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Congressional Budget Office review shows 23 million would lose coverage under health care repeal

By Dustin Pugel
Special to KyForward

The Congressional Budget Office’s (CBO) review of the health care repeal bill passed by the House weeks ago estimates that 23 million Americans would lose coverage, many low-income and older individuals’ health care costs would rise, and people with poor health would be left with unusable and unaffordable insurance options.

The American Health Care Act (AHCA) would unravel the healthcare gains Kentucky has experienced in the last three years and go beyond that by inflicting ongoing damage to the original Medicaid program.

Kentucky’s uninsured would dramatically rise

The main portion of the AHCA was left unchanged from the original version – the effective elimination of Medicaid expansion and a permanent and ongoing cut to traditional Medicaid called a per capita cap. This would result in 14 million fewer Americans covered by Medicaid. The 472,800 Kentuckians who gained coverage through Medicaid expansion would lose it, and the remainder of the 1.4 million children, seniors and people with disabilities covered under Medicaid are at risk of losing benefits, coverage and access to care.

The CBO score also predicts there will be six million fewer Americans covered through the individual market and three million fewer covered through employer coverage.

Plans would become more expensive for older Americans and most low-income people

For most people with lower incomes costs would rise as the bill abandons premium subsidies based on incomes in favor of less generous, age-based assistance. Older, low-income people are harmed even more so: the CBO estimates that for a state which does not accept a waiver under the MacArthur Amendment, a 64 year old earning $26,500 would see her premiums after tax credits rise $14,400, and in a state that did seek a waiver they would rise $11,900.

People with pre-existing conditions would be vulnerable to prohibitively high premiums

The new part of the healthcare bill allows states to waive insurer requirements so that premiums can be based on health history, and insurers would no longer be required to provide a basic suite of benefits. According to one estimate, 1.8 million Kentuckians have a preexisting condition, putting them at risk of prohibitively high insurance costs.

In addition, annual or lifetime limits on what insurers will spend on their coverage would be allowed to return, a practice that could leave the people who need care the most without usable coverage. The CBO says that individual insurance markets in states covering 1/6 of the population would become unstable, meaning people with health conditions may be unable to find coverage at any price.

Health care reform should move us forward, not cover fewer people

Kentucky’s uninsured rate was cut in half under the ACA, more than any other state. The result was more people receiving needed care and a big jump in provider revenue.

The AHCA doesn’t build on this success, it tears it down and through the per capita cap contained in the plan ends the Medicaid program as we know it. The latest CBO score is another piece in a growing mountain of evidence that the AHCA takes our healthcare system in the wrong direction.

Dustin Pugel is research and policy associate for the Kentucky Center for Economic Policy

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