CBO Score for Senate Healthcare Bill; A Lot of Implications

CBO report on Senate Healthcare Bill
via Twitter, THZ library

The Congressional Budget Office, which many of us had never heard of before this year, is making headlines again. This time, it has released its analysis of the Senate’s answer to a repeal/replace/improve Obamacare. 

The CBO is a nonpartisan number crunching office. 

The number most were looking for with this report is how many people would be predicted to lose insurance under the Senate’s proposal. The House’s version of the bill was initially reported to eventually cause 24 million people to lose insurance or access to insurance, but that number was later dropped to 23 million. 

The CBO predicts that that number will be 22 million with the Senate bill. That number is expected by 2026 with premiums for those with insurance climbing at first but eventually falling. He report estimates that premiums would climb 20 % in 2018 and 10 % in 2019, though by 2026 it predicts most would drop by 20%. 

Aimed at reducing the penalties that Obamacare includes to mandate insurance, this version of the bill would force a 6-month waiting period on anyone who lets insurance lapses for more than 63 days. This is in stead of the House bill’s proposal to allow a 30% premium increase from insurance providers for anyone who went uninsured for too long. Chuck Schumer, the Democratic Senator from New York, was quoted in The New York Times: “Being denied critical and potentially life saving health care for six months is not a fair punishment for someone who is a few hundred dollars short on insurance payments because they lost their job and finances are unexpectedly tight.”

The 22 million predicted to lose insurance by 2026 come mostly because of Medicaid rollbacks, breaking one of several promises made by President Trump as a candidate and since he’s taken office. 

With the Affordable Care Act currently in place, by 2026 28 million people would lack insurance specifically under Medicaid. Medicaid rollbacks by the Senate’s bill would mean that 49 million people would lack insurance. 

Because of these Medicaid rollbacks predominantly, the Senate version of the bill would reduce the deficit by an estimated $321 million, compared with an estimated $119 million from the House bill. That number was required to increase under Senate rules so that the bill could be handled under budgetary Senate procedure and not require a 60 vote majority to pass. 

Some Senate Republicans have already been vocally opposed to the bill, with moderates like Susan Collins of Maine opposing the cuts to Medicaid as well as the temporary defunding of Planned Parenthood, and others like Rand Paul stating that it does not go far enough to repeal Obamacare. 

Planned Parenthood receives 40% of its operational budget from the federal government. It serves 2.4 million people each year and 75% of those people are at or below 150% of the national poverty level. That year marker comes from the finding that cutting funding to Planned Parenthood for even that long would lead to significant increases in medical costs because of the people who would lose access to birth control as well as cancer and other life-saving screenings through Planned Parenthood. The number of births under Meidcaid, or from those unable to afford insurance would increase, causing hospitals and governments to have to take on the costs, which was one problem Obamacare sought to minimize with universal healthcare access. 

In addition to Republican Senators opposing the bill, which was written behind closed doors in suspicious secrecy, the American Medical Association released a statement on Monday: “Medicine has long operated under the precept of primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels.” the A.M.A. is the country’s largest organization of physicians. 

Insurance provider Anthem responded to the bill optimistically, saying that it would improve the individual market. 

Senator Ron Johnson of Wisconsin, one of five Republicans who has come out in opposition of the bill as it stands, accused Senate Republican leadership of ‘jamming it through” in a radio interview Monday. That phrase is all-to-familiar in the healthcare debate, as the Republican narrative repeated it continuously about the Affordable Care Act, which took approximately a year and a half to pass and included public debates and hearings, contrary to the Senate and House proceedings thus far in their efforts to replace it. 

Senate Republican leadership is still pushing for a vote on the bill by the end of this week, hoping for passage prior to the July 4th recess when Senators would likely face constituent outcry, protest and pressure as their House counterparts did prior to their own bill passing. 

The Senate’s bill would no longer require people to have insurance and would provide tax credits to help people buy insurance on an individual market. It would do away with most of the taxes Obamacare imposed, particularly those on those with the highest incomes as well as on health care companies, both of which had strong lobbying representation in the behind-closed-doors bill-writing process led by Majority Leader Mitch McConnell. 

The rollbacks on Medicaid would seemingly go further than merely repealing the Medicaid expansion from Obamacare by also capping the amount of federal contributions to Medicaid and placing the onus of funding on State governments. The federal government would spend an estimated $772 billion less on Medicaid in the next decade. 

That along with other provisions in the Senate bill could cause seniors to have to pay up to 5 times as much as younger people for insurance, a number which Obamacare capped at 3 times as much. 74 million people are estimated to currently have health insurance through Medicaid, 11 million of which are specifically attributed to Obamacare’s Medicaid expansion. 

2/3 of people in retirement homes, or 63%,  are reportedly covered by Medicaid; that’s 1.4 million elderly people.   7 million seniors in general rely on Medicaid as well. Additionally, it is estimated that in at least 24 states, 50% of all births are covered by Medicaid in some way. 

Without access to insurance, a problem that was becoming astronomical prior to the Affordable Care Acts’ passage close to a decade ago, people, families and societies suffer; and so does the economy.

According to the National Academies Press, without insurance an estimated 18,000 people die prematurely. People who are sick forego healthcare until their situations are far more dire than they needed to be, leading to increased deaths, higher likelihoods of epidemics, and worst outcomes overall. People are less likely to receive preventative medication, screenings and diagnoses. Individuals and families, and therefore the economy as a whole, are less likely to be financially secure because of out-of-pocket or unaffordable healthcare costs that can lead to bankruptcy, debt, or the inability to pay for other necessities. Communities with high numbers of uninsured people face high risk of increased taxation, reduced healthcare availability and exposure to otherwise preventable diseases. the NAP states: “The Estimated benefits in terms of the value of healthy life years gained by providing coverage to those currently uninsured are likely greater than the incremental societal costs the additional health care services that they would receive if insured.” Those benefits are both societal and economical, according to NAP.

A paper released in the early 2000s by the Institute of Medicine Committee on the Consequences of Uninsurance states: “Health care services used by uninsured people often are uncompensated in part or whole, resulting in costs to providers, communities, and society, as well as being a source of financial stress, anxiety, and possibly shame for recipients. The burden of uncompensated care is distributed widely and unevenly across providers and sponsors…uncompensated care costs may beget additional external costs in the forms of higher local taxes to subsidize or reimburse uncompensated care, diversion of public funds from other public programs, and reduced availability of certain kinds of services within communities.” 

These are the types of issues Obamacare sought to combat; if the Congressional replacement or amendments to Obamacare lead to more uninsured people with less access to healthcare or the inability to pay for their own healthcare costs, damage could be done to local communities and economies, as well as the country and the national economy as a whole. 

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