Policy

New CBO Estimate Does Little to Woo Critics

Pelosi: ‘As bad as TrumpCare already was, the Manager’s Amendment is crueler to Medicaid recipients‘

House Minority Leader Nancy Pelosi, D-Calif., and Senate Minority Leader Charles Schumer, D-N.Y., attend a news conference in the Capitol Visitor Center to voice opposition to House Republican's health care plan, the American Health Care Act, March 14, 2017. (Tom Williams/CQ Roll Call)

By ERIN MERSHON and JOE WILLIAMS, CQ Roll Call

An updated bill from House Republicans to repeal and replace the 2010 health care law would save the government less than half as much as the prior version, but wouldn’t result in any more people keeping their insurance coverage or lower premiums, according to a new analysis of the legislation released Thursday.

The new Congressional Budget Office estimates show how several key policy tweaks affected the impact of the package. Overall, the package would reduce federal deficits by $150 billion by 2026, roughly $186 billion less than the original language.

CBO still estimates that 24 million more people under the age of 65 would be uninsured by 2026, compared to the law’s current trajectory.

Democrats pounced on the report’s findings.

“As bad as TrumpCare already was, the Manager’s Amendment is crueler to Medicaid recipients, while handing billions more to the richest Americans,” said Democratic Leader Nancy Pelosi in a statement. “Apparently they still do not have the votes to pass the bill, and are working to make it even worse. The Speaker calls the bill ‘an act of mercy.’ TrumpCare is a moral monstrosity. It’s time to pull the plug.”

The report comes after a week of intense lobbying by House leaders and the White House that began on Monday when Republicans unveiled a manager’s amendment to the bill to repeal the 2010 health care law. The new version included a series of negotiated changes aimed at generating support from different groups. While House and GOP leaders had hoped to hold a vote on the updated legislation Thursday, divisions within the party forced leadership to postpone. It is now tentatively scheduled for Friday.

The savings and coverage estimates weren’t the only damaging news. CBO also said the revisions would not reduce expected health insurance premiums any more than the previous version, a setback for House leaders as they seek to court conservatives who have made reducing the cost of health insurance a key criteria for their support.

Conservatives in the House Freedom Caucus were continuing to push leadership to make a number of changes to the legislation, including the addition of a measure to repeal the health care law’s so-called essential health benefits requirements. Some experts predict that removing that provisions, which require insurers to cover a minimum set of services, could result in more uninsured individuals under CBO’s criteria.

CBO previously estimated that changes proposed by Republicans to Medicaid would cut federal spending in the program by $880 billion over 10 years. The new language, the office states, would increase spending by about $41 billion over the same time frame, bringing the overall savings down to $839 billion.

Much of that extra spending comes from a provision negotiated late last week by moderate House lawmakers that would make federal Medicaid payments for aged, blind and disabled enrollees slightly more generous over time.

The costs of that provision are slightly offset by a series of cuts to the program, most of which were negotiated by the conservative Republican Study Committee. CBO suggested that new provisions allowing states to choose so-called “block grant” funding or to add work requirements for their Medicaid populations would both save the federal government money.

Another saver: a provision that targets the New York state Medicaid program directly and reduces the federal matching payments associated with their county government contributions.

The new package would put aside $90 billion for the Senate to use to increase the generosity of the premium tax credits Republicans would provide for individuals who don’t get insurance through their job or a government program, particularly for older and low-income Americans, according to CBO.

South Dakota Republican Sen. John Thune has already begun work on an amendment to that effect and suggested earlier this week that an $85 billion fund would be enough for his efforts.

The new package also repeals the health care law’s taxes, like the so-called Cadillac tax, more quickly. That will cost the federal government $48 billion, CBO said.

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