Today, you are probably seeing a slew of headlines that include the words “CBO score”. That’s because the Congressional Budget Office (CBO) released its report on the impact of the Senate bill to repeal and replace the Affordable Care Act. The bill in question, known as the Better Care Reconciliation Act of 2017, is the Senate’s version of the Affordable Health Care Act, which the House of Representatives passed in May. The Senate has been expected to vote on its health care bill this week.
After a CBO score is released, it becomes the prize in a tug of war of spin between politicians for and against the bill being graded. We thought it might be helpful to focus on what the CBO report actually says, and so we’ve pulled out three passages that might be particularly important to people with diabetes.
Passage #1 – “CBO and JCT* estimate that, in 2018, 15 million more people would be uninsured under this legislation than under current law—primarily because the penalty for not having insurance would be eliminated. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 22 million in 2026. In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increases in the number of people without health insurance. By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”
In English, please: A lot of people are going to voluntarily give up their health insurance next year if the new law is enacted. A lot of people are going to involuntarily give up their health insurance a few years after that because Medicaid won’t be available to them.
Why people with diabetes should care: Few people with diabetes are going to drop coverage early, but they may lose coverage later if they aren’t caught by the shrinking social safety net of Medicaid. You have to ask yourself what are the chances you might join the ranks of the uninsured.
Passage #2 – “Some people enrolled in nongroup insurance would experience substantial increases in what they would spend on health care even though benchmark premiums would decline, on average, in 2020 and later years. Because nongroup insurance would pay for a smaller average share of benefits under this legislation, most people purchasing it would have higher out-of-pocket spending on health care than under current law. Out-of-pocket spending would also be affected for the people—close to half the population, CBO and JCT expect—living in states modifying the EHBs** using waivers. People who used services or benefits no longer included in the EHBs would experience substantial increases in supplemental premiums or out-of-pocket spending on health care, or would choose to forgo the services. Moreover, the ACA’s ban on annual and lifetime limits on covered benefits would no longer apply to health benefits not defined as essential in a state. As a result, for some benefits that might be removed from a state’s definition of EHBs but that might not be excluded from insurance coverage altogether, some enrollees could see large increases in out-of-pocket spending because annual or lifetime limits would be allowed.
In English, please: Premiums on average will go down, but out-of-pocket costs could go up, especially if your state decides under the new law that it doesn’t want to require insurers to pay for pesky things like prescribed medicine.
Why people with diabetes should care: Increased out-of-pocket costs and lifetime caps are going to come down heavier on high-volume users of the health care system.
Passage #3 – “CBO and JCT estimate that, over the 2017-2026 period, enacting this legislation would reduce direct spending by $1,022 billion and reduce revenues by $701 billion, for a net reduction of $321 billion in the deficit over that period…The largest savings would come from reductions in outlays for Medicaid.”
In English, please: With this new bill, the federal government will cut spending by $321 billion over 10 years.
Why people with diabetes should care: it comes down to your perspective. If you feel the country’s deficit is an existential threat, then this is the bill for you. If you believe this bill is a real threat to your health, then you want it not to pass.
The CBO score has so far been not kind to Republican-led efforts to get the votes needed for this bill to pass the Senate. Since this score was announced, two moderate Republicans have signaled they will vote against the bill. Republican leadership has signaled that it wants a vote on the bill before Congress leaves for the July 4th recess.
If you’re a glutton for punishment, you can read the whole CBO report here.
*The Joint Committee on Taxation. The CBO and the JCT often put out reports together, but the CBO gets all the headlines.
**Essential Health Benefits
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