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Vorys Health Care Advisors

Lesser-known CBO findings about the American Health Care Act

Posted in Affordable Care Act, Health Care Reform, Medicaid

As reported by Harris Meyer at Modern Healthcare, a deeper dive into the Congressional Budget Office (CBO) scoring of the American Health Care Act (AHCA) reveals rich data.

Top-line numbers from CBO analysis of the House proposal predicted the bill would:

  • Increase in the number of uninsured Americans by 24 million over the 10 years
  • Reduce the federal deficit by $337 billion

Here are 13 other key CBO findings cited by Modern Healthcare:

  1. By 2026, individual-market premiums would be 20% to 25% lower for a 21-year-old, 8% to 10% lower for a 40-year-old and 20% to 25% higher for a 64-year-old.
  2. Medicare disproportionate share hospital payments (DSH) would increase by $43 billion from 2018 to 2026 due to a significant rise in the uninsured population.
  3. Medicaid DSH would increase by $31 billion over 10 years.
  4. Total federal Medicaid payments to states would decline by $880 billion, or 25%, by 2026.
  5. Under the per-enrollee cap on federal Medicaid payments, states’ actual per-capita costs would grow annually 0.7 percentage points faster than federal payments from 2017 to 2026.
  6. Five million fewer low-income adults would be enrolled in the Medicaid expansion programs by 2026.
  7. By 2026, Medicaid expansion states would have only 5% of expansion enrollees left for whom they would receive enhanced federal matching payments.
  8. Consumers would have a harder time comparison-shopping for health plans because the minimum actuarial-value requirement would be repealed and insurers could sell subsidized plans outside the exchanges.
  9. The repeal of the actuarial-value requirement would prompt many insurers to offer plans with higher deductibles and higher cost-sharing. That, and the loss of ACA cost-sharing subsidies in 2020, would significantly increase out-of-pocket costs for lower-income enrollees.
  10. About 7 million fewer people would have employer-based coverage by 2026 due to: elimination of the employer and individual mandates and penalties, reduction in employer sponsored insurance, and potential for employers to send higher income workers to purchase coverage in the individual market with new premium tax credits.
  11. The 30% premium penalty for buying insurance after a coverage gap would lead to about 2 million fewer people buying coverage after 2018. Those who pay the penalty would likely be sicker people.
  12. By 2026, the average premium tax credit to help people buy coverage would be about 50% less than under the ACA.
  13. About 52 million Americans, or 19% of the non-elderly population, would be uninsured in 2026, up from 10% under the ACA. People aged 50-64 with incomes under 200% of the federal poverty level would make up a larger share of the uninsured.