WASHINGTON — House Republicans’ tax bill would lead to nearly 11 million people losing insurance, providing a key source of savings to help finance President Trump’s tax cuts, according to projections that nonpartisan congressional scorekeepers published Wednesday.
The official projections from the Congressional Budget Office give Democrats ammunition to attack Republicans for taking insurance from low-income voters to pay for tax cuts that disproportionately benefit the rich. Most Republicans say the bill only takes insurance from those without jobs who are able to work and that pregnant women, children, people with disabilities, and frail seniors will not be affected.
About 7.8 million people would lose Medicaid coverage, while much of the rest of the losses would stem from the Affordable Care Act’s exchanges. Among those losing coverage would be 1.4 million immigrants and others who don’t have, or can’t prove, a legal status that would give them access to health insurance. The bill imposes new restrictions on health insurance targeted at states that use their own funds to cover undocumented immigrants.
Hospitals, which are in an especially vulnerable position, will use the CBO projections to fight for changes in the Senate that curb enrollment losses.
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Senators will no doubt make changes to the House bill, and some are worried about Medicaid cuts, though work requirements remain popular among even those with concerns. They are not expected to write a new bill from scratch, due to time constraints. Republicans aim to pass the bill before July 4, but the real deadline might be when the government reaches its borrowing limit, expected sometime late summer.
The CBO had done preliminary “scores” of the bill, which projected the budget impact of measures and their effect on enrollment. But the CBO didn’t have time to analyze measures that were added last minute, and they hadn’t yet accounted for how pieces of the bill interact.
The healthcare portions of the bill can be placed in two big buckets: Medicaid cuts and reforms to the Affordable Care Act marketplaces.
In a smaller bucket, the bill includes reforms to drug middlemen, which amount to $664 million in government savings. It would limit how pharmacy benefit managers can receive money from drugmakers, impose transparency requirements, and prevent spread pricing in Medicaid.
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The bill also would boost payments to doctors by $8.9 billion over a decade by partially basing their Medicare payment rates on medical inflation.
