House Speaker Paul Ryan gives a presentation March 9 on the GOP's three planned phases of repealing and replacing Obamacare. | John Shinkle/POLITICO CBO: 24 million fewer insured under House bill repealing Obamacare The legislation would lead to 14 million more people being uninsured in 2018 alone.

Roughly 24 million more people would be uninsured over a decade if the House Republican Obamacare repeal bill is enacted, according to a much-anticipated Congressional Budget Office analysis that could threaten GOP hopes of getting the measure through the House.

The legislation would lead to 14 million more people being uninsured in 2018 alone. The nonpartisan score-keeping office also forecasts the GOP plan would cut the deficit by $337 billion over a decade, primarily because of its cuts to Medicaid and private insurance subsidies.


The prediction of coverage losses provided immediate fuel to Democratic arguments that the people who signed up for coverage under Obamacare would be much worse off under the GOP plan. The numbers could also cripple Republicans’ hopes of passing legislation before the April recess, coming as both conservatives and moderates express misgivings about the plan.

In total, CBO estimated that 52 million people in the U.S. would be uninsured in 2026 if the House bill became law, completely wiping out the insurance gains that have been made under Obamacare over the past seven years. A total of 48.3 million were uninsured when Obamacare was enacted in 2010, according to the National Health Interview Survey, with some other estimates as high as 50 million.

The report is far more challenging than supporters of the Obamacare repeal bill had expected and could make it more difficult to get skeptics to embrace the plan. The White House and Republican leaders will have to overcome the huge projected increase in the nation’s uninsured and an enormous cut to Medicaid, both of which are likely to make moderate Republicans nervous.

Moderates, worried about precisely the kind of coverage losses the CBO predicted, have balked at supporting the House bill. GOP leadership also caught flak from conservatives who criticize the bill as “Obamacare lite” because of the new age-adjusted tax credits it proposes. And some Republican governors who expanded their Medicaid programs under Obamacare have publicly fretted about whether they will have to drop low-income people from the rolls to avoid bankrupting their states.

"This is a work in progress and obviously we want to improve those coverage numbers. But when you don't punish people financially for their refusal to buy government approved insurance, people are gonna make a decision not to buy it," said Sen. John Cornyn of Texas, the chamber's No. 2 Republican.

Republicans in the past week tried to discredit CBO’s forecasts in anticipation of the bad news while maintaining that no one will be worse off under the GOP plan. Lawmakers and senior Trump administration officials continued to do so on Monday after the score was released, with Health and Human Services Secretary Tom Price saying Monday they "disagree strenuously" with CBO's findings.

"CBO scores, there are times that I've had real problems with them, especially on agriculture and what that means ... I'm not saying I don't have any trust or faith in CBO, I'm just saying that you gotta sorta take it with a little bit of salt,” Sen. Pat Roberts (R-Kan.) said.

Republicans immediately derided the CBO projections as an incomplete analysis, because Republicans haven’t yet revealed details of the regulatory action they plan to take, or the bills they hope to get through the Senate under the regular rules, which would allow a Democratic filibuster.

"Unlike Obamacare, we will not mandate Americans buy insurance plans they don’t want and can’t afford. Instead, we are working to create a system that gives all Americans access to affordable care and the ability to make the decisions that are right for their families," House Energy and Commerce Chairman Greg Walden (R-Ore.) said in a statement.

Apart from rolling back the law’s Medicaid expansion beginning in 2020 and making other sweeping changes to the health law, the GOP plan would revamp the entire Medicaid program and cap federal spending based on the number of enrollees by state. The bill is paid for with a staggering $880 billion cut to Medicaid over a decade, a figure that is likely to terrify governors who rely on the existing federal share of the program for their budgets. CBO projected that total Medicaid spending would be 25 percent less in 2026 than under current law.

The House bill would also repeal many of the health law’s taxes in 2018, ax the unpopular mandate requiring most people to purchase insurance and defund Planned Parenthood for a year. The one-year funding ban on Planned Parenthood would save about $157 million in 2017, CBO estimates, through a combination of $178 million in lower spending but also $21 million in additional federal spending tied to more pregnancies covered by Medicaid. Notably, the Republican bill would hurt low-income patients’ ability to avert pregnancies, CBO projects, and about 15 percent of them would lose access to care. As a result, several thousand more babies would be born.

The GOP repeal bill would also cut $673 billion by eliminating the Affordable Care Act's subsidies, CBO said. The tax credits in the Republican bill would cost $361 billion. Generally, the CBO said low-income people would face higher costs than they do under Obamacare.

POLITICO Pulse newsletter Get the latest on the health care fight, every weekday morning — in your inbox. Email Sign Up By signing up you agree to receive email newsletters or alerts from POLITICO. You can unsubscribe at any time. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

The tax credits would be larger for those with higher incomes, particularly for those with incomes above 400 percent of the federal poverty line, which is the cap for Obamacare’s existing subsidies.

The analysis also delves into effects on health insurance premiums over the next decade. Insurance premiums would rise in 2018 and 2019 under the GOP plan, by as much as 15 percent to 20 percent for single policyholders in the individual market, according to CBO. Much of that increase would be because without the mandate, fewer healthy people would sign up.

In 2020 and afterward, premiums would decline as the effects of the eliminated mandate would be offset by other factors in the Republican plan. By 2026, premiums would be roughly 10 percent lower than under Obamacare.

CBO warns that there would be significant variability for different age groups because the repeal bill would eliminate Obamacare’s requirement that older people can be charged only three times as much as younger individuals.

Seung-Min Kim and Dan Diamond contributed to this report.