May 3, 2017 (San Diego) The Republican House leadership says that they have the votes to pass the repeal and replace of the Affordable Care Act (ACA), and replace it with the American Health Care Act, dubbed Trumpcare. This new version of the bill has yet to be scored by the Congressional Budget Office. So we are going to go from the previous score and make some assumptions.
CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.
Later, following additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program, the increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026. The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.
So what is the problem with this? None of us have seen the bill. Which incidentally was one of the complaints from now Speaker Paul Ryan He even demanded that the ACA be scored, as fast as possible by the CBO. Now we are facing a situation when the House will be voting on the repeal of the ACA without a score for the current bill.
It is foolish to do this. We know millions will lose their insurance. We are talking about a sixth of the economy of the United States. So Republicans are not doing what they claim was not done for the ACA. This will also likely blow a hole in the budget since they will likely pair this bill with the tax bill in the wings.
Our view is that this will end the days when Republicans as a whole can speak of being fiscal conservatives.