At least 21 million fewer Americans would have health-care coverage from 2020 to 2026 under the Senate Republicans’ latest plan to repeal and replace parts of Obamacare, according to an estimate by the Brookings Institution.
The number “likely underestimates the reductions in insurance coverage” because it doesn’t take into account difficulties states may face setting up their own health systems, said the nonprofit policy group, which has been supportive of the Affordable Care Act.
The Brookings estimate is the first look at what the bill, backed by Republican senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, would mean for millions of people covered under Obamacare by Medicaid or private plans. The estimate could add to concerns about Republicans’ last-ditch attempts to round up enough votes to get the bill on the Senate floor next week. One of the key GOP holdouts, Senator John McCain of Arizona, said Friday he will oppose the bill, dealing the proposal a major blow.
The Congressional Budget Office, Congress’s official policy analyst, has said it won’t have its own estimate for some time. A CBO estimate of a previous “skinny repeal” proposal projected that 15 million more people would be uninsured under that bill than under current law by 2026. That legislation, called the Healthcare Freedom Act, failed to pass the Senate.
Other independent reports have found that the legislation would cut tens of billions of dollars from states that expanded Medicaid to low-income people under Obamacare, and would also result in broad spending reductions compared with current law.
The Graham-Cassidy bill would take money used to fund coverage under Obamacare and turn it over to states, which would decide how to cover their citizens. Not all states would benefit: Those that expanded Medicaid under the ACA would lose federal funding while states that didn’t expand stand to receive extra billions.
The bill also eliminates a requirement that everyone in the U.S. have health-care coverage and moves Medicaid funding to a fixed, per-enrollee amount instead of paying for a set percentage of states’ costs. And states would be allowed to apply for a waiver to allow insurers to charge more for people with pre-existing conditions -- the center of heated criticism.
Pre-Existing Conditions
States haven’t been able to offer much detail yet on how they’d use the money. But some GOP governors who support the measure have signaled they’d consider options including how to cover people with pre-existing conditions.
In South Dakota, one of the 19 states that haven’t expanded Medicaid, the conversation would include how to create more competition and how to help people with pre-existing conditions afford coverage, Tony Venhuizen, chief of staff for Republican Governor Dennis Daugaard, said Friday. He pointed out that, before Obamacare, South Dakota had 17 private health insurers offering plans -- now down to a few -- and a successful high-risk insurance pool for patients with pre-existing conditions.