About 14 million people who have health insurance today won’t have it by the end of the next year.
Many of them will be young, healthy people as well as members of families with low incomes and people over the age of 60.
That’s the conclusion of a report released Monday on the Republican healthcare bill to repeal and replace the Affordable Care Act (ACA).
The report authors predicted the GOP plan would lead to 14 million more people being uninsured in 2018.
By 2026, 24 million more people would be uninsured than if the ACA, also known as Obamacare, remained in place.
Over the next decade the uninsured rate would rise from its current 11 percent to 18 percent, wiping out the gains made under the ACA.
Who would lose insurance?
Much of the initial spike in the number of uninsured would result from the repeal of the individual mandate.
Without the threat of the ACA’s penalties for not having insurance, some people would opt out of buying coverage.
Others, though, would give up coverage when their premiums increase.
And some people would lose coverage when their employer stopped offering insurance to workers. The Republican plan repeals the employer mandate to provide insurance as well.
A large number of uninsured would also result from the plan’s reduced funding of Medicaid, which was expanded under the ACA.
By 2026, 14 million fewer people would be enrolled in Medicaid under the Republican bill — accounting for more than half of the increase in uninsured people.
This includes people who are eligible now for Medicaid, and those who would have become eligible if more states expanded coverage under the ACA.
The CBO found that 95 percent of people who became eligible for Medicaid through the expansion would lose coverage by 2024, as federal funding to states decreases.
In addition, 15 percent of people who received healthcare services at Planned Parenthood would “lose access to care.” Most federal funds to Planned Parenthood cover services for people enrolled in the states’ Medicaid program, often people with low incomes.
In addition, the Republican bill would defund Planned Parenthood for a year.
Premiums would eventually fall … for some
Under the Republican plan, insurance premiums would rise in 2018 and 2019 as fewer healthy people — those with lower health costs — signed up.
Single people in the individual marketplace might see premium increases up to 20 percent.
Starting in 2020, the repeal of the individual mandate would be offset by other parts of the legislation, and premiums would drop. By 2026, they would be around 10 percent lower than under the ACA, according to the CBO report.
However, premiums would vary widely by income and age.
Under the Republican bill, insurers would be able to charge older people five times more than they do younger people.
At the same time, tax credits for older people would only be twice the size of credits for younger people.
As a result, the plan would raise premiums “substantially” for older Americans, and lower them “substantially” for younger buyers.
For example, a 64-year-old with an income of $26,500 in 2026 would pay $14,600 a year, compared to $1,700 under Obamacare.
But a 21-year-old earning $68,200 — 450 percent above the poverty line — in 2026 would pay $1,450 under the Republican bill, compared to $5,100 under the ACA.
Lower premiums for younger people might encourage more of them to sign up for coverage, something that the ACA had difficulty convincing them to do.
Federal deficit would drop
Over the next decade, the Republican bill would cut the federal deficit by $337 billion.
A large part of this would come from an $880 billion decrease in Medicaid spending over the next decade. This amounts to 25 percent less spending for the program by 2026 than projected under the ACA.
Repealing ACA subsidies would save $673 billion, although the Republican plan’s tax credits would cost $361 billion, according to the CBO report.
Defunding Planned Parenthood for a year would save about $157 million in 2017. But this would also lead to a $21 million increase in Medicaid spending for several thousand pregnancies, as women with low incomes lose access to family planning services.
Several Republicans have called the CBO’s estimates into question, saying future Republican legislation will affect these numbers. However, those plans have not been released yet.
Experts who monitor the CBO say they have found that its predictions are unbiased and “largely sound.”