WASHINGTON — The Republican health care bill that passed the House earlier this month would nearly double the number of Americans without health insurance over the next decade, according to a new analysis by the nonpartisan Congressional Budget Office.
The much-anticipated report cast a new shadow over the controversial legislation and likely will complicate Republican efforts to get the bill through the Senate, where it already faces difficult prospects.
According to the budget office, which both parties in Congress look to for estimates on the impact of complex legislation, the bill would cause 23 million fewer people to have health insurance by 2026. Many additional consumers would see skimpier health coverage and higher deductibles, the budget office projected.
The budget office report further undermines claims by President Donald Trump and House Republicans that their campaign to repeal and replace the current health care law, often called Obamacare - will protect all Americans' access to health care.
The new CBO report updates an analysis the office did in March of the original version of the legislation developed by House GOP leaders.
Since then, Republicans made a series of modifications tailored to win enough votes from conservative and centrist GOP lawmakers to pass the bill. It cleared the House on May 4 without any Democratic votes.
But the revisions did not fundamentally change the structure of the bill or its impact, budget analysts concluded.
The American Health Care Act, as it is called, cuts more than a $1 trillion from the assistance the government gives low- and moderate-income Americans, primarily through a historic retrenchment in Medicaid, the half-century-old government health plan for the poor.
The bill also fundamentally restructures the system of insurance marketplaces created by Obamacare to guarantee health coverage to Americans, even if they are sick.
Obamacare extended coverage to more than 20 million previously uninsured Americans. The law drove the nation's uninsured rate to the lowest levels ever recorded.
The Republican measure would reverse many of the changes Obamacare brought about.
It would scale back the subsidies that the current law makes available to help people who don't get coverage through an employer afford to buy insurance.
And under a series of changes made at the last-minute to win the final votes in the House, states would be given new flexibility to scrap protections in the current law. Those include the ban on insurers charging sick people more and the requirements that all health plans cover a basic set of benefits, including mental health, prescription drugs and maternity care.
GOP leaders have argued the changes would make health insurance more affordable.
But while average premiums for those who buy their own insurance are projected to be lower after 2020 than under Obamacare - partly because plans would cover less - many consumers would pay more than they would under the current law, the budget office said.
Particularly hard hit would be older and sicker Americans who could see higher premiums or lose coverage altogether.
The changes made to get the bill through the House also included additional aid to states to soften some of the blows to low-income consumers. But that means the bill would reduce the deficit by less than the earlier version would have.
Meanwhile, wealthy Americans and the medical device and insurance industries still fare best in the House bill.
They stand to benefit from $663 billion in tax cuts over the next decade as the House legislation gradually eliminates taxes that were included in the Affordable Care Act to fund the law's coverage expansion.
In the first nine months of 2016, just 8.8 percent of U.S. residents lacked health coverage, data from the Centers for Disease Control and Prevention show. That was down from 16 percent in 2010, when President Barack Obama signed the health care law.
Under the House GOP plan, the percentage of uninsured would jump by 2026, according to the CBO. That is in part because consumers would no longer be required to have insurance and in part because millions of Americans would lose assistance that now allows them to afford to get coverage.
The scale of those coverage losses has troubled some Senate Republicans, who have argued that their legislation rolling back the current law should protect more vulnerable Americans.
The new CBO report may strengthen this position, largely held by GOP lawmakers from states that have expanded Medicaid under Obamacare, including Ohio, West Virginia, Louisiana and Arizona.
What effect the report will have on the Senate Republican discussions remains unclear, however: All the debate is taking place behind closed doors.
Senate Majority Leader Mitch McConnell, R-Ky., who is leading the effort, has elected not develop health care legislation through the traditional process of holding public hearings and debating amendments in committee.
The slim deficit reduction in the House bill leaves Senate Republicans without many options as they try to both follow through on their promises to cut taxes and preserve coverage for millions of Americans.
In an interview Wednesday with Reuters, before the budget office report was released, McConnell offered a downbeat assessment of the health bill's chances of winning a majority in the Senate.
"I don't know how we get to 50 (votes) at the moment," he said. "But that's the goal."
©2017 Tribune Co.