sen. Susan Collins, Republican from Maine, and other moderate GOP senators have also expressed concerns about the measure’s impact on coverage. On the other side, four conservatives have said they oppose the current version of the bill for not doing enough to reduce premiums.
One of those moderates, Sen. Shelley Moore Capito, Republican from West Virginia, answered only “we’ll see” when asked if she would support a pivotal procedural vote, expected Wednesday, on whether to formally begin debate. McConnell can lose only two of the 52 GOP senators to move onto the legislation.
The Senate plan, aimed at rolling back much of Obama’s 2010 statute, would end the tax penalty that law imposes on people who don’t buy insurance, in effect erasing Obama’s so-called individual mandate. It would let states ease Obama’s requirements that insurers cover certain specified services like substance abuse treatments, and eliminate taxes on wealthier people and medical companies that Obama’s law used to expand coverage.
It would also phase out extra federal money that law is providing to 31 states to expand Medicaid to additional low-income earners. And it would put annual caps on overall Medicaid money the government until now has automatically paid states, whatever the costs.
CBO said that under the bill, most insurance markets around the country would be stable before 2020. It said that similar to the House bill, average premiums around the country would be higher over the next two years — including about 20 percent higher in 2018 than under Obama’s statute — but lower beginning in 2020.
But the office said that overall, the Senate legislation would increase out of pocket costs for deductibles and copayments. That’s because standard policies would be skimpier than currently offered under Obama’s law, covering a smaller share of expected medical costs.
In another troublesome finding for the legislation, the budget office warned that in some rural areas, either no insurer would be willing participate in the individual market or the policies offered would be prohibitively expensive. Rural America was a stronghold for Trump in the presidential election.
Earlier Monday, Republican leaders added a penalty to their bill for people who’ve had at least a 63-day gap in coverage during the past year. Under that proposal, if they then buy insurance, they would face a six-month delay before it takes effect. The budget office said its estimate included the impact of that addition.
The change was aimed at helping insurance companies and the insurance market by discouraging healthy people from waiting to buy a policy until they get sick. Insurers need healthy customers who are inexpensive to cover to help pay the costs of people with medical conditions that are costly to treat.
ALAN FRAM
