Twenty-two million Americans will lose health insurance coverage over the next 10 years under the draft Senate healthcare bill, according to the non-partisan Congressional Budget Office (CBO).



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The bill is the Senate’s version of a healthcare bill passed by the House of Representatives in May, which the CBO found would cost 23 million people healthcare coverage and decrease the federal budget deficit by $119bn over a 10-year period.

The Senate legislation would reduce the federal deficit by $321bn over a decade, the CBO found, largely due to the bill’s steep cuts to the Medicaid health program for the poor and the scaling back of federal assistance for those individuals purchasing their own private coverage.



Roughly 15 million more people would be uninsured next year compared with the figure under the current healthcare law, according to the CBO, a number that would increase to 19 million in 2020.



The highest impact would fall on low-income and elderly Americans, with those between the ages of 55 and 64 bearing a disproportionate share of the burden.



Those who rely on Planned Parenthood for women’s health services would also take a substantial hit, since the Senate bill would defund the organization for a year. The funding prohibition would cause the number of births in the Medicaid program to increase by “several thousand”, the CBO said, affecting predominantly those areas that lack other health clinics or medical practitioners. The CBO projected that about 15% of those people would lose access to care.

The CBO score comes after Republicans amended the draft Senate bill they released last week to require those who have gone without health coverage for more than two months to wait an additional six months if they want health insurance coverage. Advocates have pointed out that the waiting period could be fatal for those suffering from acute illnesses, such as cancer or heart disease.

The intent of the proposal is to provide an incentive for healthy people to purchase health insurance coverage, in lieu of the individual mandate required by the Affordable Care Act.

Top Senate Republicans have insisted on holding a vote this week through a process known as budget reconciliation, which would require a simple majority of 51 votes in the 100-member Senate in order for the legislation to pass.



On Twitter, the Senate majority whip, John Cornyn of Texas, stated of the impending vote: “I am closing the door. We need to do it this week before double-digit premium increases are announced for next year.” In order for the bill to be passed by the end of the week, Republicans need to hold a procedural vote on the bill in the next two days on a “motion to proceed”.

Republicans can afford to lose only two senators in the vote, and the leadership’s strategy of applying pressure by scheduling a vote in haste has been met with skepticism from rank-and-file lawmakers.



Ron Johnson of Wisconsin, a conservative who is opposed to the current draft bill but hopes to support a final version, said Senate GOP leadership was “trying to jam this thing through” on Monday. In an interview with the conservative pundit Hugh Hewitt, Johnson insisted: “You don’t have to do it this week.”

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White House allies are taking steps to pressure skeptics like Johnson. America First Policies, a Super Pac that supports Trump and includes former top White House staffer Katie Walsh in its leadership, announced a $1m ad campaign against the Nevada Republican Dean Heller.

Heller, who announced his opposition to the current draft bill, is facing re-election in 2018 in his Democratic-leaning home state and is considered the most vulnerable Senate Republican in the midterm elections.



The CBO estimates are unlikely to pacify moderates, who had already voiced doubts about the draconian cuts to Medicaid and potential gutting of coverage for maternity, mental health and addiction.



One moderate Republican, Susan Collins of Maine, came out in opposition to the bill on Monday evening and cited her concerns about the CBO score in doing so. In a tweet, Collins said: “I want to work w/ my GOP & Dem colleagues to fix the flaws in ACA. CBO analysis shows Senate bill won’t do it. I will vote no on [the motion to proceed].”



Sen. Susan Collins (@SenatorCollins) I want to work w/ my GOP & Dem colleagues to fix the flaws in ACA. CBO analysis shows Senate bill won't do it. I will vote no on mtp. 1/3

The deficit savings projected in Monday’s score do provide at least some leeway for leadership to add additional measures designed to alleviate those concerns – such as separate funding to combat America’s opioid epidemic, which has increasingly become a bipartisan priority.

But such a move could risk angering the conservatives who are not only spending hawks but have already argued that the Senate bill does not go far enough in dismantling Obama’s healthcare law.



One prominent conservative, Rand Paul of Kentucky, told reporters on Monday that he would oppose the motion to proceed as well as the underlying bill itself.

[Obamacare] may have done some good for some people, even for 10 million or whatever ... Alabama senator Richard Shelby

Other Republicans were gung-ho about the bill. Senator Richard Shelby of Alabama told reporters that it was essential to repeal Obamacare. “It may have done some good for some people, even for 10 million or whatever,” said the Alabama Republican. “But I think what we’re trying to do is put healthcare on the right path, financially and otherwise.”

Other Senate Republicans were skeptical about the CBO’s numbers. Tim Scott of South Carolina said that the CBO’s assumption that 14 million Americans would lose coverage because of the end of the individual mandate was “unrealistic”.

Marco Rubio of Florida was more forgiving, saying: “I understand that they have to conservatively assume that because they are accountants at the end of the day and accountants always live in the realm of the worst-case scenario and they have to account for it.”

The White House issued an unsigned statement bashing the nonpartisan office, saying “the CBO has consistently proven it cannot accurately predict how healthcare legislation will impact insurance coverage”.

The Senate bill also faced new opposition from the American Medical Association, the trade group of American doctors. The letter stated that the current proposal violates the Hippocratic oath taken by all doctors to “first, do no harm”.

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