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CBO: 23 million lose insurance under House GOP health bill

The Congressional Budget Office analysis of the Republican health care bill passed recently by the US House of Representatives, shows that 23 million people will lose health insurance under the GOP bill over a ten-year period.

Premiums will also go up for people with pre-existing conditions, and even people without pre-existing conditions may pay more for health care because plans will cover less.

There is talk that Donald Trump may try to claim that this is great news, as the original House health care bill took insurance away from 24 million people.

Among other findings in the CBO report:

* Premiums could be slightly lower than under the original GOP bill because this bill offers worse benefits. So you get less and pay slightly less.

* The bill will cut $ 834 million from Medicaid. It will also lose $ 210 billion that would have been collected under current law (aka the Affordable Care Act, aka Obamacare).

Here’s more from CBO:

CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under H.R. 1628 than under current law. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 23 million in 2026. In 2026, an estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law. Under the legislation, a few million of those people would use tax credits to purchase policies that would not cover major medical risks.

CBO says that in states that choose to opt-out of the current requirement to include a list of ten essential health benefits in every health plan (e.g., maternity, prescription drugs) and the requirement to treat people with pre-existing conditions the same as other insurees, in terms of the cost for their coverage, prices may go down because sick people will no longer be able to afford insurance, and those who can afford insurance will be getting fewer benefits (violating a key promise Trump made):

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. As a result of the narrower scope of covered benefits and the difficulty less healthy people would face purchasing insurance, average premiums for people who did purchase insurance would generally be lower than in other states—but the variation around that average would be very large.

Another key paragraph from CBO. Not only will premiums soar for people with pre-existing conditions, but anyone getting sick will have to pay much more out-of-pocket under the GOP plan. First, because many of the current benefits, like maternity care, won’t necessary be covered under the GOP plan.

Second, because Obamacare limits on annual payments (meaning, you only have to pay $ 2,000 or $ 6,000 per year for essential health benefits before your plan covers 100% of the rest of the essential benefits for that year) will be lifted in states that opt-out under the GOP bill. A specific example, if a state opts-out of maternity benefits being considered “essential,” then not only do their plans not have to include maternity benefits, but even if they are included, there will no longer be an annual limit on what you pay out-of-pocket for those benefits, because they’re no longer “essential.”

And thirdly, for benefits no longer deemed “essential,” insurers could reimpose annual and lifetime limits on benefits. Meaning, if you spend too much in one year, or your lifetime, on a certain benefit, it’s over, you get no more. Before Obamacare, this would happen to people with bad cancers — their insurance would simply cut them off, and they’d never get insurance again.

Although premiums would decline, on average, in states that chose to narrow the scope of EHBs, some people enrolled in nongroup insurance would experience substantial increases in what they would spend on health care. People living in states modifying the EHBs who used services or benefits no longer included in the EHBs would experience substantial increases in out-of-pocket spending on health care or would choose to forgo the services. Services or benefits likely to be excluded from the EHBs in some states include maternity care, mental health and substance abuse benefits, rehabilitative and habilitative services, and pediatric dental benefits. In particular, out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for the nongroup enrollees who would use those services. Moreover, the ACA’s ban on annual and lifetime limits on covered benefits would no longer apply to health benefits not defined as essential in a state. As a result, for some benefits that might be removed from a state’s definition of EHBs but that might not be excluded from insurance coverage altogether, some enrollees could see large increases in out-of-pocket spending because annual or lifetime limits would be allowed. That could happen, for example, to some people who use expensive prescription drugs. Out-of-pocket payments for people who have relatively high health care spending would increase most in the states that obtained waivers from the requirements for both the EHBs and community rating.

You can read more details on these various issues in my previous analysis of the bill.

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