GOP plan would cause 15 million to lose coverage, report says

At least 15 million people over 10 years will lose coverage under the American Health Care Act, according to analysis by the Brookings Institution ahead of a Congressional Budget Office report expected to be released as early as Monday.

Because the Republican plan to repeal and replace the Affordable Care Act does away with the individual mandate, many healthy people would drop insurance coverage, the Brookings report said. This would cause individual market premiums to rise by 20 percent, it said.

[Also: Senate Republicans vote to repeal Obamacare, bill heads to House]

Ahead of the CBO's analysis of the Republican bill, Trump administration officials have been spinning former CBO figures as incorrect.

Health and Human Services Secretary Tom Price told "Meet the Press on Sunday, "CBO has been very adept in not providing appropriate coverage statistics."

White House Budget Director Mike Mulvaney told ABC on Sunday, according to the same report, "If the CBO was right about Obamacare to begin with, there'd be 8 million more people on Obamacare today than there actually are. So I love the folks at the CBO, they work really hard, they do, but sometimes we ask them to do stuff they're not capable of doing."

House Speaker Paul Ryan, who rolled up his sleeves to tout the new plan in a PowerPoint presentation last week, told CBS's "Face the Nation" on Sunday, "The one thing I'm certain will happen is CBO will say, 'Well, gosh, not as many people will get coverage.' You know why? Because this isn't a government mandate,'" according to CNN.

Republicans who favor the American Health Care Act have said Americans need relief from the high deductible plans of the ACA, while conservative members call it Obamacare Light and reject what they call the continuation of costly entitlement programs. 

[Also: Federal cost projection of ACA reduced by a third]

The Brookings Institution report, released Thursday estimated that six million people would lose individual coverage by 2026. This number would rise to 15 million as repeal of employer mandate would add another two million to the uninsured rolls and reduced Medicaid coverage would net another seven million. 

The new tax credit would be less generous for lower-income people, especially older Americans living in higher-cost areas, Brookings said. Many higher-income people would qualify for a larger tax credit, particularly young people living in low-cost areas. n

Fully eliminating subsidies would risk a near-complete unraveling of the individual market in a death spiral of healthy individuals dropping coverage causing premium increases that spur still larger coverage losses.

The GOP legislation would reduce the share of Medicaid costs that the federal government pays for low-income adults from 90 percent under the ACA to each state's regular Medicaid match rate, which averages 57 percent.

The legislation would allow states to continue receiving the enhanced match rate for individuals who are currently eligible until those individuals leave the program. However, relatively few people remain continuously enrolled in Medicaid for years at a time, according to the report.

As a result, in ten years, there will be little difference between  reducing the Medicaid match rate from simply eliminating the enhanced match rate entirely.

The Medicaid cap rate per beneficiary put forward in the new plan will not fund current cost of those needing coverage. States can fund the provision, reduce provider payment rates, reduce benefit coverage and curtail outreach.

Other provisions affecting private coverage including changes in subsidy structure, state grants and created a late enrollment penalty and regulatory changes are unclear, but are unlikely to substantially mitigate coverage loss, the report said.

Twitter: @SusanJMorse