The bill would still reverse all of the historic coverage gains achieved since the ACA was enacted in 2010.
The Republican overhaul of the federal health law passed by the House this month would result in slightly lower premiums and slightly fewer uninsured Americans than an earlier proposal. But it would leave as many as one-sixth of Americans living in states where older and sicker people might have to pay much more for their health care or be unable to purchase insurance at all, the Congressional Budget Office said Wednesday.
In some states, said the report, “less healthy people would face extremely high premiums, despite the additional funding that would be available” in the bill to help offset those increases.
The report incorporates the changes to the bill made just before it narrowly passed the House on May 4. Those changes included an amendment offered by Rep. Tom MacArthur (R-N.J.) that would let states waive some key provisions of the health law, including requirements to cover “essential health benefits” and to offer insurance to people with preexisting conditions at no extra cost.
CBO said the current version would result in savings of $119 billion over 10 years and 23 million more uninsured people than would be expected under the current law.Use Our ContentThis KHN story can be republished for free (details).
According to the estimate, premiums would be slightly lower than under the Affordable Care Act, but mostly because “the insurance, on average, would pay for a smaller proportion of health care costs.”
Prior to the changes, the CBO estimated that the bill would result in savings of $150 billion over the next decade and grow the number of uninsured Americans by 24 million. That dollar figure was a considerable change from the original version of the bill that CBO said would have saved $337 billion, but lawmakers decided to spend back some of those savings on help for those likely to be cut off from insurance.
The two earliest versions of the bill could not muster enough support for the House leadership to bring them to a vote on the floor. Later, MacArthur and leaders of the conservative Freedom Caucus negotiated changes that they said should help bring down premium costs for consumers. That is the bill approved and now evaluated by CBO.
The CBO also estimated that in states deciding to take the option to waive requirements related to charging sicker people more, “the nongroup market would start to become unstable.” In particular, said the report, “people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”
And in states that chose to waive the requirements for essential benefits, even people with insurance “would experience substantial increases in what they would spend on health care,” because their policies might no longer cover expensive treatments like those for maternity care or mental health and substance abuse.
Despite repeated claims from President Donald Trump and congressional Republicans that the Affordable Care Act is collapsing, the CBO specifically said that the market would continue “to be stable in most areas” under current law. It predicted the same for the original version of the House bill.
In fact, the only place the CBO specifically said the individual insurance market might become unstable is in states that decide to waive the ACA’s coverage requirements. It did not guess which states might do that, but the report says that one-sixth of the population could be subject to that instability.
“What is clear is that these waivers make life much, much worse for people with preexisting conditions, for older people, for sicker people,” said Aviva Aron-Dine, a senior fellow at the Center on Budget and Policy Priorities and former Obama administration health staffer.
The savings in the bill are mostly the result of capping federal funding to states for the Medicaid program for those with low incomes and scaling back the tax credits that help some people with low and modest incomes pay for private insurance. An estimated 14 million of the 23 million people who would no longer have insurance would otherwise have obtained it through Medicaid.
The bill would also repeal nearly all the taxes imposed in the ACA to pay for the new benefits, including taxes on wealthy individuals and much of the health industry.
Reaction to the new estimate fell mostly along predictable party lines.
“CBO continues to find that through our patient-focused bill, premiums will go down and that our reforms will help stabilize the market,” said a statement from House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) and its health subcommittee chairman, Michael Burgess (R-Texas).
By contrast, Rep. Steny Hoyer (D-Md.) said the new estimate shows “TrumpCare will kick millions of Americans off their insurance coverage and force consumers to pay more for less.”
But the reaction was not completely partisan. Sen. Bill Cassidy (R-La.), a key swing vote in the Senate, said that “Congress’s focus must be to lower premiums with coverage which passes the Jimmy Kimmel test,” referring to the late-night host’s tearful monologue about the health problems of his newborn son. The House-passed bill, he said, “does not. I am working with Senate colleagues to do so.”
The much-anticipated report cast a new shadow over the controversial legislation and likely will complicate Republican efforts to get the bill through the Senate, where it already faces difficult prospects. According to the budget office, which both parties in Congress look to for estimates on the impact of complex legislation, the bill would cause 23 million fewer people to have health insurance by 2026. Many additional consumers would see skimpier health coverage and higher deductibles, the budget office projected.
Today’s interview is with Micaela DelMonte, a lawyer from the European Parliamentary Research Service, who is at the Law Library for one month.
Describe your background.
I am Italian and was born in Siena, Italy. Shortly after my birth, my family moved to Florence and then to Carrara, the city of white marble, where I spent most of my youth. I arrived in the U.S. almost three years ago and I will go back to Brussels, Belgium this summer, when my posting in D.C. comes to an end.
What is your academic/professional history?
I was educated in Italy at the Law School of the University of Pisa where I graduated cum laude. Afterwards, I studied in Spain at the Human Rights Institute Bartolomé de las Casas in Madrid. I have always been fascinated by Europe and the European project so I was glad to have the chance to move to Brussels for professional reasons.
I started working for the European Union in 1999, when I moved from Spain to Belgium to join the Legal Service of the Council of Ministers. In 2000, I moved to the European Commission (the EU Executive) where I worked for 12 years on a range of issues including justice and home affairs, and health and consumer protection. As a civil servant of the EU institutions, I have to comply with the so called “mobility obligation” which means that I have to move to another position at least every 5 years. In 2012, I joined the European Parliamentary Research Service (EPRS), the in-house think tank providing bi-partisan, comprehensive, and analytical research to the members of the European Parliament and its committees. I very much like EPRS’ motto “Empowering through knowledge”, because it supports the idea that I can serve my institution by providing facts and analysis.
How would you describe your job to other people?
The work done by EPRS is similar to the work done by the Congressional Research Service (CRS) and indeed we were very much inspired by CRS. I have to write different types of documents: briefings, in-depth analyses, and short “at-a-glance” on topics of interest for the members of the European Parliament. However, when I joined EPRS in 2012, I worked in a unit called “EU added value”. I had to assess the potential benefit of future action by the Union in policy areas where collective good could be realized through common action at a European level instead of at a national level. It was quite challenging considering the growing Euroskepticism in Europe, including in the European Parliament.
Why did you want to come to the Law Library of Congress?
For the month of May, I am volunteering at the Law Library of Congress to gain an understanding of how the Law Library works. Its products and services are indeed of great interest to the European Parliament in Brussels since EPRS also houses a very small Comparative Law Library unit. Two years ago, Peter Roudik met with some of my colleagues, and they were so impressed by the work done here that they thought that a similar institute would be very beneficial for the European Parliament. Obviously we do not have the same collections or the same expertise, but we do hope to move in the right direction by observing and learning the great work you are doing here.
What is the most interesting fact you have learned about the Law Library of Congress?
In my opinion, the most impressive thing is the law collection. The first week I arrived here, Connie Johnson showed me the two reading rooms and the collections in the closed stacks in the basement of the Madison building. It looked to me like a maze, a maze of knowledge.
Also I must say that the Law Library is most similar to an EU institution, because people have different language skills, come from around the world, and it looks like a very international environment.
What’s something most of your co-workers do not know about you?
I am a very ordinary person, though I like to keep busy with other activities besides enjoying time with my family and working. I do enjoy playing piano, jogging, and reading. While staying here in the U.S., I took some classes on American literature to get a better understanding of the U.S. and discovered many authors I did not know before. When you study in Europe, most of the authors you come across are from your own country and other European countries, so I must admit that I did not know much about American literature. Hopefully this has improved a little bit in the meantime!
Millions of children would face the risk of losing their health coverage or going without needed care under the harmful changes to the Children’s Health Insurance Program (CHIP) and Medicaid that President Trump proposes in his budget. While proposing just a two-year extension of federal CHIP funding, the budget would immediately shift significant costs to states, reduce benefits and raise out-of-pocket costs for near-poor older children, and eliminate tools that help states enroll more eligible children.
[Po]lice made three more arrests and said they were investigating a “network” as the probe intensified into the suicide bombing at a pop concert that killed 22 people and wounded scores more. Home Secretary Amber Rudd said the sophistication of the attack Monday at Manchester Arena indicate Salman Abedi, 22, likely did not act alone. … “extensive searches” across the city. The latest arrests came one day after the suspected bomber’s brother was taken into custody. (Hjelmgaard, Onyanafajife;ajf and f;jfaisj, 5/24)
Robert Greenstein, president of the Center on Budget and Policy Priorities explains why the stakes for the Supplemental Nutrition Assistance Program (SNAP) are particularly high right now.
We’ve explained that President Trump’s 2018 budget is the most radical, Robin-Hood-in-reverse budget that any modern President has ever proposed, and here’s a perfect illustration: it cuts health coverage and care for poor and modest-income families by nearly $2 trillion over ten years, while giving high-income people a nearly $2 trillion tax break on
President Trump’s budget would shift massive new costs to states by cutting federal funding for health care, food assistance, and many other areas. States can’t afford to assume these costs without raising taxes significantly so, instead, they’d very likely cut many key investments and public services.
Specifically, the Trump budget slashes:
President Trump’s budget would cut the Temporary Assistance for Needy Families (TANF) block grant and Contingency Fund — which provide funds to states for short-term income assistance, work programs, and other crucial supports for poor families with children — by $22 billion over ten years. Such cuts conflict sharply with the purported goals, as stated in the budget, of reducing poverty and providing work opportunities to poor families.
Five years ago this week, Kansas Governor Sam Brownback signed one of the biggest income tax cuts a state has ever enacted, promising that they’d act “like a shot of adrenaline into the heart of the Kansas economy.” Tax cut promoters Art Laffer and Stephen Moore, who helped design the cuts, said they would produce an “immediate and lasting boost” to the state’s economy. Rather than fueling an economic surge, however, the tax