CBO scores GOP ‘Obamacare’ repeal: 24 million would lose health care insurance (updated)


Just as anyone with even a rudimentary knowledge of health care policy had predicted, the Congressional Budget Office (CBO) today scored the GOP “Obamacare repeal” bill aka Ryancare Trumpcare, and finds that the Obamacare revision would reduce insured numbers by 24 million:

House Speaker Paul D. Ryan’s proposal to revise the Affordable Care Act would lower the number of Americans with health insurance by 24 million while reducing the federal deficit by $337 billion by 2026*, congressional budget analysts said Monday.

[This is dynamic scoring required by the Budget and Accounting Transparency Act of 2014 to make long-term budgetary effects appear better. See Paul Krugman on dynamic scoring, Selective Voodoo.]

UPDATE: The way the bill achieves the 10% lower average premiums has little to do with increased choice and competition. It depends on penalizing older patients and rewarding younger ones. According to the CBO report, the bill would make health insurance so unaffordable for many older Americans that they would simply leave the market and join the ranks of the uninsured. No Magic in How G.O.P. Plan Lowers Premiums: It Penalizes Older People.

The report from the Congressional Budget Office underscores the dramatic loss in health insurance coverage that would take place if the GOP health-care plan is enacted, potentially contradicting President Trump’s vow that the plan would provide “insurance for everybody” and threatening support from moderate Republican lawmakers.

Fourteen million people would lose health coverage next year alone, the report stated. Premiums would be 15 to 20 percent higher in the first year compared to the ACA, and 10 percent lower on average after 2026. By and large, older Americans would pay “substantially” more and younger Americans less, the report states.

No wonder Donald Trump does’t want the GOP plan to be called “Trumpcare.” White House: Don’t call it Trumpcare. This grifter and con man literally brands his name on every product imaginable, so how bad does this GOP bill have to be for him to say “sorry, no“?

The CBO report marks the beginning of a new phase in the debate over the week-old health-care bill, which is moving through the House on an accelerated timetable despite opposition from Republicans, Democrats and virtually every sector of the U.S. health-care industry. Conservative Republicans, in particular, have demanded changes to the measure in exchange for their support.

The White House has spent the last week engaged in a charm offensive aimed at bringing those conservatives on board, as well as an effort to discredit the CBO before it released numbers that might cast the plan in a negative light.

Ryan had predicted that the CBO would forecast a loss in coverage, but he suggested those affected would merely be exercising their choice not to buy health plans, a choice that is currently penalized under the ACA.

“CBO will say, ‘Well, gosh, not as many people will get coverage,’” Ryan said Sunday in an appearance on CBS’s “Face the Nation.” “You know why? Because this isn’t a government mandate.”

“It’s up to people,” he said. “People are going to do what they want to do with their lives because we believe in individual freedom in this country.”

When these young, healthy individuals who think they are invincible and don’t need health care insurance have an unexpected illness or accident and require medical care, hospitals will have to provide mercy care and you the taxpayer will wind up paying for them.

The same is true for the poor, for whom the GOP plan of a $4,000 tax credit will not be enough to pay for health insurance. Chuck Todd on Meet the Press used the Kaiser Family Foundation analysis overlaid with election results to demonstrate that Trump Voters Have Most to Lose Under Republican Health Plan (video).

UPDATE: Jeff Guo at the Washington Post has a simialr analysis. Losers in the GOP’s health plan? Some of the most pro-Trump places in America.

This does not even begin to address the GOP plan for cuts to Medicaid by block grants to the states and imposing a cap on federal assistance, while ending the Medicaid expansion under Obamacare. Many poor will have no  health coverage, and be forced to rely on mercy care at hospitals.

And if the hospitals that are providing mercy care at a level of government reimbursement that affects their profitability, these hospitals will be closing their doors and going out of business. All because the party of individual freedom does not believe in individual responsibility — TeaPublicans always want someone else to pay the bill for their “freedom.”

The GOP’s Obamacare repeal bill is not really about health care at all, but rather is about rescinding the taxes on the wealthy that pay for the subsidies to expand health care insurance coverage to individuals who do not have access to affordable health care. GOP’s health care tax swindle: Tax cuts for the rich financed by taking coverage from everyone else.

The ACA has increased coverage by 20 million to 22 million – almost half of those through the insurance markets the law created for people who cannot get affordable coverage through a job, and the rest through an expansion of Medicaid in 31 states and the District of Columbia.

According to the CBO, an estimated 52 million people would be uninsured in 2026, compared with 28 million who would lack insurance that year under current law.

* * *

“Right now, the date that’s in the bill is what the president supports,” White House press secretary Sean Spicer told reporters. “It’s not a question of negotiation,” he added.

On Friday, members of the House Freedom Caucus remained split over which elements more urgently needed change. Some called for changing the Medicaid timetable, while others urged the elimination of basic benefit requirements for health plans.

On Sunday, a growing group of conservatives was still threatening to kill the plan unless GOP leaders agreed to renegotiate parts of it.

* * *

In January, Trump had promised to replace the ACA with a plan that provided “insurance for everybody.”

“There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us,” Trump said in a Jan. 15 interview with The Washington Post.

“It’s not going to be their plan,” Trump said of people covered under the Affordable Care Act. “It’ll be another plan. But they’ll be beautifully covered. I don’t want single-payer. What I do want is to be able to take care of people.”

Sorry suckers! President Trump is the king of flip-flops:

At The Fact Checker, we award an Upside-Down Pinocchio when a politician shifts position on a policy without acknowledging that they did so.

Perhaps no politician is a bigger flip-flopper than Donald Trump.

* * *

No ‘cuts’ to Medicaid

When Trump started running for president, on several occasions he asserted that he would not reduce funding for Medicaid, the health-care program for the poor. It was a key part of his strategy to show that he was different from other Republican candidates. Here are some examples:

Screen Shot 2017-03-13 at 2.52.56 PM

In his announcement speech, on June 16, 2015, Trump said: “Save Medicare, Medicaid and Social Security without cuts. Have to do it.”

In an interview with the Brody File on the Christian Broadcasting Network on May 20, 2015, Trump declared: “I’m not going to cut Social Security like every other Republican. I’m not going to cut Medicare or Medicaid. Every other Republican is going to cut. Even if they wouldn’t they don’t know what to do because they don’t know where they money is. I do.”

Screen Shot 2017-03-13 at 2.56.18 PM

Granted, Trump does not appear to have made such promises about Medicaid since the early days of his presidential campaign. But it was in his announcement speech and he has never explained why he suddenly decided Medicaid was not worth mentioning again.

This is relevant now because the president has embraced the House Republican plan to replace the Affordable Care Act, which would change the financing of Medicaid to a block grant system.

Currently, Medicaid financing is open-ended, depending on how many people are enrolled and what care they need; states have to match a percentage of the federal funding. But under the proposal, states would just get a set amount of money per beneficiary, and thus would have to make up any additional costs. Most experts say this shift would put such a burden on the states that they would be forced to reduce Medicaid enrollment. (The left-leaning Center on Budget and Policy Priorities estimates that $116 billion in costs would be shifted to the states over 10 years, not including the ACA expansion.)

The GOP proposal also would effectively end the expansion of the Medicaid program, encouraged under the ACA, starting in 2020.

House Republicans have long pushed to convert Medicaid to a block grant system, so their proposal is not especially surprising. But clearly, this is a flip-flop on Trump’s previous pledges not to cut Medicaid — which he had even touted as an example as to why he was not like other Republicans. Yet now he is embracing a plan that reflects a key GOP goal.

The White House did not respond to a request for an explanation for Trump’s shift.

Grifters and con artists never explain their actions, they just walk away from their victims.

Contact your member of Congress and senators to tell them to kill this bill.

UPDATE:  The Washington Post editorializes, The CBO shows there is no rational justification for the GOP health plan, and the New York Times editorializes, Trading Health Care for the Poor for Tax Cuts for the Rich. That accurately sums it up.


  1. Martha McSally, who really wants to keep her job but votes with Trump 100%, posted this on Facebook:

    Rep. Martha McSally
    March 10 at 10:19am ·
    I have spent this week poring over the American Health Care Act and looking at how it will affect my constituents in Southern Arizona. I would encourage everyone to read the legislation at http://readthebill.gop and share your thoughts with me. You can send me an email here: https://mcsally.house.gov/contact/email

  2. The number of Americans getting workplace health insurance has plummeted in the Obama era, thanks to the stagnating economy and destructive Obamacare regulations.

    So, that means that all of the people getting health insurance have gotten it with borrowed money.

    Finally, deductibles have increased to over a $1000 per person. All of the stats on coverage provide a false picture. What is the percentage of covered health care expenses, not what is the percentage of people with worthless health insurance.

    It also means that the CBO estimates are worthless. Worthless economic projections already outdated by a stock market that values Trump policies completely differently than CBO’s corrupt computer models. If CBO’s models were correct, the stock market would have gone down by trillions after being surprised by Trump’s election. Instead, it has gone up by 3 trillion.

    If Trump can get rid of the Obamacare regulations, small companies can begin to grow and get into a position where they can both afford to add health coverage and to be competitive, have to add coverage. Simultaneously, it will put tax revenues back on track to where we can have more powerful high risk healthcare pools.

    Not one Republican staffer, not one Republican congressman appears to have the intellectual horsepower necessary to fight their way out of this jungle.

    • “All of the stats on coverage provide a false picture. What is the percentage of covered health care expenses, not what is the percentage of people with worthless health insurance.”

      Underinsurance is, in fact, a major problem that preceded the Obama Administration and the Affordable Care Act.

      I think it was 2009 when I had to apply for individual insurance. After filling out something like a 20 page application with almost my entire medical history, I did manage to get approved mainly because I had no pre-existing conditions. This policy was not cheap but it had a high deductible, a high co-pay, and a very high maximum out of pocket. It provided no preventative care whatsoever except for two doctor visits per year. My sister, who was self-employed and always had individual insurance, explained that what you are paying for was the insurance company’s lower negotiated price for services. She was right. Barring some catastrophe where you reached your maximum out of pocket, this policy was not going to pay for a thing. Also, your catastrophe would be a one shot deal because you would be cancelled for using the insurance and entered into the high risk group where you probably could not afford the premiums.

      The ACA has eliminated many of the problems with underinsurance. First, there is a minimum level of healthcare that insurance companies must cover, and where the ACA is very good is in preventative care. This makes sense, of course, because this is where there is the most benefit for the most people in all age groups can be achieved. And, second, no one can be excluded regardless of pre-existing conditions.

      Underinsurance becomes an issue for those who buy private insurance through the ACA when they need diagnostic healthcare and treatment. This is when the deductible, co-insurance, and the maximum out of pocket amount may exceed their ability to pay. And these amounts are set back to zero once per year. So these people would be faced with many of the same problems that preceded the ACA.

      I’m not the person with the answers. But it does appear that private insurance companies do not want to insure people from 50-64 because they hate paying their claims. They prefer higher profits for themselves.

      I believe the first step is to lower the Medicare age to 50. Then we have to look at who remains and determine if private healthcare insurance is necessary at all.

    • The CBO data is based on the data they’re given by congress. If congress gives them garbage, you get garbage out.

      And you love them when the data is going your way. Trump tweeted about the CBO and Obama dozens of times when it suited him.

      But let’s get into the really fun part of your post, Master of Sock Puppets.

      “The number of Americans getting workplace health insurance has plummeted in the Obama era, thanks to the stagnating economy and destructive Obamacare regulations.”

      At the end of the Bush years, we were losing 900,000 jobs a month. Can we assume that some of those included company healthcare?

      During the Obama years, we had 75 straight months of job growth and 11 million jobs created.

      Also under Obama, corporate profits hit record highs and the economy grew every year. The stock market you fantasize about in your dreams more than doubled.

      But somehow, you’re saying none of those 11 million jobs came with company health insurance, and people who had company health insurance lost it, while those same companies made record profits?

      I swear someday, Falcon9, you’re head is going to pop open and a prize is going to come out.

    • I have another story for you, John. Some older folks might remember that phase of employer provided health insurance when HMO’s were popular. I believe it was the early 90s, just before and around the time when Bill Clinton was campaigning on universal healthcare.

      Well, I was with the UCSD group in San Diego. So I’m having all this pain in my right shoulder and arm and got a referral to a see a nationally renowned orthopedic surgeon. He explained what he thought was wrong and the amount of physical therapy I needed. He also said that my insurance would not allow me to have more than one visit, but we could file it with Worker’s Comp and I would get what I needed. He also included me in one of his research studies.

      These were the years when clerical people working for insurance companies were arbitrarily denying or cutting back treatment. There was no reason, just simply we can so we will. Now I suppose if you presented with a bone sticking out of your skin they would have to fix it. But for health issues that were not so obvious, they would deny treatment.

      Think of that. Some clerk had the power to deny treatment prescribed by a nationally recognized physician. And this preceded Obamacare.

    • So, why do we want people getting insurance through their employer, anyway? Pretty much all economists I know of believe that our system of employer-sponsored coverage is an inefficient outgrowth of a system that began with workplaces responding to FDR’s wage freezes during the height of WW2 (whether that policy was good is one that I’m not going to attempt to address).

      “Finally, deductibles have increased to over a $1000 per person. All of the stats on coverage provide a false picture. What is the percentage of covered health care expenses, not what is the percentage of people with worthless health insurance.”

      No counterfactual was presented here to suggest that we collectively wouldn’t be in the same boat today in the absence of the ACA, and projections of healthcare expenditures I am aware of have suggested that while total spending has increased, the cost curve is starting to bend down a little bit. Of course, the best thing that Americans can do to lower the healthcare costs we face as a nation is to get off their butts and get to a healthy weight, and the next best thing we could do is make harder decisions regarding end-of-life care, but given that we’ve collectively decided to remain an obese nation and that we’re not unplugging grandma, we’re left with the consequences of those choices. A little bit of lobbying and regulatory capture by the big providers hasn’t helped, either.

      • “So, why do we want people getting insurance through their employer, anyway?”

        Employers, especially those who are large and profitable, can provide better health insurance at a lower cost. Even when this isn’t true, people tend to believe that it is. Many people with good employer insurance fear that a government sponsored plan covering everyone more or less equally will mean they will get less. John Huppenthal, for example, is terrified that he will be denied an MRI or a CAT-scan.

        But, of course, there is Medicare in which private insurance companies are allowed to participate (Medicare Advantage and Medigap), so it isn’t necessarily a one size fits all system.

        There is no reason for employer sponsored healthcare insurance except that certain beneficiaries want to keep it in place.

        • The only reason why that would be the case, of course, is because a larger pool more evenly spreads risk than does a small pool or no pool at all. Which is inherently why Medicare has such a low overhead; they have a massive amount of economies of scale, and they use that their bargaining power to push down prices, maybe even to the point where some providers balk at the rates. Well, except when it comes to prescription drugs, because Congress, in its *infinite* wisdom, decided that pharmaceutical companies should be exempt from Medicare’s ability to negotiate down prices for its beneficiaries.

          But I still want to hear Mr. Huppenthal’s answer.

  3. Leave it to a liberal to declare that giving people the freedom to decide something for themselves is an evil thing fraught with horrors in waiting for everyone. Allowing people to decide what is best for them is something liberals cannot allow because people may make the “wrong choice” (based on what liberals think is the right thing) and that simply cannot be allowed.

    Why on earth do you think that some people who choose not to take out health insurance going to the emergency room is going to cost more than people being forced to buy insurance whether they want it or not added to the cost of subsidizing millions of poor people to pay for their health insurance? Either way, the majority are being forced to pay for the minorities health care. I will take freedom anytime over the forced ministrations of a liberal nanny state any time. Particularly since liberals rarely get it right. Obamacare was a bad case of escalating uncontrolled costs rising out of site, with the deliberate intention of forcing the whole system to accept single payer government care.

    “In January, Trump had promised to replace the ACA with a plan that provided “insurance for everybody.”

    The GOP Plan does provide insurance for everyone, if they want it. It doesn’t force people to buy it, but it is there if they choose it. A promise kept.

    “Perhaps no politician is a bigger flip-flopper than Donald Trump.”

    C’mon! The guy hasn’t reached 100 days in office and yet you liberals like to claim he has failed this and failed that. I assume it is desperation, but it is very unseemly and loser-like. What’s funny is you haven’t laid a glove on him yet despite all your efforts. I am not a big supporter of Trump, but it is humorous watching liberals almost soil themselves trying to hurt him and him ignoring the hell out of you. But what is doubly pleasurable is the knowledge that, even in the worst case scenario if liberals manage to impeach Trump (a highly dubious project at the moment), it is good to know we have a great conservative waiting in the wings to take over. It’s a win-win for the GOP.

    • Regardless of what Trump said during the campaign, one of his major goals which he shares with Paul Ryan is just simply to repeal Obamacare. The Obamacare replacement is irrelevant to this goal.

      But since they have been forced into a replacement, they decided to make it a tax cut. Their replacement is essentially garbage because 1.) They never fully understood the ACA so they don’t know what they are replacing, and 2.) Providing affordable healthcare to all Americans is not their objective.

      For the so called GOP leaders, the repeal is about their hatred for Obama and destroying his legacy. Turning that into a tax cut is just dandy. And for someone like Paul Ryan, who is determined that poor people who are sick and/or old must die, repealing Obamacare is his first step in dismantling the entire social safety net.

      Paul Ryan wants to be the guy who can do what the Republicans have been trying to do since 1935 when Social Security was legislated. He wants to be the one who destroys or privatizes all Democratic social programs.

      None of this is new, of course. But what is less understandable is that the GOP seems relatively unconcerned about getting voted out of office. It is as though this is their big chance, they’ve waited for this for over 80 years, and they intend to get it done come hell or high water. It will be a fait accompli.

      But unlike invading Iraq, they can’t just make up lies about weapons of mass destruction. This is different. People react when you f*** with their rice bowl and they begin to act defensively. Even their supporters will protect their own rice bowl.

    • The above comment is misplaced. It was not intended as a reply to Steve. I need to pay more attention to what I’m doing…

      • Its okay, Steve likes the attention.

        This whole Obamacare/Trumpcare discussion is such crap. Choosing you own plan? This is insanity.

        The GOP crap about “choice” is the shiny thing they use to deter people from the real discussion. They make it seem like this is a Freedom!!!!!!!! thing when it’s not at all.

        The GOP and the Dems are all just protecting the insurance companies that own them. And an insurance company never put so much as a band aid on a boo boo let alone save a life.

        Oh, let’s see, well, plan A is cheaper but it doesn’t cover half the diseases people get in real life, and plan B has a lower deductible but it only pays for half of that $80,000 a year drug treatment you need….

        You don’t need a “plan”, you need healthcare. The End.

        Single payer. Saves corporations money, saves taxpayers money, gives us an equal playing field on trade with countries that already have single payer, healthcare as a percentage of GDP is lowered, and since everyone is covered there are more doctors and nurses and orderlies needed so we get more jobs, too.

        Problem solved. Now we can all go home.

        You’re welcome.

        • Yeah, I really hoped that after two years of the ACA being fully operational, that we were at least past these right wing talking points.

          What kind of person denies healthcare to another person?

          • “What kind of person denies healthcare to another person?”

            Steve. Paul Ryan. John Huppenthal. Beelzebub.

            People who listen to Nickleback.

          • All you liberals deny health care to anyone who dies of an infectious disease, all those people in cuba who have no access to CatScans or other modern medicine technology. To all the millions of people in the future who will die because we stick them with a healthcare system that no longer evolves, all those people who are dying and will die from alzheimers because you all shut down the drug development process. All those people who die from hospital infections because we don’t have good marketplaces in medicine.

            The list of people that are denied healthcare by liberals is in the billions both in the numbers and and incidents.

            The ability to see someone for a half hour in a white coat who will write you a prescription is not healthcare.

            Healthcare is an incident which both increases your probability of living and the quality of your life.

            The socialization of medicine reduces both. That’s why the death rate has gone up and life expectancy has gone down under Obama.

          • It was a liberal POTUS who lifted the shortsighted Cuba embargo.

            So you may want to revise your statement.

            And you do not seem to hold human beings in very high regard. How many times have you heard a story about someone who got into medical research after a loved one caught a disease?

            The profit motive is the least virtuous and most overrated motivator.

            Even the average corporate employee only cares about their paycheck to about 100K, after that, they want recognition, a good work environment, and other factors.

            Not everyone worships the dollar.

            Isn’t the love of money the root of all evil or something?

        • “The GOP crap about “choice” is the shiny thing they use to deter people from the real discussion.”

          I have often said that one thing leftists truly fear is giving people the right to decide for themselves. If they are allowed to do that, they might choose the wrong thing rather than choose what the left knows is the best thing for them. Better to force the correct thing down their throat forcefully than to take a chance they will make the wrong choice.

          “Single payer. Yaddah. Yaddah. Yaddah. Problem solved.”

          Like I said, better to force it down the people’s throats than to take a chance they will choose incorrectly.

          • Not having the “freedom” to see a doctor or have an illness treated because you do not have healthcare is not freedom of choice. It is tyranny.

            Emergency rooms are intended to stabilize patients with life threatening situations. They were not intended to be the source for diagnosis and treatment for those without healthcare.

          • “Not having the “freedom” to see a doctor or have an illness treated because you do not have healthcare is not freedom of choice. It is tyranny.”

            Tyranny?!? Really, Liza?!? You don’t think you are getting a little overwroght emotionally about it?

            One thing I have noticed when I hand out boxes of food at St. Mary’s Food Bank is that almost without fail, the people receiving these boxes have I-Phones or Android Phones clutched in their hands. Those phones are not cheap nor are the plans used to support them. Many times I am loading the boxes into the back of a new or late model car. In the United States, our definition of “poor” is very strange. Our “poor”, by statistical studies, have 1-1/2 automobiles, big screen color televisions, air conditioning, the ability to eat out 11 days of the month, etc., etc. Our “poor” would be considered well off in most places in the world.

            The point I am making is that there are choices to be made and, as a people, we don’t make very good choices. There is this sense of entitlement that says if you can’t afford it, that’s not your fault and the government should provide it for you. What makes this especially bad is we have a political party based on that philosophy. The democrats do not stress personal responsibility…in fact, they discourage it. That is the secret to thier success. There is a significant number of people who are looking for someone to take care of them and the democrats say they will. All you have to do is sit back, give them your money and they will do what is best for you. If you don’t agree with them, they will punish you. EVERY bit of legislation passed by democrats has punitive measures to be taken should you not conform.

            Now THAT, Liza, is tryanny.

          • Conservatives confuse insurance with healthcare.

            “Choosing” between a bunch of “plans” that do not provide full coverage healthcare is not healthcare.

            And I have often said that any man who starts a sentence with “I have often said” is about to say something ignorant and pompous.

          • “And I have often said that any man who starts a sentence with “I have often said” is about to say something ignorant and pompous.”

            You crack me up, Tom! That was funny! And more than a little true, too!

          • Yes, Steve, tyranny, by this defintion:
            cruel, unreasonable, or arbitrary use of power or control.”

            And how about that welfare Cadillac, Steve? You left that out, or is that too 1960s/70s? The cell phones and the TVs are the new welfare Cadillac?

            I’ve heard it all before. Didn’t impress me then, and it doesn’t now.

            You quite obviously would prefer that people have absolutely nothing before they get one dime of public assistance. Try living without a phone or a television or a computer or any access to information.

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