The current Republican bill to repeal and replace major parts of Obamacare will lead to 23 million fewer Americans with health insurance coverage by 2026 if it becomes law, the Congressional Budget Office projected Wednesday. That is only 1 million fewer uninsured people than had been projected for an earlier version of the GOP bill. Most of the coverage losses still would occur next year, when 14 million more people would become uninsured than would otherwise be the case if Obamacare remained in place, CBO said in its new report. By 2026, there would be 51 million uninsured Americans under the GOP bill, known as the American Health Care Act, compared to the 28 million people projected to be uninsured if Obamacare stays the law of the land. Most of the reductions in coverage would come from people on Medicaid, the joint federal-state program that covers primarily the poor, as well as from people enrolled in non-job-based private individual health plans. The controversial bill also would "tend to increase" average premium prices of individual health plans by about 20 percent relative to the current law in 2018, according to the analysis, but just 5 percent higher than Obamacare prices would be expected to be in 2019. However, starting in 2020, premiums in different states would be affected in different ways by the bill because of an amendment that would allow states to obtain waivers from current Obamacare rules mandating the design of health plans, and barring insurers from charging less-healthy people higher prices, CBO said.

Waivers sway premium forecasts

Average premiums in states that did not request those waivers would be about 4 percent lower than under the current law by 2026, and about 20 percent lower in areas containing one-third of the U.S. population. Older people would still pay much more for their insurance under the GOP bill, up to 10 times as much as the premiums that would be paid by young adults, and more than nine times what they would pay if Obamacare staying in place, CBO said. The agency also said that starting in 2020, the individual insurance markets in areas in the United States containing one-sixth of the nation's population would "start to become unstable" because of the bill. "In addition, premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums, despite the additional funding that would be available under H.R. 1628 to help reduce premiums," CBO said. "Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly," the report said. And the non-partisan CBO said that the federal budget deficit would decrease by $119 billion over the next decade if the AHCA is signed into law. That is $32 billion less in net savings projected to be achieved under an earlier version of the bill. But the latest version still achieves enough deficit savings to avoid the House of Representatives having to recast the legislation, and to vote on it a second time to ensure that it qualifies for Senate consideration.

The CBO's report comes three weeks after the House, by a margin of just a single vote, passed the AHCA with strong encouragement from President Donald Trump and his administration. The House conducted that vote May 4 without first having the CBO analyze the revised bill, as is the norm, and as CBO had done for prior versions of the legislation in the weeks leading up to the vote. The new report reflects the projected effects of several amendments that were made to the bill before that vote, including the so-called MacArthur Amendment that opens the door to "skimpier" health plans and higher charges for people with pre-existing health conditions in some states. Before Wednesday's analysis, the most-recent CBO report on the AHCA said that an earlier version of the bill would lead to 24 million more people being uninsured by 2026 than would be the case if Obamacare stayed the law in current form. The coverage losses result from the proposed elimination of the Obamacare rule that currently requires most Americans to have some form of health coverage or pay a fine, as well as changes to the nation's Medicaid program. The CBO in that same report issued March 23 also had projected that average premiums for individual health plans would be 15 to 20 percent higher by next year and in 2019 than they would be if Obamacare remained in place. However, CBO also estimated that by 2026, individual premiums under AHCA would be 10 percent lower than Obamacare premiums are expected to be by that year.

Price disputes CBO findings

The prior CBO report projected that the Republican bill would reduce federal budget deficits by $150 billion over the period of 2017 through 2026. Tom Price, the secretary for Health and Human Services Department, disputed the latest CBO report's findings. "The CBO was wrong when they analyzed Obamacare's effect on cost and coverage, and they are wrong again," Price said. "In reality, Americans are paying more for fewer health-care choices because of Obamacare, and that's why the Trump Administration is committed to reforming healthcare. In a new analysis released just last night, HHS reported that premiums in the individual market have more than doubled since many of Obamacare's regulations and mandates were implemented," he said. Dr. Andrew Gurman, president of the American Medical Association, the nation's largest group of physicians, said, "Today's estimates from the nonpartisan Congressional Budget Office show that last-minute changes to the AHCA made by the House offered no real improvements." "Millions of Americans will become uninsured — with low-income families on Medicaid being hit the hardest," Gurman said. "We urge the Senate to ensure that any changes made to current law do not cause Americans to lose access to affordable, meaningful health insurance coverage." Despite the fact that the report was eagerly awaited Wednesday, the bill it analyzes is considered unlikely to survive in its current form after the Senate formally receives it. Sen. Mike Lee, R-Utah, a member of a group of Republican senators that has been regularly meeting to craft health-care legislation, told Fox News on Wednesday, "We all understand that the House bill has to be essentially rewritten." "There is not going to be a whole lot about the Senate bill that looks identical to the House bill," Lee told Fox. But even as Lee and his GOP colleagues continue their meetings, there is skepticism that Republicans will be able to pass a major bill that repeals and replaces much of Obamacare, despite holding control of both the House and the Senate.

Within their own caucuses, GOP leaders in both chambers of Congress face members who are worried about political fallout from a bill that could lead both to very large increases in the numbers of uninsured Americans, as well as to even higher price hikes for health plans that would be seen under Obamacare. Senator Majority Leader Mitch McConnell, the Republican from Kentucky, told Reuters in an interview published Wednesday that "I don't know how we get to 50 [votes] at the moment. But that's the goal." Republicans, who hold 52 seats in the Senate, would need 50 of their members to pass any health-care reform bill, assuming that no Democrats vote for it, and that Vice President Mike Pence would break any tie. Leslie Dach, director of the Obamacare-defense group Protect Our Care Campaign, after release of the new analysis said, "The Congressional Budget Office confirmed yet again any health care repeal cuts coverage for millions, increases health costs for everyday people, and eliminates protections millions rely on — all to give massive tax breaks to the wealthiest Americans and insurance and drug companies." "People across the country have rejected Republican repeal and pleaded with the Republican party to stop their partisan rush. Yet, the Senate is heading down the same repeal path the House did, working secretly behind closed doors, refusing to hold hearings and using the House repeal as a starting point," Dach said. He called on the Senate to "abandon partisan repeal of the ACA and instead work across the aisle to keep what works and fix what doesn't — not tear our health care apart." The AHCA has been broadly unpopular among the general public. But it has been pushed by leading Republicans, including Trump, who have noted that many of their supporters have demanded that Obamacare be repealed. Those Republicans also argue that Obamacare is failing because premiums have risen sharply, and because of the lack of competition among insurers in large parts of the United States. Defenders of Obamacare say the law could be improved, but is not failing, and argue that it has led to historic reductions in the number of uninsured Americans, as well as to protections for people with health conditions. The bill would make multiple, major changes to Obamacare, particularly in the way the federal government subsidizes insurance coverage for millions of Americans. The AHCA would increase the amount of federal subsidies to young people to help them pay for their individual plan health insurance premiums, but it would reduce the amount for older adults. It also would allow those subsidies to buy health plans outside of government-run Obamacare marketplaces. The bill also would allow insurers to charge older adults premiums that are up to five times higher than what they charge younger adults. Obamacare, in contrast, imposes a 3:1 ratio for premiums. The AHCA would impose a premium penalty on people who do not maintain continuous health coverage. And the bill would establish funding for states that can be used for "high-risk" individuals, or other purposes. Read the entire CBO report on the Republican health-care law below.