CBO analysis estimates 23 million Americans will lose health coverage under Republican House-passed AHCA

The American Health Care Act will cause 23 million Americans to lose their health coverage and nearly double the projected number of uninsured individuals to 51 million by 2026, according to the independent, non-partisan Congressional Budget Office.

Read more: List of 217 House Republicans who voted to repeal the Affordable Care Act

H.R. 1628, the bill passed by House Republicans earlier this month to repeal and replace Obamacare, is now being considered by the Senate.

“The report makes clear Trumpcare would be a cancer on the American health care system, causing costs to skyrocket, making coverage unaffordable for those with pre-existing conditions and many seniors and kicking millions off of their health insurance,” said Senate Democratic Leader Chuck Schumer. “This report ought to be the final nail in the coffin of the Republican effort to sabotage our health care system.”

Read more: House Republicans rush through Affordable Care Act repeal

According to the CBO’s analysis, AHCA would slash health care spendings by $1.1 trillion and give $992 billion in tax cuts to modestly reduce the deficit by $119 billion over 10 years.

Medicaid would bear the brunt of most of the spending cuts, amounting to $834 billion, as a result of the “termination of enhanced federal matching grants” and the switch to block grants or “per capita-based cap on Medicaid payments” to states. The CBO estimated that 14 million Americans would be enrolled in Medicaid as a result of the bill.

The AHCA would reduce subsidies that help low-income and middle-class Americans buy health insurance in the individual market by $276 billion and replace those subsidies with more limited tax credits.

The bill also contained $992 billion in tax cuts, of which $644 billion were attributed to the repeals of the surtax on net investment income, annual fees imposed on health insurers, and “income threshold for determining tax deduction for medical purposes”.

“The basic frame is hundreds of hundreds of billions of dollars of tax cuts for the most fortunate in America, and hundreds and hundreds of billions of dollars in Medicaid cuts for the most vulnerable,” said Sen. Ron Wyden (D-Oregon).

In addition to low-income Americans, Wyden said families with special needs children or parents in nursing home care would be severely impacted by the steep Medicaid cuts under AHCA.

“These Medicaid cuts are going to hit American communities like a wrecking ball, and the pain is going to be felt throughout the ages,” said Wyden.

And while House Republicans repeatedly claimed that the revised AHCA still would cover people with pre-existing health conditions, the CBO’s analysis pointed out that may not be true in practice in states that opt to waive the “essential health benefits” or health status (or “community rating”) requirements.

In other words, states can waive requirements and allow insurers to discriminate against Americans with pre-existing conditions, such as diabetes, heart disease, and cancer, and charge them much higher premiums.

“[P]eople who are less healthy (including those with pre-existing or newly acquired medical conditions) would ultimately be unable to purchase comprehensive non-group health insurance 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,” according to the CBO.

(The AHCA allocated just $8 billion over 10 years to help individuals with pre-existing conditions offset higher premiums in states that waive the “community rating” requirement.)

“[T]his CBO score says…that these high risk pools that the House conceived do not work. The CBO score…says that if you are an individual with a pre-existing condition in a state that uses the waiver, you will not be able to buy insurance,” said Sen. Chris Murphy (D-Connecticut). “So this whole idea that the House has set up a separate way to deal with people with pre-existing conditions is now exposed as a fiction by CBO. If you’re sick, if you’ve ever been sick in this country, you’re now at risk of losing your health care.”

Read more: Reactions from health care & patient advocacy groups to the House GOP’s Affordable Care Act replacement bill

And even individuals who do not have a pre-existing condition may see “increases in their out-of-pocket costs” by “thousands of dollars per year” in states that waive the essential health benefit requirements, according to the CBO.

The CBO noted, in particular, that pregnant women who purchase insurance in the individual market could face “substantially higher out-of-pocket health care costs” – by more than $1,000 a month – for maternity care.

In addition to children, women, and people with pre-existing conditions, the CBO found that a disproportionate number of older Americans – between the ages of 50 and 64 “with income of less than 200% of federal poverty level”, which in 2017 amounted to $24,120 – would lose their health coverage under the American Health Care Act for two reasons.

One, the bill would “allow insurers to charge older people five times more than younger people beginning in 2018”. And two, “net premiums would be much larger” for older people with lower income under the bill’s tax credit scheme to replace the Obamacare subsidies.

“What this score shows is monstrous, mounting costs – skyrocketing financial costs, catastrophic human costs, unconscionable moral costs,” said Sen. Richard Blumenthal (D-Connecticut), who called the AHCA a “horror show”.

Schumer urged Senate Republicans to “reject” the House-approved health care bill and “work with Democrats to fix our health care system, instead of pulling the plug on it.”

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Transcript: Sen. Chuck Schumer’s remarks on the CBO score for the House-approved American Health Care Act

Transcript: Sen. Patty Murray’s remarks on the CBO score for the House-approved American Health Care Act

Transcript: Sen. Ron Wyden’s remarks on the CBO score for the House-approved American Health Care Act

Transcript: Sen. Bernie Sanders’s remarks on the CBO score for the House-approved American Health Care Act

Transcript: Sen. Richard Blumenthal’s remarks on the CBO score for the House-approved American Health Care Act

Transcript: Sen. Chris Murphy’s remarks on the CBO score for the House-approved American Health Care Act

Transcript: Q&A w/ Senate Democrats on the CBO score for the House-approved American Health Care Act