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At least 15 million people risk losing health coverage under the Republican plan, according to one estimate. (Photo: Thomas Altfather Good/flickr/cc)

Even Without CBO Score, the Republican Healthcare Plan Gets Bad Marks

Multiple American Healthcare Act (AHCA) analyses show millions losing coverage while costs increase for vulnerable Americans

Deirdre Fulton

As the Trump administration continued on Friday to downplay a forthcoming cost analysis of the GOP's healthcare plan, independent assessments of the proposal revealed the likelihood of large coverage losses and cost increases to hit voters who supported President Donald Trump the hardest. 

The Congressional Budget Office (CBO) is expected to release its report on the American Healthcare Act (AHCA) on Monday. In advance of that, top administration officials including press secretary Sean Spicer have been "questioning the agency's track record," in what some described as "a preemptive effort to undermine faith in the agency's assessment, which—when it finally appears—is unlikely to validate GOP boasts that their plan will provide better access to care."

Health and Human Services Secretary Tom Price joined the chorus on Friday morning, telling "Fox & Friends" that the CBO has "been woefully underperforming when it comes to evaluating health systems. And that's not because they're bad folks. It's because it's challenging stuff."

But should the CBO report indeed reflect poorly on AHCA, that assessment will be supported by separate analyses of the legislation that came out this week. 

A report from the Center for Health Policy at the Brookings Institution and the University of Southern California's Schaeffer Center for Health Policy and Economics released Thursday drew upon prior CBO estimates and analysis to assess how CBO will likely expect this legislation to impact insurance coverage.

Pointing to widespread "coverage losses associated with curtailing federal funding to Medicaid expansion states" in addition to other factors, it predicts the CBO "will likely estimate that at least 15 million people will lose coverage under [AHCA] by the end of the ten-year scoring window. Estimates could be higher, but it is unlikely they will be significantly lower."

What's more, according to data journalist Nate Cohn of the New York Times, the system of tax credits established under the GOP plan leaves rural, older, and white working-class voters—many of whom voted for Trump—the most financially vulnerable.

Citing data from the Kaiser Family Foundation and the Cooperative Congressional Election Study (CCES), a large survey of tens of thousands of Americans on healthcare and voting, Cohn reported Friday:

[T]he Republican plan offers less assistance to older and lower-income Americans, especially in rural areas, according to the Kaiser data. These groups generally backed Mr. Trump. Most of all, President Trump's white working-class supporters often make enough money to be ineligible for Medicaid, but not enough to afford costly health insurance that might even become more expensive under the Republican plan.

The plan would hit older and rural Americans hardest because it wouldn't provide a larger tax credit to people with more expensive plans. Older Americans pay the highest premiums, and the law would allow insurers to raise premiums for older customers even further.

And Cohn's analysis didn't even take into account the direct impact on those benefiting from the Affordable Care Act's (ACA) Medicaid expansion—though Cohn notes that "Trump led by 49-46 percent among Medicaid beneficiaries in the nine red expansion states that have voted Republican in the last two presidential elections."

Reporting on Cohn's analysis for the Washington Post, Greg Sargent said the numbers leave "little doubt" that Trump "scammed many of his working-class supporters."

"Trump strongly indicated" to those voters "that he would not adopt a typical Republican's ideological stance on healthcare that would leave many of them stranded," Sargent wrote. "But now he has."

And he has done so while handing a giant tax break to wealthy individuals and insurance and drug companies and greatly expanding tax-sheltering opportunities for high-income people through health savings accounts (HSAs), as the Center on Budget and Policy noted in one of several AHCA analyses it published this week. Those changes, the group noted, come at a cost of almost $600 billion.

"At the same time," the center's Chye-Ching Huang wrote Wednesday, "the plan would seek to offset the cost of these windfall tax breaks by ending the ACA's Medicaid expansion, radically restructuring the entire Medicaid program by converting it to a per capita cap, and dramatically scaling back the subsidies that low- and moderate-income families use to purchase affordable healthcare, as well as other coverage changes that would undermine the health and financial security of millions of households."

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