CBO Reaffirms Just How Cruel GOP Health Care Bill Really Is

Today, the Congressional Budget Office released its score of the White House's revised version of the Affordable Care Act repeal bill, and the score confirms what we knew: This bill would devastate health care across America. It would leave millions of people uninsured, increase premiums and deductibles, and prevent millions of Planned Parenthood patients from getting essential health care at their chosen provider.

The American Health Care Act is simply the worst legislation for women’s health in a generation. This bill cruelly slashes Medicaid — which 20% of reproductive-age use — while prohibiting people with Medicaid coverage from getting health care at Planned Parenthood.

The fact is, one in five women in America has relied on Planned Parenthood. Their health care shouldn’t be subject to Donald Trump and Paul Ryan’s extreme agenda. The Senate must reject this bill.

 

---

Related:

• Top 3 Things You Need to Know About the CBO Score on the “Defund” Planned Parenthood Provision, March 14, 2017
• Five Must-Know Facts About the ACA Repeal Bill, March 23, 2017
• Ignoring Stark Numbers from CBO, House Budget Committee Advances Bill Jeopardizing Health Care for Millions, March 16, 2017

  ---

   

The CBO score highlights several key points regarding the far reaching loss of health care coverage prescribed by the AHCA:

• CBO confirms that women will lose access to maternity coverage and other critical health care. In fact, CBO expects that states that previously did not cover benefits, such as maternity care and mental health services, would again stop ensuring coverage for those services. For instance, CBO notes that before the ACA, only 18 states mandated coverage of maternity care in the nongroup market before 2014.

• CBO says this bill will result in pregnant women being charged thousands of dollars more for insurance. For instance, CBO confirms that instead of maternity care being covered by insurance, many women will have to buy a maternity "rider" if they want care -- at $1,000 per month. Furthermore, CBO states: “out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for those in need of such coverage.”

• CBO says that at least half of states will waive protections for people with pre-existing conditions -- allowing people who are or have been sick to be charged significantly more for insurance.

 

Key takeaways from the CBO score of the ACA repeal bill:

1. AHCA would still result in a dramatic increase in the number of people who are  uninsured.

The CBO is now estimating that 14 million people will lose coverage by 2018 and 23 million people will lose coverage by 2026 under the version of the bill that passed the House. By 2026, an estimated 51 million people under the age of 65 would be uninsured (compared to 28 million who would lack insured under current law).

• Importantly, this new score reflects the loss of coverage resulting from the last minute amendments to the bill, whereby states can waive protections that prevent people with pre-existing conditions from being priced out of insurance coverage. In these states,  people with pre-existing conditions would have increased premiums and “ultimately not be able to purchase comprehensive” health coverage.

• This reduced access will impact  those who need coverage the most, such as women living with HIV, breast cancer, diabetes, or other chronic illnesses. This will also impact women who have been pregnant and women or individuals who have experienced domestic violence.

• AHCA would be a huge step back from the gains made under the ACA which has brought the uninsured rate to an all-time low. Specifically, under the ACA, 22 million people have gained coverage. Approximately 9.5 million women have gained coverage. The uninsurance rate for women of reproductive age has fallen 36 percent.

• AHCA harmful policies will overwhelmingly harm African-Americans and Latinx. Under the ACA, the uninsured rate for African-Americans has declined 11.8%, meaning that approximately 3 million African-American adults gained coverage. The uninsured rate for Latinx declined 11.3%, meaning that approximately 4 million Latinx adults gained coverage.

 

2. AHCA would dramatically increase the cost of insurance for people across the country.

The CBO is now estimating that premiums , are expected to increase by 20 percent in 2018 and another 5 percent in 2019. This increase in costs will happen when AHCA also significantly reduces the amount of financial assistance available to purchase coverage.

• Following the initial analysis, independent reports estimated an average enrollee purchasing a plan could expect to see her/his cost increase $3,174 in 2020 and low-income people would see cost at $4,815 the same year - these costs would be even higher in some parts of the country.

• The CBO score confirms that under current law, most people are insulated from increasing premium costs -- and AHCA cannot make that same guarantee.  Under the ACA, the average American is able to find an insurance plan on the Marketplace for under $75 a month with tax credits. Under the ACA, even as premiums have risen, enrollees were insulated from the rising costs. For instance, enrollees eligible for tax credits on average saw only a $4 per month increase in 2016, and a $1 per month premium increase at the close of 2017.

• The increased costs of care would disproportionately impact women, particularly women of color, given the inequities in earnings for women. Subsequently, AHCA will exacerbate existing health disparities. People of color already report less confidence in being able to afford care.

 

3. CBO notes that needed access to health care services, such as maternity care, would depend on where you live.

CBO estimates that one-sixth of the population would reside in an area where the non-group market would start to become unstable beginning in 2020, resulting from states being permitting to waive community rating and essential health benefit requirements.

• CBO also estimated how premiums would be impacted in states that have been granted waivers for community rating and EHBs. They predict that about half of the population resides in states that would request a waiver. In the states with a waiver, plans would, as expected, begin to cover a smaller percentage of expected health care costs.

• CBO also finds that people with pre-existing conditions would have higher costs and be less likely to afford care. We know that pre-existing conditions can include a range of health conditions, such as breast cancer and HIV, but also insurers can deem as a “pre-existing” condition pregnancy, C-section, or domestic violence.

• CBO notes that before the ACA only 18 states mandated coverage of maternity care in the nongroup market before 2014. It is expected that states that previously mandated fewer benefits would be more likely to apply to modify the EHBs to again restrict coverage.

• CBO explicitly states that pregnant women would likely face substantially higher out-of-pocket health care costs or see the scope of benefits narrowed. For example, maternity benefits could be sold as a rider by insurers in states that do not include maternity care, which could cost more than $1,000 per month.

 

4. As the previous CBO score estimated, the “defund” Planned Parenthood provision targets Planned Parenthood exclusively

This would result in reduced access to care for patients who live in areas where Planned Parenthood is the only health care option or where Planned Parenthood serves low-income populations. (CBO has not changed that assessment in this updated score.)

• Fifty-four percent of Planned Parenthood health centers are in health professional shortage areas, rural or medically underserved areas. The report stated that, “The people most likely to experience reduced access to care would probably reside in areas without other health care clinics or medical practitioners who serve low-income populations. CBO projects that about 15 percent of those people would lose access to care.”  

• CBO is totally clear that the provision singles out Planned Parenthood. It states: "CBO expects that, according to those criteria, only Planned Parenthood Federation of America and its affiliates and clinics would be affected.” This undermines proponents’ claim that the provision does not violate the Byrd Rule because it affects a “class of providers,” and not just Planned Parenthood. Thus, this CBO analysis confirms that the purpose for including the “defund” Planned Parenthood provision in the ACA repeal bill is not budgetary. Instead, it is to advance the political goal of preventing Planned Parenthood health centers from participating in the federal Medicaid program. It would appear that this provision violates the Byrd Rule, since the Byrd Rule stipulates that if a provision’s budgetary impact is “merely incidental” to the non-budgetary components of the provision, it should not qualify for reconciliation in the United States Senate.

• CBO estimates that “defunding” Planned Parenthood for one year would result in $156 million less in direct spending from the federal government over 10 years. This is a result of not providing Medicaid reimbursements to Planned Parenthood coupled with increased spending for Medicaid services for patients who would have reduced access to care. This is significantly less than the $235 million in savings CBO estimated for the same provision in 2015. Of note, CBO has also previously estimated that permanently defunding Planned Parenthood would actually cost the federal government $130 million over ten years.