Make America uninsured again: CBO says 52M uninsured by 2026 Presented by

The CBO analysis of the Republican health bill is out — and POLITICO scooped an internal White House analysis with even more bleak coverage numbers.

MAKE AMERICA UNINSURED AGAIN — That's the inescapable conclusion of a bombshell CBO report, which predicts that 24 million more people would be uninsured by 2026 if the House Republican health bill becomes law.

But the CBO number is huge. It's a much larger decline than projections issued by Brookings and other groups last week. And it would totally wipe out the coverage gains under the Affordable Care Act, which CBO had predicted would lead to 24 million more insured within a decade. Chart.

The near-term effects are stark: According to CBO, 14 million more people would be uninsured next year if the Republican bill takes effect. That would mean that President Donald Trump — who promised "insurance for everybody" in a January interview with the Washington Post — would instead oversee the biggest one-year jump in uninsured in U.S. history. More.

52 million residents would be uninsured in 2026. The previous national high, according to the National Health Interview Survey, was 48 million in 2010.

Medicaid would be dramatically reduced. CBO projected that the program would be cut by $880 billion over a decade, which amounts to about a 20 percent reduction.

But AHCA's deficit-reducing impact is real. CBO projected that the AHCA would lower spending $337 billion by 2026 — mostly by cutting Medicaid spending, which would be somewhat counterbalanced by repealing many of the law's taxes — and Republicans seized on those effects.

"This is an $883 billion tax cut for families and small businesses that helps lower their health care costs," House Speaker Paul Ryan told Fox News. "It saves money and reduces the deficits." More for Pros.

Ryan and other top Republicans, like HHS Secretary Tom Price, reiterated that the bill is just one part of their planned three-prong approach to health reform. They also took shots at how CBO got its numbers.

“We disagree strenuously with the report that was put out,” Price told reporters after leaving a Cabinet meeting with Trump. “We believe that our plan will cover more individuals at a lower cost and give them the choices that they want for the coverage that they want for themselves and for their families, not that the government forces them to buy.” More.

One takeaway from CBO report: The bill directly hits Trump voters. "Every piece of health care legislation has winners and losers," Pro's Jason Millman and Adriel Bettelheim write. "In this case, the CBO says the clear losers would be older, low-income Americans between 50 and 64, just below the Medicare eligibility age." More on the impact for Trump voters and other takeaways: More for Pros.

A WHITE HOUSE ANALYSIS LOOKS EVEN WORSE — An internal report suggests 26 million more uninsured over a decade and 54 million uninsured by 2026, Pro's Paul Demko scoops. More.

White House officials dispute that the document is an analysis of the bill’s coverage effects. Instead, they say it was the Office of Management and Budget's attempt to predict what CBO’s scorekeepers would conclude about the GOP repeal plan.

“This is not an analysis of the bill in any way whatsoever,” White House Communications Director Michael Dubke tells POLITICO. “This is OMB trying to project what CBO’s score will be using CBO’s methodology.”

HOW THE PROJECTIONS ARE PLAYING — Not well, with Democrats seizing on the numbers, some Republicans acknowledging the unfavorable score and key lobbyists — already worried about the health bill's effects — ramping up their warnings.

Industry reaction was harsh. The nation's public hospital association was the first trade group out of the gate to blast the bill.

"This bill would make the country worse off than we were before the ACA," said Bruce Siegel, head of America's Essential Hospitals. "The estimated coverage losses in the CBO report are unacceptable. Patients and providers will suffer, and the cost shift will strain state and local government budgets."

Small health plans didn't like it either. The CBO score was "extremely troubling," says Ceci Connolly of the Alliance of Community Health Plans. "No one wants to see America move backward."

And some lawmakers are backing away. Several senators, whose support could be essential to getting the Republican bill through their chamber, instead attacked it after the CBO score was released.

"Can't sugarcoat it," said Sen. Bill Cassidy (R-La.) "It doesn't look good, does it?"

"To do what they're doing right now is absolutely unconscionable," said Sen. Joe Manchin (D-W.Va.), who warned that the bill hits the elderly, Medicaid beneficiaries and opioid-addicted populations — three key groups in his state. "It's just awful … There's gotta be a moral compass inside somebody."

The CBO score also scared off Rep. Rob Wittman (R-Va.), a moderate who wants to repeal the ACA — just not like this. "It is clear that this bill is not consistent with the repeal and replace principles for which I stand," Wittman posted on Facebook. "I do not think this bill will do what is necessary for the short and long-term best interests of Virginians and therefore, I must oppose it."

More on the Republican reaction: More.

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MEANWHILE: SEEMA VERMA CONFIRMED TO RUN CMS — The final tally was 55-43, with Sens. Joe Donnelly (D-Ind.), Heidi Heitkamp (D-N.D.), Manchin and Angus King (I-Maine) crossing party lines to join Republicans. Sens. Johnny Isakson (R-Ga.) and Gary Peters (D-Mich.) missed the vote. More for Pros.

Advice for Verma? Former CMS administrators surveyed by PULSE had words of wisdom for the new administrator, who's stepping into a big job at a time of major change.

"Her biggest issues [are] … she doesn’t know the weeds," Tom Scully told POLITICO's "Pulse Check" podcast last month, pointing to wonky challenges like navigating outpatient payments and Medicare coding. Scully was CMS head under the George W. Bush administration.

"There are lots of members, [in] both parties, with lots of problems," Scully added. "She's going to spend a lot of time on the Hill getting to know those people."

… "Seema is extremely smart," Andy Slavitt — Verma's immediate predecessor, who served during the Obama administration — told PULSE. "My public and private advice is that it always helped me to keep in mind in making tough decisions that my true bosses were the American people — not anyone else as much as I valued their opinion."

"Today I might also add — speak up for the evidence; don't let people discard it because of political momentum," Slavitt added.

THIS IS TUESDAY PULSE — Where OPM has announced a three-hour delay, but no matter: team POLITICO never takes a snow day.

You can help us shovel out from a heavy news dump; send tips to Brianna Ehley at [email protected] or @briannaehley on Twitter, who's covering me tonight. I'm at [email protected] or @ddiamond on Twitter and will be back for Thursday PULSE.

With help from Sarah Karlin-Smith (@SarahKarlin).

MORE ON AHCA

Planned Parenthood cuts would lead to more births. 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. The result? Several thousand more babies would be born in the coming years.

EYE ON FDA

Report pushes for more FDA transparency on drug, device applications. The agency should “more aggressively correct misleading information,” about medical products' safety and effectiveness of medical products, according to a new report published by a coalition of more than a dozen academics, patient and public health advocates and pharma staffers.

… FDA doesn't disclose information about an application under its review, and it usually can’t even confirm it is looking at a product. It also can’t say why it didn’t approve something. This lack of communication can let companies disclose misleading information to the public, other researchers, doctors and investors, the report’s authors says.

The report follows 2010 recommendations on transparency from an FDA task force, that the authors say still have largely not been implemented.

… The authors also said FDA should be more transparent when and why it stops an ongoing clinical trial for safety and effectiveness reasons. They added that when FDA rejects a product, it should make public its analyses of why the product didn’t get through the agency.

A loophole to abuse orphan drug incentives? One evergreening strategy that's often overlooked in the recent debate: How some drugs can receive multiple orphan designations that may further extend the product’s market monopoly, FDA Law Blog points out.

For instance:

— Humira has two orphan drug designations related to its treatment of a type of arthritis in children.

— Avastin, a cancer drug, has six orphan drug designations.

But lawyer Kurt Karst argues in the blog, that opening up the Orphan Drug Act may not be the solution to this practice. Instead, he said FDA’s office of generic drugs could make it easier for generic companies to copycats of the products approved for the older users of the drug, even when they have received new orphan disease approvals.

AROUND THE NATION

Institute for Healthcare Improvement, National Patient Safety Foundation to merge. The two nonprofits, both focused on patient safety, will officially merge on May 1 under the IHI name. They'll be led by Derek Feeley, IHI's current president and CEO, while the merged patient safety teams of the two organizations will be led by Tejal Gandhi, NPSF's president and CEO.

WHAT WE'RE READING by Brianna Ehley

Medical residency program accreditors are lifting the caps on work hours for first-year doctors — allowing them to work 24-hours straight, Forbes writes. More.

The AP profiles Rep. Joe Kennedy, who continues his family legacy of fighting Republicans on health reform. More.

Lanhee Chen writes in CNN that the CBO score of the Republican health bill can be a rallying cry for conservatives. More.

Kaiser Health News looks at a new federal law that requires hospitals to notify Medicare patients when they are getting observation care and why they were not admitted. More.

Researchers find Canadians with cystic fibrosis outlive Americans by a decade, STAT News reports. More.

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