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Congressional Budget Office Releases Report On GOP Health Care Bill


Congressional forecasters are warning that 14 million more Americans will be without health insurance next year if Republicans succeed in their plan to repeal and replace Obamacare. The report put out by the Congressional Budget Office says the number of uninsured would grow by about 24 million over the next decade. NPR's Scott Horsley joins me now in the studio. Hey there, Scott.


CORNISH: So let's start with this analysis from the CBO. They're trying to predict what the GOP plan would cost the government and also how it would affect the insurance market, right? What are they saying?

HORSLEY: Well, as you say, the forecast from the CBO says the GOP plan would insure a lot fewer people than Obamacare does - 14 million fewer next year, 24 million fewer by 2026. Some of that would be voluntary. The GOP plan eliminates the tax penalty for not having insurance, so some people who were buying reluctantly just to avoid that penalty would stop doing so. House Speaker Paul Ryan says that's OK.


PAUL RYAN: They sort of overestimate the uninsured number, just like they overestimated who would be insured by Obamacare. But I do believe that if we're not going to force people to buy something they don't want to buy, they won't buy it. And that's kind of obvious.

HORSLEY: Now, CBO also cautioned, though, that some people would stop buying insurance because they won't be able to afford it. Now, the government subsidies and the Republican plan are, on balance, less generous than in Obamacare, especially for the poor and older people. And finally, forecasters say we're likely to see a drop in the Medicaid rolls as the federal government starts to limit its funding for that program and states cut back on eligibility.

CORNISH: Now, what about the cost of insurance itself? I mean, what could happen to premiums?

HORSLEY: Initially, CBO predicts that we will see an increase in insurance premiums on the individual market. Premiums will be 15 to 20 percent higher than under Obamacare. After about 2020, though, forecasters are predicting somewhat lower premiums as more stripped-down policies are introduced. That's one of the few things in this report that White House budget director Mick Mulvaney likes. He says greater competition would be good for insurance prices.


MICK MULVANEY: Every place else where the market is allowed to function, quality goes up and costs go down. And I think if you look for something the CBO may have gotten right in this report, it's that the premiums are actually going to come down in cost.

HORSLEY: Now, the CBO also says the mix of people buying coverage would likely shift, with more healthy, young people who can afford that bare-bones coverage, but fewer people in their 50s and 60s who might need or want more comprehensive policies.

CORNISH: Now, even before the forecast came out this afternoon, you had the White House and some of their allies on Capitol Hill essentially discrediting the numbers. I thought this was a nonpartisan office. What's going on here?

HORSLEY: Nobody wants to look like they're knowingly taking health insurance away from millions of people, so the White House is trying to inject as much uncertainty as it can in these CBO numbers. White House spokesman Sean Spicer says lawmakers should take this forecast, which is known as a score, with a big grain of salt.


SEAN SPICER: Obviously, they're going to look at the score. I get it. But in the same way that members relied on the score last time, they were way off.

HORSLEY: The CBO did overestimate the number of people who'd gain coverage through the Obamacare exchanges. They also underestimated the number that would gain coverage through the Affordable Care Act's Medicaid expansion. So this is tricky business, Audie, and the CBO concedes there is considerable uncertainty around these predictions.

CORNISH: In the meantime, there's still a lot of criticism of the Affordable Care Act, right? What's going on there?

HORSLEY: Yeah, Republicans are highlighting the rising premiums in the individual market, the drop in insurance company competition. President Trump tweeted this morning, Obamacare is imploding. He and other Republicans are trying to create a yardstick that will make the GOP plan look better by comparison. However, the Congressional Budget Office forecasts that in most parts of the country the individual insurance market will remain stable whether or not Obamacare is repealed.

CORNISH: That's NPR's Scott Horsley. Scott, thanks so much.

HORSLEY: Good to be with you, Audie. Transcript provided by NPR, Copyright NPR.

Scott Horsley is NPR's Chief Economics Correspondent. He reports on ups and downs in the national economy as well as fault lines between booming and busting communities.