The Congressional Budget Office released on Thursday its score of the latest version of the Better Care Reconciliation Act, the Senate's Obamacare repeal-and-replace legislation. The version scored includes a few tweaks to the original: It maintains some of the Affordable Care Act's taxes, includes an additional $70 billion in stabilization funds for the non-group markets (money that is meant to address the destabilizing effects of the Consumer Freedom Amendment), allows for some waivers to the Medicaid per-capita caps, and adds $45 billion in funding to address the opioid crisis. However, the version scored does not factor in the Consumer Freedom Amendment, which the CBO is reportedly still working on; the absence of this component, which is expected to have big effects on government spending, coverage levels, and premiums, limits the score's usefulness.
Not surprisingly, given the relatively minor differences between this version and the previous one, this CBO score looks a lot like the last one. The CBO estimates the latest version of the BCRA would reduce the federal deficit by $420 billion over the next 10 years, a slightly larger reduction than the previous version of the bill. This is largely a result of the retained ACA taxes. Medicaid spending under this version of the BCRA would be 26 percent lower by 2026 than under the ACA.
The CBO predicts that, in 2018, 15 million more people would be uninsured.
As with the prior version, the CBO predicts that, in 2018, 15 million more people would be uninsured under the BCRA than under the ACA. By 2026, 22 million more people would be uninsured than under current law. The effects of this version of the BCRA on benchmark premiums are similar to the previous version—the CBO projects that average premiums on benchmark plans would increase pretty significantly in 2018 and 2019, and then decrease beginning in 2020, due in large part to the benchmark plans having lower actuarial values. Some people, particularly older Americans in high-cost areas, could, however, see higher premiums than under current law.
The CBO projects, as with the previous version, that deductibles in the non-group market would be higher—about $13,000, as compared to about $5,000 under current law—because of the change in the actuarial values of benchmark plans under the BCRA. The higher deductibles, the CBO predicts, would lead many low-income people to forgo insurance altogether.
The fate of the Senate's ACA repeal efforts remain uncertain. At the president's behest, Republican senators met last night in an attempt to hash out a deal, but the GOP reportedly still lacks the 50 votes it needs to pass the BCRA. Senate Majority Leader Mitch McConnell has said he will hold a vote next week on a motion to proceed to either a repeal-and-replace bill or a clean repeal bill, even if the vote is expected to fail. In a score released yesterday, the CBO projected that clean repeal would result in premiums in the non-group market doubling and 32 million additional people being uninsured in 2026.