The House votes on the American Health Care act on Thursday, a bill that would undo President Barack Obama’s signature policy achievement as president, the Affordable Care Act, a.k.a Obamacare.
New changes have brought in support from some moderate Republicans. A federal risk-sharing plan, which provides some backup insurance for states to help stabilize high-risk coverage, and an extra $8 billion in funding over five years to help cover people in high-risk pools with pre-existing conditions have been added as amendments. For the Freedom Caucus representatives dissenting from the right, an amendment was added to allow states to get a waiver letting insurers charge more to people with pre-existing conditions, potentially putting their insurance out of reach.
The AHCA, however, goes to a vote in the House unscored by the Congressional Budget Office, as Republicans hurry to present a victory to President Trump before the House’s 11-day recess begins Friday.
Without a score, many argue Congress is voting blind. “You cannot justify voting for healthcare reform without knowing the cost,” Maya MacGuineas, president of the Committee for a Responsible Federal Budget, tweeted early Thursday. But the bill is largely unchanged from the previous AHCA that was yanked at the eleventh hour by Speaker Paul Ryan, who did not have the votes to ensure the bill’s safe passage. That bill was evaluated by the CBO.
The CBO’s score was devastating. The report found 24 million more people would likely be uninsured by 2026 than they would under current law, for a total of 52 million by that time.
Experts say $8 billion is not enough
A big question for this entire system: Is the $8 billion, proposed by Rep. Fred Upton (R-Mich.), enough? Unsurprisingly, Democrat leadership says no. Senate Minority Leader Chuck Schumer called it “cough medicine” for “stage-four cancer.”
Analysts across the spectrum appear to be in agreement about the new proposal. Free-market think tank Mercatus Center, associated with the Koch brothers, told the Hill the $8 billion added by the amendment is a “pittance,” and “spread over five years, it’s a fifth of a pittance.” Massachusetts Rep. Jim McGovern read that full quote in opposition on the floor of the House Thursday, before telling his Republican colleagues: “I guarantee you your constituents will figure this out and they will not be happy.”
The Hill also reported similar analysis from the nonpartisan Kaiser Family Foundation, which said the amount likely made the high-risk pools “unworkable.” Analysis from the left-leaning Center for American Progress found the numbers underfunded by $200 billion over 10 years, writing that the Upton amendment will have almost no effect.
High-risk pools have also been underestimated by Democrats. The Obama administration miscalculated how much high-risk patients cost under Obamacare during a transition period from 2010 to 2014. The costs to insure patients with pre-existing conditions were double what they had expected, and the funding was only sufficient to pay for coverage to 375,000 of the 2 to 4 million people in this group.
So what happens if the $8 billion sandbag is hit by a hurricane of massive pre-existing condition costs? The bill doesn’t make provisions for what happens if the experts are proven correct. “If it’s not enough to make [premiums and out-of-pocket costs] whole, that’s on the [pooled] people,” Kaiser Family Foundation’s Karen Pollitz told Yahoo Finance. “No further responsibility for the state or the feds.”
Should the bill pass the House, it will face serious scrutiny in the Senate, where the Republicans enjoy a very narrow advantage.