Senate GOP's ACA Repeal Bill Would Knock 22 Million Off Insurance: CBO

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The Senate Republicans' bill to repeal and replace the Affordable Care Act (ACA) will result in 22 million fewer people having health insurance in 2026 compared with current law, the Congressional Budget Office (CBO) said Monday.

That number is a million shy of the estimate of 23 million people that the CBO estimated would be cut from the insurance rolls during that same period under the House version of the bill, known as the American Health Care Act. That bill passed the House on May 4. The Senate bill -- known as the Better Care Reconciliation Act -- that was scored Monday by the CBO is a revised version of the discussion draft released last week.

The Senate repeal-and-replace bill would also cut the deficit by $321 billion through 2026, which is $202 billion more than the reduction in the deficit under the House bill, the CBO said. The reductions include a $772 billion cut in Medicaid spending -- a little lower than the $800 billion Medicaid cut in the House version of the bill -- and $408 billion in reduced subsidies for individual enrollees in the health insurance exchanges. Those spending reductions are partially offset by $541 billion in tax cuts and $210 billion in reduced penalties collected from employers and the uninsured, as well as $107 billion in increased spending to help some enrollees reduce their premiums and for other purposes.

The Senate bill has many similarities to the House bill, including the use of per-capita caps to lower Medicaid spending (with an option for states to chose block grants instead), the repeal of the ACA's individual and employer mandates, and a provision allowing states to impose work requirements on Medicaid recipients. However, while the House bill would allow insurers to levy a 1-year premium surcharge to enrollees in the individual health insurance marketplace who had a gap in insurance coverage of at least 63 days, the Senate bill did not include that option.


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