AHCA would leave millions uninsured and destabilize markets, says CBO

The Congressional Budget Office (CBO) projected the number of uninsured Americans would rise to 51 million under the American Health Care Act (AHCA), compared to the 28 million who lack insurance under the Affordable Care Act (ACA).

While the bill would reduce the federal deficit by $199 billion, pleasing fiscal conservatives, the provision allowing states to waive the ACA’s essential health benefits would contribute to astronomic increases in premiums among the sick and elderly and destabilize the nongroup market, according to the CBO.

About half of the US population lives in states the CBO believes will make changes to market regulations, including obtaining waivers for essential health benefits or community rating. The changes in essential health benefits would vary widely, but the CBO predicted the most likely services to excluded include maternity care, mental health and substance abuse benefits and pediatric dental coverage.

However, the requirement insurers cover out-of-pocket costs for approved preventative screening exams may be safe because of imaging’s importance to the overall healthcare system, according to Chris Sherin, Executive Director of Congressional Affairs for the American College of Radiology.

“We are very skeptical that imaging would be removed, It’s highly unlikely it will happen,” he said. “It’s a key part of insurance plans right now, whether that’s in the individual market or employer-based coverage.”

The Senate may not even get that far: several prominent Republicans gone on record with their desire for a fresh start, including Senate health committee chair Lamar Alexander, R-Tennessee. There’s also the issue of the budget reconciliation process.

In order to pass legislation without a 60 vote majority in the Senate, lawmakers have increasingly used a strategy called budget reconciliation to pass legislation. The catch? The bill can only change spending, revenues and the federal debt limit.

Industry experts, including Sherin, believe the state waivers stray too far from fiscal policy to be passed through reconciliation.

“We believe this whole MacArthur amendment gets stripped by the senate because it violates reconciliation rules—that’s the primary reason it was not in the initial bill released by Speaker Ryan,” said Sherin. “Every single indicator shows they are going to take a different look and craft a unique bill, and I don’t think they are going to do anything on this EHB issue, primarily because it won’t make it through budget reconciliation.”