By now I’m sure you’ve seen the Congressional Budget Office (CBO) assessment of TrumpCare/the American Health Care Act (AHCA) and its topline findings: 23 million would lose coverage, it cuts $1.1 TRILLION in coverage assistance to low-income Americans, it would increase premiums for those age 50-64 by more than 850%, all while providing a massive tax cut to the wealthy and various healthcare industries like device manufacturers.
What’s less obvious is CBO’s complete repudiation of virtually every talking point Republicans used to sell the bill.
- “Nobody on Medicaid will lose coverage”: CBO found TrumpCare would gut Medicaid like a fish, cutting $880 billion from the program over 10 years. That would in turn result in 14 million fewer Americans losing Medicaid, as TrumpCare cuts out the match rate for the Affordable Care Act’s (ACA’s) Medicaid expansion, which raised eligibility to 138% of the federal poverty level, and by imposing a “freeze” on enrollment in 2020.
- “Everyone with pre-existing conditions can keep their coverage”: The bill includes a “compromise” proposal letting states waive certain rules that would allow insurers to price sick people out the market. That spooked moderates, so after adding $8 billion dollars to subsidize coverage for people with pre-existing conditions, Republicans claimed they had solved the problem, and said everyone covered under Obamacare today would still be able to afford insurance. CBO says TrumpCare doesn’t even come close to providing adequate funding for this population, and millions would be priced out of coverage.
- “The bill would only affect a few people”: The GOP tried to allay concerns about widespread disruption from TrumpCare by saying it would only impact a few. CBO confirmed the nearly 156 million people who get employer-sponsored insurance – roughly half the country – are also in danger when ACA consumer protections are rolled back. TrumpCare also eliminates the employer mandate, meaning many employers will drop health benefits altogether. CBO said “over time, fewer employers would offer health insurance because the legislation would change their incentives to do so.”
- “Americans will have lower premiums and deductibles”: CBO found, while premiums for some plans may decline as those with pre-existing conditions are segregated into underfunded high-risk pools, deductibles for a typical health insurance plan under TrumpCare would more than double for most. This is because TrumpCare incentivizes a shift to high-deductible plans that would cover an average of 65% of a person’s medical costs, versus an Obamacare plan’s average actuarial value of 72%.
- “ObamaCare is collapsing under its own weight”: Speaker Paul Ryan practically screamed crisis. But CBO found “the nongroup market would probably be stable in most areas” if Obamacare remains in place. The continuing uncertainty caused by the Trump Administration threatening cost-sharing subsidies, and its delay in the House v. Price litigation on subsidies another 90 days past bid deadlines, is creating a crisis of their own making.
CBO did this nation a huge service with its unblinking analysis of the horrors TrumpCare would wreak on millions of Americans and our healthcare system. Members of Congress who continue to “debate” this must be held to account, and this nightmare legislation should be scrapped entirely.
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