Erin Kelly

USA TODAY

WASHINGTON — A Republican bill to replace Obamacare would lead to 14 million fewer Americans with health insurance by 2018 and 24 million fewer by 2026, the non-partisan Congressional Budget Office said Monday in an analysis that could make the controversial legislation even tougher for GOP leaders to push through Congress.

Health and Human Services Secretary Tom Price said the projections of uninsured were too high and called them "just not believable."

Most of the initial increase in uninsured people in 2018 would come from consumers deciding not to buy insurance because they would no longer have to pay a penalty for failing to do so, the CBO said in an analysis done with the Joint Committee on Taxation. However, others would stop buying insurance because premiums will go up over the next two years, the report said.

The bill is expected to raise the average premiums that Americans would have to pay before 2020, and then lower them after that, the CBO projected. In 2018 and 2019, the average premiums for single policyholders who do not get insurance from their employers would be 15% to 20% higher than under Obamacare, the analysis said. Starting in 2020, those premiums would begin to go down. By 2026, average premiums would be roughly 10% lower than under the existing Affordable Care Act, the CBO projected.

However, younger Americans would benefit more than older ones. The GOP bill would allow insurers to charge five times more for older patients than younger ones — rather than three times more as allowed under Obamacare, the report said. The effect, the report said, would be "substantially reducing premiums for young adults and substantially raising premiums for older people."

"If ever there was a war on seniors, Trumpcare — this bill — is it," said Senate Minority Leader Chuck Schumer, D-N.Y.

The number of uninsured Americans would rise dramatically during that same period as the Republican replacement plan phases out Obamacare's Medicaid expansion, the CBO said.

"In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law," the analysis said.

The Republican bill would reduce federal deficits by $337 billion over the 2017-2026 period, according to the CBO. The biggest savings would come from reductions in outlays for Medicaid and from the elimination of the Affordable Care Act’s subsidies for low-income Americans to buy insurance.

Administration officials said the CBO overestimated the number of people who would lose insurance and did not take into account future phases of the Republican proposal. However, unlike the current GOP bill under consideration, any subsequent legislation would have to attract support from Democratic senators, who are unlikely to provide it.

One of the subsequent steps that Republicans are pushing is for Price to use his administrative power to reduce regulations to inspire more insurance companies to participate, which Price said would give consumers more choices at competitive costs.

"They're going to be able to buy a coverage policy that they want," Price said.

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The CBO report came as Republican leaders in Congress were already scrambling to keep their fractious caucus together on the bill. Some conservatives have denounced the plan as "Obamacare lite," arguing that it does not go far enough in scrapping the Affordable Care Act and creates new entitlements by replacing the current law's federal subsidies for low-income people with tax credits. At the same time, some moderate Republicans in the Senate fear their low-income constituents and seniors in nursing homes will lose coverage because the legislation phases out the expansion of Medicaid that Obamacare helped fund in many states.

Democrats, who were already fiercely opposed to the legislation, said the CBO score underscores that President Trump was wrong when he promised "insurance for everybody" under the GOP plan.

"The CBO score shows just how empty the president's promises, that everyone will be covered and costs will go down, have been," Schumer said. "This should be a looming stop sign for the Republicans' repeal effort."

House Speaker Paul Ryan, R-Wis., is leading the push for the bill, saying it is the best hope that Republicans have of ending Obamacare and passing a replacement bill under a fast-track budget procedure that cannot be blocked by Senate Democrats.

"This report confirms that the American Health Care Act will lower premiums and improve access to quality, affordable care," Ryan said. "CBO also finds that this legislation will provide massive tax relief, dramatically reduce the deficit, and make the most fundamental entitlement reform in more than a generation. These are things we are achieving in just the first of a three-pronged approach."

House Minority Leader Nancy Pelosi, D-Calif., said Ryan is wrong when he says Republicans want to kill Obamacare as "an act of mercy" because it is in a death spiral of rising costs and decreasing insurance choices for consumers.

She said that 24 million more uninsured Americans by 2026 is "a remarkable figure" that underscores the need for GOP leaders to scrap their bill.

"It speaks remarkably to the cruelty of a bill that the Speaker calls an act of mercy," she told reporters Monday. "In terms of insurance coverage, it's immoral."

The Congressional Budget Office, which was created by Congress in 1974, is a non-partisan group of economists and analysts that produces hundreds of cost estimates for Congress on proposed legislation each year. The office has a reputation for being impartial and its cost estimates — or "scores" — of bills are taken seriously by lawmakers as they decide whether to support legislation.

Republican leaders unveiled the American Health Care Act last week, and it has already been approved by the House Ways and Means Committee and the House Energy and Commerce Committee. It is scheduled to be taken up by the House Budget Committee on Wednesday, unless an expected snowstorm forces the Capitol to close. The bill will then go to the House Rules Committee, followed by a vote on the House floor as soon as next week. If the House passes the bill, it will be sent to the Senate for approval.

The GOP bill would no longer require Americans to buy health insurance. It also would replace direct federal subsidies with tax credits to help low-income people buy insurance, phase out the expansion of Medicaid, and allow insurance companies to charge older Americans more for their coverage. It increases the amount of money people can contribute to Health Savings Accounts, which are tax-exempt accounts that can be used to pay medical expenses.

Contributing: David Jackson

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