The anxiously awaited CBO score of the AHCA – reflecting the last round of changes made to the bill before it was passed – was released yesterday afternoon. The nonpartisan scorekeeping office forecast the AHCA would cut the federal deficit by $119 billion over the next 10 years, down from $150 billion in the prior score. From a process perspective, the bill still easily passed the test to save at least $2 billion to qualify for consideration under a reconciliation process that is filibuster-proof by requiring only 51 votes in the Senate, not the typical 60-vote threshold.
What else changed in the report? There was a very small decrease in the projected number of uninsured, which had been 24 million over ten years and was revised to 23 million. That’s not much of a ROI for the additional $38 billion aimed at keeping people covered. The largest savings stem from reductions in Medicaid funding and from the replacing ACA’s subsidies for individual health insurance with new tax credits for individual/non-group health insurance.
Of particular interest to employers are the waivers that could be granted to states starting in 2020 allowing them more flexibility on age rating and essential health benefits. In scoring the bill, the CBO and JCT examined three general approaches states could take to implement H.R. 1628 and estimate that about half the population resides in states that would not request waivers regarding the EHBs or community rating; about one-third of the population resides in states that would make moderate changes to market regulations, and about one-sixth of the population resides in states that would obtain waivers involving both the EHBs and community rating. There’s a table showing the estimated impact on premiums by age group in states that would and wouldn’t obtain waivers in this Vox article, and the story isn’t good for older Americans. It’s not yet clear how, or whether, state waivers – which are targeted for individual and small group coverage – would affect employer-sponsored plans.
Politico summed it up best, “…the report highlights the central dilemma that Republicans are grappling with now — how to write a health care bill that preserves peoples’ coverage at a reasonable price, without resorting to government mandates and billions in federal spending. And it drops that problem right on the Senate’s doorstep.”