The Congressional Budget Office released its analysis of the House Republican’s health bill today, and it does not bode well for the millions of people who buy their own insurance or have insurance through the Medicaid program. CBO is a non-partisan entity that “scores” new legislation proposed in Congress. A law’s score tells Congress and the public how much the new law might cost and provides some analysis of what the country will achieve with that money. Congress cannot pass any law without a CBO score.

While HCFANY and other health advocates around the country will be looking more closely at CBO’s analysis over the next few days, the bottom line is that CBO thinks this bill will take health insurance away from 14 million people next year and another 10 million over the next ten years. Most of those people will be those on Medicaid, which would be cut by $880 billion over 10 years. Wealthier states like New York will do their best to make up the shortfall, but the magnitude of those cuts means states will have to make extremely difficult decisions about Medicaid, a program that primarily serves the elderly, people with disabilities, and children.

The problem for people who buy their own insurance is that the bill replaces the ACA’s tax credits, based on income, with tax credits based only on age. Under this system, people who earn low incomes will receive less help with premiums than they did under the ACA, and it may be that few can afford health insurance after losing that help. Older people who have not yet reached age 65 may also struggle to afford health insurance. The Republican bill allows insurers to charge older people up to five times more than younger people (the ACA only allowed them to charge older people three times more). The new tax credit system would be based on age, so older people would be given more assistance than younger people. But they can only get twice as much help – not enough to make up for premiums that are five times as high.

And what are we buying by taking away 24 million insurance cards from low and middle income people? The biggest item on the list is a $250 billion tax cut for high earners, the vast majority of whom earn over $1 million a year.[1] Every policy decision has winners and losers – but this one seems particularly lopsided to a lot of people.

[1] Center on Budget and Policy Priorities, “Eliminating Two ACA Medicare Taxes Means Very Large Tax Cuts for High Earners and the Wealthy,” January 11, 2017, available here.