CBO update of estimates of premiums and coverage under repeal of ACA

How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums

Congressional Budget Office, January 2017

A little more than a year ago, the Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) estimated the budgetary effects of H.R. 3762, the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, which would repeal portions of the Affordable Care Act (ACA) — eliminating, in two steps, the law’s mandate penalties and subsidies but leaving the ACA’s insurance market reforms in place. At that time, CBO and JCT offered a partial assessment of how H.R. 3762 would affect health insurance coverage, but they had not estimated the changes in coverage or premiums that would result from leaving the market reforms in place while repealing the mandate penalties and subsidies. This document—prepared at the request of the Senate Minority Leader, the Ranking Member of the Senate Committee on Finance, and the Ranking Member of the Senate Committee on Health, Education, Labor, and Pensions—provides such an estimate.

In brief, CBO and JCT estimate that enacting that legislation would affect insurance coverage and premiums primarily in these ways:

* The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill. Later, after the elimination of the ACA’s expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million, and then to 32 million in 2026.

* Premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by 20 percent to 25 percent—relative to projections under current law — in the first new plan year following enactment. The increase would reach about 50 percent in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026.

If the Congress considers legislation similar to H.R. 3762 in the coming weeks, the estimated effects could differ from those described here. In particular, the response of individuals, insurers, and states would depend critically on the particular specifications contained in such legislation.


Trump vows ‘insurance for everybody’ in Obamacare replacement plan

By Robert Costa and Amy Goldstein
The Washington Post, January 15, 2017

“It’s not going to be their plan,” he said of people covered under the current law. “It’ll be another plan. But they’ll be beautifully covered. I don’t want single-payer. What I do want is to be able to take care of people,” he said Saturday.

Trump did not say how his program overlaps with the comprehensive plan authored by House Republicans. Earlier this year, (Tom) Price suggested that a Trump presidency would advance the House GOP’s health-care agenda.



By Don McCanne, M.D.

So far Congress has initiated a process to eliminate health plan subsidies and eliminate individual and employer mandates authorized by the Affordable Care Act. This update estimates the numbers who would be uninsured and estimates the increase in non-group insurance premiums that would occur if insurance reforms such as guaranteed issue remained in place. In the next decade another 32 million people would be without insurance and premiums for exchange plans would double.

It is highly unlikely that Congress would stop here since they have promised a replacement plan. We do not know what that is but President-elect Trump now says that he does not want single payer, and the Republicans in Congress do not either. Trump does say that he has a plan and that people will be “beautifully covered.”

Beautiful coverage is not a standard health policy term, but if it means that everyone will be covered with plans that are affordable and provide access, we can see problems ahead. Expanding coverage to everyone, reducing financial barriers such as high deductibles, and ensuring access while rejecting the efficiencies of a single payer system will be very expensive. Most Americans will not be able to afford the cost of such coverage which means that Congress must authorize massive subsidies to help pay for the very high costs. This Congress?

You can see that this tale is not finished. The people are going to have to watch closely as it unfolds and then be prepared to thrust our wrath onto our elected representatives as they begin to move down the wrong path on reform. Although our signs will say SINGLE PAYER, our pitchforks should have more than the traditional two or three tines since forks with four or five tines are crafted to pitch manure.