Report: 23M more to be uninsured, $834B in Medicaid spending to be slashed under AHCA

Mixed reactions from Utahns on effects of replacing Obamacare

SALT LAKE CITY — A report from the Congressional Budget Office on Wednesday estimated that 23 million more Americans will be uninsured by 2026 under the American Health Care Act compared to current law, while also projecting more than $119 billion in savings to the federal budget deficit over 10 years.

The report also concluded that average insurance premiums on the individual market would rise through 2019, but ultimately drop about between 4 and 20 percent for most of the country by 2026.

In all, "tens of thousands" of Utahns could lose coverage in the next nine years if the U.S. Senate passes the law, said Utah Health Policy Project spokesman Jason Stevenson, who added that an exact figure for the state was difficult to immediately estimate.

The report, which also predicted 14 million fewer Americans would be insured under the American Health Care Act as early as next year, elicited anger from state Democratic lawmakers, who argued that the changes show federal lawmakers are callously depriving disadvantaged, elderly and sick people from essential coverage.

"It would do great devastation to so many low-income Utah families, it's almost unfathomable that anyone could be that noncaring," said state Sen. Jim Dabakis, D-Salt Lake City and a member of the Senate Health and Human Services Committee. "It's kind of the opposite of when you have done it unto one of the least of these my brethren. This plan takes away from the poorest and those most needy and the most deserving of our help and gives it to the ... the richest in our community."

However, the report's contents received a fairly neutral response from U.S. Sen. Orrin Hatch, R-Utah, who said Wednesday that the analysis of the House-approved bill is simply "an important marker for the Senate," which is widely expected to rework the measure.

Instead, Hatch focused his remarks on his distaste for the Affordable Care Act's "higher premiums, fewer choices and burdensome complications."

"Just look at my home state of Utah, where over half of our counties have access to only one health insurance provider and over the past year our premiums have jumped on average by a whopping 30 percent," Hatch said in a short video.

Hatch spokesman Matt Whitlock clarified with the Deseret News that Hatch "would be the first to say the (new) bill needs significant improvements."

Utah's delegation to the House, all Republicans, voted in favor of the American Health Care Act earlier this month, contending it was a preferable alternative to the Affordable Care Act.

Rep. Mia Love said the fact that 23 million Americans will be without insurance is due to many people who purchased insurance only because of the ACA mandate will ultimately choose to opt out under the new law.

"Critics of the AHCA should get their facts straight," Love said in a statement. "What they have conveniently left out is that CBO stated that many of the people that won’t have health insurance will either choose not to have it, or will choose to pay with cash."

Rep. Rob Bishop also stood behind the American Health Care Act in a statement Wednesday.

"The Congressional Budget Office today told us that the AHCA will lower premium costs, reduce the deficit, and lighten the burden on the American taxpayer," Bishop said. "I look forward to these benefits, plus those that will come from additional reforms designed to fully repeal and replace Obamacare."

The offices of Sen. Mike Lee and Rep. Jason Chaffetz declined to comment on the report, while Rep. Chris Stewart could not be reached.

Hatch, Lee and other senate leaders have previously said that the American Health Care Act passed by the House will be substantially revised.

The Congressional Budget Office report says "about one-sixth of the (American) population resides in areas" where the individual market for health insurance will become unstable by 2020. Those areas would be in states that seek a waiver to the requirement that insurance companies cannot use a person's pre-existing condition to increase premiums, as well as a waiver from providing a certain number of essential health benefits.

Stevenson said he is worried that Utah will fall into that category, based partly on the comments made earlier this month by Rep. Jim Dunnigan, R-Taylorsville, to the Deseret News, saying that seeking the pre-existing conditions waiver would be a "good step."

The granting of such a waiver would require the creation in Utah of a federally subsidized high risk pool. Dunnigan said he believed that pool would be subsidized enough to be beneficial to less healthy Utahns.

Matt Slonaker, executive director of the Utah Health Policy Project, believes both waivers would ultimately be devastating to Utahns who have pre-existing conditions or chronic health problems.

“Good policy should be evaluated not just by its results, but how it accomplishes them,” Slonaker said in a statement. “Lowering premiums for the lucky few by kicking older, poorer and sick Utahns to the curb is a gimmick, not smart or effective policy."

Stevenson cautions that allowing insurance companies to omit essential health benefits can raise problems for the insured. For example, a person with diabetes could purchase insurance at a reasonable rate, but later find out that the plan doesn't cover insulin, dramatically devaluing their actual coverage.

"It creates gotchas," Stevenson said.

As for premiums, the budget office predicted 4 percent drop by 2026 for about half of Americans and 20 percent for another 35 percent of the country. The remaining 15 percent of the population would be subject to too many variables for a reliable prediction, the agency said.

The bill largely saves money for the federal government because $834 billion less would be spent on Medicaid through 2026, according to the report. This is due to a cap placed on per-enrollee Medicaid funding in each state and reducing federal matching funds funneled to states, Stevenson said.

Because Utah opted against substantial Medicaid expansion in recent years, it would be "less affected by the Medicaid impacts" than other states, Stevenson explained.

State Rep. Brad Daw, R-Orem and chairman of the House Health and Human Services Committee, said the smoother-than-normal Medicaid funding transition in Utah reflects well on the decision of state lawmakers not to chase after expansion.

"I just have to point out that makes us as House members who resisted the expansion look awfully stinking smart," he said. "Utah's going to be ... a lot less affected than the states that bought in to the Obamacare experience early on and had their budgets turned upside down because of it."

Daw said he did have significant concerns about so many more people uninsured, but he is hopeful the new federal health care law will allow states to come up with solutions to help reduce that number and ensure their residents don't fall through the cracks.

Molina Healthcare, which serves a large population of low-income Utahns, sounded a warning bell Wednesday.

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"We do not believe that dramatic cuts to the Medicaid program, which is the most effective way to provide coverage for low-income Americans, is in the nation’s best interest," said Danielle Smith, spokeswoman for Molina Health Care, said in a statement.

The Sutherland Institute, which has favored the decentralizing of Medicaid insurance plans, agreed that the 23 million number was concerning.

"The best hope for simultaneously improving health outcomes, offering affordable coverage, and protecting the taxpayer is through practical, free market health care reforms," said Derek Monson, director of public policy for Sutherland Institute, in a statement.