The Joint Committee on Taxation and the Congressional Budget Office have released their assessment of the likely impact of the GOP's Obamacare "replacement plan." That analysis is more grim than even most of the bill's critics expected, and it also explains why Republican officials have been so nervous about its release:
1.) The analysis found that the impact of the bill would be felt almost immediately, with 14 million more uninsured Americans in 2018, rising "to 21 million in 2020 and 24 million in 2026." Overall, 52 million Americans would be uninsured by 2026, compared to 28 million projected under current law.
2.) President Trump and congressional Republicans have tried to paint a picture of Obamacare as a failing program in a death spiral, but according to the CBO, that assessment is false. The report says that "the non-group market would probably be stable under either current law or the legislation."
3.) In 2018 and 2019, it predicts, "premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher" under the GOP bill. By 2026, average premiums would be 10 percent lower than under current law, but that would vary greatly by age. "By 2026, premiums would be 20 percent to 25 percent lower for a 21-year-old ... but 20 to 25 percent higher for a 64-year-old."
4.) Over the next decade, the GOP legislation would lower government revenue by $883 billion, mostly in the form of tax cuts for the rich. That lower revenue would be offset by an almost identical cut of $880 billion in spending on Medicaid, which provides health care to the poor. In other words, the bill produces an almost perfect dollar-for-dollar shift away from the poor and into the bank accounts of the wealthy.
5.) The GOP has emphasized the problem of high deductibles in their overall critique of Obamacare, but according to the CBO, deductibles under the GOP plan "would be higher than those anticipated under current law ... significantly increasing out-of-pocket costs" for health-care consumers. That is not by accident. Significantly increasing out-of-pocket costs has been a central pillar of GOP planning for years now, even though they rarely mention it to voters.
6.)The GOP has also stressed the importance of price competition in bringing down costs, but according to the CBO, "under the legislation, plans would be harder to compare, making shopping for a plan on the basis of price more difficult."
7.) According to the CBO, "fewer employers would offer health insurance" under the GOP plan "because the legislation would change their incentives to do so." The number of Americans who get health coverage through their employer would drop by 2 million by 2020 and by 7 million in 2026.
8.) Finally, barring Planned Parenthood from participating in Medicaid's family-planning and contraception programs would hurt low-income recipients. Overall, that reduced access to family planning assistance means "births in the Medicaid program would increase by several thousand" annually, the CBO projects.
Personally, I think that's a pretty damning assessment overall, but others claim to have had a very different reaction.
"If you read the entire report, I am pretty encouraged by it - it exceeded my expectations," House Speaker Paul Ryan said this evening in response to the CBO analysis. If he's being honest, that pretty much confirms my thesis from earlier in the day, when I argued that the GOP goal has never really been to replace Obamacare, but instead to use repeal to drive as many lower-income Americans as possible off of insurance and deeper into economic and health insecurity.
And since 24 million additional uninsured is more than 15 million, the previous worst-case estimate, Ryan says he's pleased. I'm not sure that a lot of his fellow Americans will share in that pleasure.