Thursday morning Senate leaders published their plan to
replace the Affordable Care Act and modified it earlier today. The Senate
proposal closely follows the bill
that passed the House in May. According to today’s Congressional
Budget Office’s report, the Senate bill would increase the number of
uninsured Americans by 15 million next year and 22 million by 2026, including
15 million losing Medicaid. Increases in the uninsured rate would cross income
and age categories, but would fall hardest on low-income and older Americans. The
Senate bill would reduce Medicaid funding to states more than the House bill
but spreads those cuts out over three years. Under the Senate bill, Medicaid
funding to states would drop by $772 billion by 2026. According to the CBO,
“With less federal reimbursement for Medicaid, states would need to decide
whether to commit more of their own resources to finance the program at
current-law levels or to reduce spending by cutting payments to health care
providers and health plans, eliminating optional services, restricting
eligibility for enrollment through work requirements and other changes, or (to
the extent feasible) arriving at more efficient methods for delivering
services.” CBO also estimates that the Senate bill would increase private
insurance premiums by 20% on average next year but lower them beginning in 2020
when plans could be less generous. By 2026 premiums would be 20% lower than
under current law, but because of less generous plans, consumer out-of-pocket
costs would be higher. CBO predicts that some people will “experience
substantial increases in what they would spend on health care” depending, in
part, on whether states choose to waive Essential Health Benefit standards in
current law.
(Update added 6/30/17) A subsequent extended CBO analysis finds
that under the Senate bill federal Medicaid spending would decrease even
farther in the future. Analysts estimate that under the Senate’s bill, federal
spending on Medicaid would decrease by 26% by 2026 and 35% by 2036.
The Kaiser Family Foundation has published a side-by-side
comparison of ACA repeal and replacement proposals.
