U.S. Speaker of the House Rep. Paul Ryan speaks at a weekly news briefing on May 25, 2017 during which he took questions from the media on the CBO score of the AHCA. | Getty Federal actuary: 13M more uninsured under GOP repeal package

The House-passed Obamacare repeal bill would leave 12.6 million more Americans uninsured over the next decade and reduce federal spending by $328 billion, according to an analysis released today by CMS’ Office of the Actuary.

The coverage estimate is well below the 23 million more uninsured that the CBO has projected under the American Health Care Act. The congressional scorekeeper additionally estimated that the American Health Care Act would reduce spending by only $119 billion over a decade.


The disparity is a result of differing assumptions about whether cost-saving measures in the House bill will work. The CMS actuary and CBO have disagreed in the past on the budgetary effects of legislation, including surrounding the enactment of Obamacare. The new actuary's analysis does not estimate the effects of taxes repealed.

The CMS report also cautions that its analysis doesn’t reflect the possibility that some states could obtain waivers under the AHCA that severely limit what benefits must be covered or allow insurers to charge higher premiums for people with expensive medical conditions.

“If such actions were implemented, we would expect that the individual market in these areas would destabilize such that the premiums for comprehensive coverage for a significant proportion of the population would become unaffordable and the coverage would cease to be offered,” the actuary states.

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Most of the coverage losses stem from the anticipated rollback of Obamacare's Medicaid expansion. CMS estimates that 6 million fewer individuals would be shut out because of the House bill's tighter eligibility criteria, and that an additional 2 million will cycle out of the program because of new requirements. Medicaid spending will be cut by $105 billion by 2026, chief actuary Paul Spitalnic estimated — amounting to an 11 percent reduction.

The CMS report has mixed news about what the House GOP bill will do to insurance premiums. It projects that average premiums will be 13 percent lower in 2026 under the AHCA. But once subsidies are taken into account, premiums would be 5 percent higher for enrollees — and out-of-pocket costs would be 61 percent higher than under Obamacare.

“The impacts vary widely by age and income of the enrollee and depending on whether the enrollee resides in a State that applies for waivers for Essential Health Benefits or community rating," CMS warns.

The latest analysis comes as the Senate seeks to build consensus around its own repeal package. It's hoping to vote on a bill before breaking for the July 4 recess.