Skip to main content

The context you need, when you need it

When news breaks, you need to understand what actually matters — and what to do about it. At Vox, our mission to help you make sense of the world has never been more vital. But we can’t do it on our own.

We rely on readers like you to fund our journalism. Will you support our work and become a Vox Member today?

Join now

Newest Senate health bill would cause 32 million to lose coverage

Senate GOP Leadership Addresses The Press After Lunch With President Trump At The White House
Senate GOP Leadership Addresses The Press After Lunch With President Trump At The White House
Photo by Alex Wong/Getty Images

Senate Republicans’ newest health care bill would cause 32 million additional Americans to become uninsured over the next decade, the Congressional Budget Office projected Thursday.

Republicans on Wednesday put forward the Obamacare Repeal Reconciliation Act, a bill that would wipe the health law’s coverage expansion off the books without a replacement in 2020. The bill comes as the Senate has struggled to agree on what plan should replace the Affordable Care Act. On Monday, Senate Majority Leader Mitch McConnell put forward the idea that the party should vote on a clean repeal bill and set a deadline in the future for creating a replacement plan.

If they didn’t come up with a new plan, the CBO report projects a dire future for the individual health insurance market: Premiums would double by 2026, and three-quarters of Americans would live in areas without any health plans willing to sell coverage.

The CBO expects that the elimination of the health law’s coverage expansion would decrease the federal deficit by $473 billion.

Republicans have described this policy as “repeal and delay,” because the bill would not take effect until 2020. The CBO report suggests this is somewhat of a misnomer. Some of the changes in the ORRA would take effect immediately, and the CBO estimates this would cause 17 million Americans to lose coverage immediately, in 2018.

The newest Senate bill would wreak havoc on the insurance markets

The ORRA does thorough work demolishing Obamacare’s insurance expansion. It eliminates funding for the Medicaid expansion, which extended the government insurance program to millions of low-income adults, as well as the tax credits to purchase health coverage on the individual market.

It would leave millions without health insurance unless Republicans were able to agree on a replacement plan at their two-year deadline.

The ORRA would keep key Obamacare regulations on the books, including the requirement that insurance plans not discriminate against people with preexisting conditions. Republicans cannot repeal these parts of Obamacare because they are using the reconciliation process to pass the bill with a 50-vote majority and avoid a filibuster. But in reconciliation, provisions that are regulatory, with no budgetary impact, are off limits.

The CBO projects that requiring insurers to offer coverage to everyone but not requiring all Americans to purchase coverage would badly damage the individual market. They expect that this bill “would destabilize the non-group market, and the effect would worsen over time.”

Specifically, they expect that 17 million Americans would lose coverage next year, because the individual mandate penalty would be repealed immediately. This number would include some people who legitimately did not want to purchase coverage and only did so because of the federal requirement. But it would also include some people who wanted to buy insurance but whose premiums became unaffordable as healthy people exited the market.

Over time, the Congressional Budget Office expects that health plans would flee the insurance marketplaces. By 2026, three-quarters of the population would live in areas where zero health insurers sold individual plans.

Over time, Medicaid enrollment would fall by 18 million

The ORRA would end the health law’s Medicaid expansion, which extended coverage to millions of low-income Americans, in 2020.

The CBO estimates that this would lead to 18 million fewer Americans having coverage through that public program by 2026.

In total, an estimated 59 million Americans would be expected to have no health coverage within a decade — compared with 28 million under current law.

More in Politics

Podcasts
The Supreme Court abortion pills case, explainedThe Supreme Court abortion pills case, explained
Podcast
Podcasts

How Louisiana brought mifepristone back to SCOTUS.

By Peter Balonon-Rosen and Sean Rameswaram
Politics
Trump’s China policy is nearly the exact opposite of what everyone expectedTrump’s China policy is nearly the exact opposite of what everyone expected
Politics

As Trump heads to China, attention and resources are being shifted from Asia to yet another war in the Middle East.

By Joshua Keating
Politics
Are far-right politics just the new normal?Are far-right politics just the new normal?
Politics

Liberals are preparing for a longer war with right-wing populists than they once expected.

By Zack Beauchamp
The Logoff
Flavored vapes doomed Trump’s FDA headFlavored vapes doomed Trump’s FDA head
The Logoff

Why Marty Makary is out at the FDA, briefly explained.

By Cameron Peters
Politics
Virginia Democrats’ irresponsible new plan to save their gerrymanderVirginia Democrats’ irresponsible new plan to save their gerrymander
Politics

Democrats just handed the Supreme Court’s Republicans a loaded weapon.

By Ian Millhiser
The Logoff
Can Trump lower gas prices?Can Trump lower gas prices?
The Logoff

What suspending the gas tax would mean for you, briefly explained.

By Cameron Peters