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The Congressional Budget Office (CBO) released its updated score of the GOP health care bill Wednesday.
While the analysis includes some notable changes — the American Health Care Act (AHCA) would lead to 23 million more Americans being uninsured in a decade (as opposed to the original 24 million) and would cost slightly more than previous versions — the biggest headache the CBO report brings for lawmakers is its assessment that sick people could face significantly higher prices and even be priced out of the insurance market if the health care bill passes unchanged.
After the release of the score, House Speaker Paul Ryan (R-Wis.) responded saying,“This CBO report again confirms that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit.”
Premiums might go down on average for healthy people, but for sick people? Well, no.
The health care bill House Republicans passed three weeks ago included an amendment allowing states to repeal certain regulations of the Affordable Care Act — namely Essential Health Benefits (EHBs), which created a federal standard for what health insurance plans should cover, and community ratings, which prevented health insurers from charging individuals with preexisting conditions higher prices for coverage.
The CBO scored the updated version of the bill with the amendment and concluded states choosing to repeal those mandates would affect one-sixth of the U.S. population and would cause premiums for sick people in waiver states to skyrocket.
Additionally, “Out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year” if states strip EHBs, the report asserted.
Freedom Caucus Chairman Mark Meadows (R-N.C.), — who played a pivotal role in including state waiver options in AHCA — hadn't read the full report yet, but initially said he saw it as “good news.”
When reporters pointed out the portion of the CBO report saying individuals with preexisting conditions in waiver states would be charged higher premiums and could even be priced out of the insurance market — destabilizing markets in those states — under AHCA, Meadows seemed surprised.
“Well, that’s not what I read,” Meadows said, putting on his reading glasses and peering at the paragraph on the phone of a nearby reporter.
The CBO predicted:
“...the waivers in those states would have another effect: Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive non-group health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under H.R. 1628 to help reduce premiums."
Republicans insisted in the days after AHCA's passage that the health care bill would not weaken protections for preexisting conditions, citing the plan's high-risk pools for sick people.
Critics argue those high-risk pools are not adequately funded, though. The Center for American Progress projected, before House Republicans passed AHCA in May, that its high-risk pools “would fall short by at least $19.7 billion per year, or by about $200 billion over 10 years.”
The CBO analysis was likewise adamant that AHCA's current high-risk pool funding isn't enough to cover sick people if states use the mandate waivers.
After reading the paragraph, Meadows told reporters he would go through the CBO analysis more thoroughly and run the numbers, adding he would work to make sure the high-risk pools are properly funded.
Meadows, suddenly emotional, choked back tears and said, "Listen, I lost my sister to breast cancer. I lost my dad to lung cancer. If anybody is sensitive to preexisting conditions, it’s me. I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself.”
“In the end, we’ve got to make sure there’s enough funding there to handle preexisting conditions and drive down premiums. And if we can’t do those three things, then we will have failed.”
Meadows indicated he would support less-conservative changes to provide more funding for high-risk pools in the Senate, if needed.
Rep. Pete Sessions (R-Texas), who wrote his own health care bill (titled “The World's Greatest Health Care Plan”) and has said he strongly opposes undermining preexisting conditions protections, argued the CBO's analysis of the mandate waiver option could be misguided.
Sessions was reluctant to comment on the potential impacts of the waivers on people with preexisting conditions because he said no states will be “wild about” pursuing the repeal of those ACA mandates, anyway.
“I need to look at [CBO's] detail,” he said. “The unprofessional evaluation that I put in my mind was I did not believe any state — based upon the conditions that would be required for them to go — would be accepting that challenge. So, evidently, the CBO felt like someone would, so I really need to go look at it.”
Others, like Rep. Tom MacArthur (R-N.J.), who was a primary negotiator in getting AHCA through the House, also downplayed the CBO score, noting that CBO personnel are “not prophets.”
“They’re trying to answer questions that I think it would be better where they say 'I don’t know,'” MacArthur said.
The CBO score is another step forward in the GOP's health care push, as AHCA will now go on to the Senate where Republican senators will take the CBO's analysis into account as they work to draft their own version of the health care bill in the coming weeks.