CBO: 22 million more uninsured under Senate health bill

Today, the Congressional Budget Office released its score on the "Better Care Reconciliation Act."  Its findings include the following - "By 2026, among people under age 65, enrollment in Medicaid would fall by about 16% and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law."  

That is just one example of the  damage that this legislation would do to the health and well-being of individual Americans, to our communities and to our economy.  

You can draw your own conclusions from the CBO analysis and watch for further analysis. 

CHF Board President, Leni Preston, stated that:

"This bill shows a complete lack of moral clarity or fiscal responsibility.  It must not pass.  Rather we must work together to build upon the framework of the Affordable Care Act to ensure thattrue and equitable access to care is a right for all and not a privilege for the few." 

Defeating The Better Care Reconciliation Act

The bill unveiled Thursday by Senate Republicans has been out in the open for less than a week, and it is drawing nearly universal criticism from members of Congress, policy leaders, and all of the major health care players: hospitals, providers, patient and consumer groups, and advocacy organizations. Here's a rundown of what's in the bill and how you can help protect the health care of millions by ensuring its defeat.

The Senate bill mirrors the worst of the House bill, known as the American Health Care Act, with some stunning additions. For a detailed unpacking of the bill, read this Health Affairs Blog article by Timothy Jost and Sara Rosenbaum, or scroll down, to read a summary.

To get an idea of how this week may play out, click here. There will likely be changes made to the bill this week to overcome concerns of individual Republicans, in order to get to the 50 votes needed. They may delay harmful provisions, undo some of the cuts, or add small amounts of money to address big problems. None of these will fix the structural problems with the bill.


  • Retains nearly all damaging provisions in House AHCA, including the draconian per capita caps;
  • Regarding the Medicaid Expansion: 
    • Phases out the enhanced federal match over 3 years, beginning in 2020;
    • Repeals Essential Health Benefits for the expansion population;
  • Reduces rate of increase in state per capita caps beginning in 2025;
  • Allows states to impose work requirements; 
  • Blocks Medicaid funding to Planned Parenthood for one year; 

Private Market 

  • Includes subsidies that are more similar to ACA than to AHCA, but less generous. 
  • Phases out subsidies at 350% FPL, rather than ACA's 400% FPL, stripping affordable insurance from moderate-income families.
  • Adds age component to subsidies and makes them more generous for younger individuals, less generous for older. For example, a 60-year-old with income between 300 and 350 percent of the FPL would have to spend 16.2 percent of household income on premiums before becoming eligible for APTC, while a 28-year-old would only have to pay 4.3 percent. Under the ACA, both would have had to pay 9.5 percent. 
  • Makes individuals eligible for employer coverage ineligible for premium tax credits regardless of the affordability of the employer coverage. For details on premiums and tax credits by county, see the Kaiser Family Foundation interactive map.
  • Changes the benchmark plan to be roughly equivalent to the lowest-cost bronze plan under ACA, leaving people with much higher out of pocket costs.
  • Funds the Cost-Sharing Reductions through 2019, then repeals them, greatly increasing out of pocket costs for the lowest-income families.
  • Maintains AHCA's 5:1 age bands, meaning premiums can cost up to 5 times more for an older person than a younger one. ACA is 3:1.
  • Repeals the individual mandate, but does not provide any mechanism to incentivize continuous coverage to prevent adverse selection and maintain market stability. 
  • Does not permit waivers of community rating, but does allow states to see waivers of essential health benefits, out of pocket limits, and actuarial value requirements, so those with pre-existing conditions would still be at risk. 
  • Eliminates the "Section 1332" waiver guardrails that require waivers to be budget neutral, cover as many people, and maintain the same affordability.

There will likely be changes made to the bill this week to overcome concerns of individual Republicans, in order to get the 50 votes needed. They may delay harmful provisions, undo some of the cuts, or add small amounts of money to address big problems. None of these will fix the structural problems with the bill

We expect the process to move very quickly, with a vote by Thursday or Friday (see post directly below), so it is critical that we do all we can to make our voices heard. Make sure to read our latest Action Alert to see how you can help this week.

How This Week Could Go

From Today's Politico Pulse:  There are several key steps that need to happen before the Senate bill can pass, setting up opportunities for opponents or wary Republicans to slow down the bill or kill it altogether. Here's a quick look via POLITICO's Jennifer Haberkorn. (Or as she puts it - "Schoolhouse Rock: Senate reconciliation edition.") 

Step 1) Motion to proceed vote. This is the procedural vote to allow debate to begin on the House bill, which will act as the shell for the Obamacare repeal legislation in the Senate. If the bill is going down in flames, it could go down here, Jennifer tells PULSE, and Heller on Friday did say he'd vote no on this procedural measure. 

Step 2) Twenty hours of debate, equally divided. This will be a prime chance for Democrats to make emotional pleas against the bill and in favor of Obamacare.

Step 3) Points of Order. The most powerful tool Democrats will have to kill the bill - or strip out parts of it - is to raise Points of Order on the Senate floor, or argue the bill violates Senate rules, and hope the parliamentarian agrees.

Step 4) Vote-a-rama. This process usually begins at about 4 p.m. in the afternoon and goes until the minority gives up. Liberal activists want Democrats to stretch it out as long as possible.

Step 5) Vote on the substitute amendment. This is the vote on stripping out the whole House bill and replacing it with the Senate plan.

Step 6) Vote on final passage.

”Better Care” Reconciliation Act Revealed, But Offers ”Worse Care” For Millions

Consumer Health First is appalled at the bill Republican Senators have put forth to "replace" the Affordable Care Act. Despite promises to provide better coverage at a lower cost, this bill will strip coverage from millions of Americans, decimate our health care safety net, and put people with pre-existing conditions at risk, all to provide massive tax cuts to the wealthy and to corporations. 

This bill was put together behind closed doors and we anticipate that it will be rammed through the Senate next week. It could then be sent to the House, thereby avoiding any need for a conference, and be on the President's desk before July 4. There are a number of Senators who have expressed their reservations both about the process and the bill, and advocates MUST take action immediately to ensure this bill is defeated. 

Here are two things you can do:

  • Use this interactive toolkit to contact friends and family in key states and encourage them to call their senators.    

Politico compares the Senate bill to the ACA in this chart. At its core, the bill would: 

  • return us to the pre-ACA days when our most vulnerable neighbors would be left without access to care;
  • gut Medicaid, putting at risk the more than 1 million Marylanders who depend on the program, including 300,000 newly covered through the expansion;    
  • slash health care for poor and middle-class Americans in order to finance a huge tax cut for corporations and the ultra-wealthy;
  • eliminate the Public Health and Prevention Fund, leaving all Marylanders at risk should there be a Zika epidemic or other type of outbreak;
  • allow states to let insurance companies drop coverage of essential health benefits such as maternity care, hospitalizations, prescription drugs, and mental health services - thereby gutting protections for people with pre-existing conditions;
  • allow states to let insurance companies reinstate limits on annual and lifetime coverage, which could affect employees of large corporations no matter where they live; and,
  • removes individuals' choice of providers by removing Planned Parenthood from the Medicaid program for one year.

It's also worth noting that the provisions and proposed funding in this bill to address the nation's opioid epidemic are wholly insufficient for this devastating health emergency. 

In a press release from the National Health Law Program, President Elizabeth Taylor noted:

"This bill hatched in secrecy is cruel and dehumanizing...This measure if enacted would radically damage the Medicaid statute, which has been protecting low-income children and their families, people with disabilities and seniors since it was enacted in 1965. We deserve much better than what is being served up to us today."

This bill demonstrates a total lack of concern for the health and well-being of Americans. The Congressional Budget Office score should be available on Monday or Tuesday, so stay tuned for more information.

Consumer Health First and 36 Partner Organizations Call on MIA to Reject CareFirst Premium Increases

This morning, CHF President, Leni Preston, and Secretary, Beth Sammis, are testifying before the Maryland Insurance Administration, asking Commissioner Redmer to reject the outrageous 2018 premium increases that CareFirst has proposed for the individual market.

CHF, along with 36 organizations, provided the MIA with its analysis of CareFirst's proposed rates. Its submitted rate request seeks an average 50.4 percent increase on its HMO plans and an average 58.8 percent increase on its PPO plans. Other insurance companies in the state's individual market also requested increases, but CareFirst's request was by far the highest.

"CareFirst is not living up to its obligations as a nonprofit health service plan to provide affordable, accessible insurance in the individual market," said Preston. "These rates would make insurance unaffordable for thousands of Marylanders, particularly those who do not qualify for a federal subsidy under the Affordable Care Act."

Sammis, who served for about 18 months as acting Insurance Commissioner in the O'Malley administration, analyzed the documents CareFirst submitted to the MIA and identified a number of concerns, including the fact that CareFirst's assumptions about increases in medical costs far exceeded those of other insurance carriers. CareFirst also asserted its morbidity rate will increase in 2018, but there is no evidence to suggest that this will happen.

"The Commissioner should insist that CareFirst alters its assumptions around medical trend and morbidity and ensure that the company lives up to its statutory obligation to ensure affordability and accessibility in the individual market," said Sammis.

Despite the current uncertainty caused by the healthcare debate at the federal level, Marylanders must be protected. Consumers should not have to bear the burden of the uncertainties that CareFirst may face due to actions, or inaction, by Congress and the Administration.

We, therefore, urge Commissioner Redmer to reject CareFirst's proposed premium increases.

Read the letter here, our press release here, and press coverage here:

Rally To Speak Out Tomorrow: Tell Senate Republicans to Vote "NO" on Secret Health Care Bill

There is growing dissension and opposition, even among Republicans, about the shroud of secrecy under which just 13 Senators are crafting the current healthcare legislation - with no hearings, no public testimony, and no input whatsoever from their constituents. 

Join health care advocates this Wednesday to speak out and protect our care. Senators will join parents, children, and people from around the country who will tell their personal stories about how important the Affordable Care Act and Medicaid are to keeping them healthy. 

MomsRising is organizing mothers and children to dress as superheros to attend the rally and then deliver books of family stories to their senators.

Join the rally to tell the Senate to protect us from Trumpcare - a plan developed without any input from the public that will cost MORE and cover LESS than the ACA.

To register for the event, RSVP here.

Read about how the ACA has saved lives and averted financial disaster for Marylanders, and share your own story here.