CBO report contradicts Tillis on Trumpcare and pre-existing conditions

Carla Harmon
May 26, 2017

Erasing former President Barack Obama's health care law was a top promise of Donald Trump during his presidential campaign, and by congressional GOP candidates since its 2010 enactment.

And thus, almost all the talk since the new report came out has been about CBO's assessment of the individual insurance market changes that persuaded the House Freedom Caucus to climb onboard the Trumpcare train, along with the last-minute money thrown at high-risk pools for people with preexisting conditions that kept just enough "moderates" onboard to pass the bill.

Senate Majority Leader Mitch McConnell didn't offer an opinion, emerging from his shell to say that the CBO report was just a simple "procedural step" that would pave the way for the Senate to do its work. That could involve providing money to insurance companies so they can contain customers' costs, and perhaps retaining Obama's individual mandate, which imposes tax penalties on people who go uninsured. It also said the legislation would make coverage more costly, even unaffordable, for many people with costly medical problems.

Senate Republicans have been holding private meetings to narrow differences and produce their own health care package. Instead, he discussed a Trump administration report showing that premiums have grown in recent years and accused Democrats of trying to "blame someone other than themselves for the failures of Obamacare". "Unless you're a healthy millionaire, Trumpcare is a nightmare", said Senate Minority Leader Chuck Schumer, D-N.Y.

The report was released just weeks after Republicans narrowly passed a health bill through the House of Representatives. "It's time for Republicans to finally wake up an realize the basic fact that undermining our nation's health care system, imposing an age tax on seniors and eliminating protections for those with pre-existing conditions will not improve health outcomes in this country".

In some regions, people with pre-existing medical conditions and others who were seriously ill "would ultimately be unable to purchase" robust coverage at premiums comparable to today's prices, "if they could purchase at all", the report said.

The report said older people with lower income would disproportionately lose coverage.

The Center for American Progress estimates that over the next decade, 57,000 people on Medicaid in ME would lose coverage, as well as 47,000 people in the individual market.

The reforms would reduce the federal deficit by some $119 billion-$32 billion less than the estimated net savings in the previous version of the bill, CBO reported. The extra $8 billion funding added to the House bill to subsidize them would not be "sufficient to substantially reduce" their "large increases" in premiums, the CBO said. But if Republican "moderates" ultimate accede on Medicaid, which they very well may so long as their states get sweet transition deals for ending the ACA expansion, then Democrats need to make a lot of noise on behalf of the 14 million people at risk of losing benefits, and the many millions more that will be endangered eventually if the GOP succeeds in its long-term goal of gradually handing the Medicaid population over to the states.

But the CBO also acknowledges that its analysis includes some uncertainty, in part because the AHCA would allow states to get waivers that would exempt their insurers from many Obamacare coverage rules.

The CBO looks to states' past behavior to predict whether they would take up a waiver from the essential health benefits requirement and the community rating protection.

While some people would see their costs rise, Republicans say healthy people will see their premiums reduced because they won't be forced to accept plans that cover services they don't need.

There is also the possibility that the GOP healthcare bill will destabilize insurance markets in certain states. Citing markets where insurers have left or sought huge premium increases, Republicans have repeatedly said the statute must be dismantled because it is in a death spiral.

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