Middle-Class Families Would Face Higher Costs, Worse Coverage Under Senate Health Bill
End Notes
[1] Robert Greenstein, “Greenstein: House Votes to Take Health Care Coverage Away From Millions and Make It Less Affordable, Skimpier, or Both for Millions More,” Center on Budget and Policy Priorities, May 4, 2017, https://www.cbpp.org/press/statements/greenstein-house-votes-to-take-health-care-coverage-away-from-millions-and-make-it.
[2] Center on Budget and Policy Priorities, “Tracking Reports About the Emerging Senate Bill to Repeal the Affordable Care Act,” June 22, 2017, https://www.cbpp.org/research/health/tracking-reports-about-the-emerging-senate-bill-to-repeal-the-affordable-care-act.
[3] These estimates are derived from CBO backup data available at https://www.cbo.gov/publication/52849. Except where otherwise noted, all CBO estimates referenced in this analysis are from Congressional Budget Office, “H.R. 1628, Better Care Reconciliation Act of 2017,” June 26, 2017, https://www.cbo.gov/publication/52849. Similar backup data for the CBO score of the revised Senate bill are not available, but since the overall coverage impacts are largely unchanged, the coverage impacts for particular groups would likely be similar as well.
[4] Adam Looney and Kathryn Martin, “One in Five 2014 Marketplace Consumers was a Small Business Owner or Self-Employed,” U.S. Department of the Treasury, January 12, 2017, https://www.treasury.gov/connect/blog/Pages/One-in-Five-2014-Marketplace-Consumers-was-a-Small-Business-Owner-or-Self-Employed.aspx.
[5] For further details and the methodology behind these estimates, see Aviva Aron-Dine and Tara Straw, “Senate Bill Still Cuts Tax Credits, Increases Premiums and Deductibles for Marketplace Consumers,” Center on Budget and Policy Priorities, revised June 25, 2017, https://www.cbpp.org/research/health/senate-bill-still-cuts-tax-credits-increases-premiums-and-deductibles-for.
[6] Centers for Medicare & Medicaid Services, “Data Brief: 2016 Median Marketplace Deductible $850, with Seven Health Services Covered Before the Deductible on Average,” July 12, 2016, https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-07-12.html.
[7] American Cancer Society, “Patients Would Pay More for Less Coverage Under Senate Health Bill,” June 22, 2017, https://www.acscan.org/releases/patients-would-pay-more-less-coverage-under-senate-health-bill.
[8] Matthew Fiedler, “Like the AHCA, the Senate’s health care bill could weaken ACA protections against catastrophic costs,” Brookings, June 23, 2017, https://www.brookings.edu/blog/up-front/2017/06/23/like-the-ahca-the-senates-health-care-bill-could-weaken-aca-protections-against-catastrophic-costs/.
[9] This could occur because under current rules, large employer plans can select any state’s definition of Essential Health Benefits to use in applying rules around annual and lifetime limits.
[10] Thomas D. Musco and Benjamin D. Sommers, “Under the Affordable Care Act, 105 Million Americans No Longer Face Lifetime Limits on Health Benefits,” Department of Health and Human Services, March 2012, https://aspe.hhs.gov/basic-report/under-affordable-care-act-105-million-americans-no-longer-face-lifetime-limits-health-benefits.
[11] Matthew Buettgens, Stan Dorn, and Hannah Recht, “More than 10 Million Uninsured Could Obtain Marketplace Coverage through Special Enrollment Periods,” Urban Institute, November 2015, http://www.urban.org/sites/default/files/publication/74561/2000522-More-than-10-Million-Uninsured-Could-Obtain-Marketplace-Coverage-through-Special-Enrollment-Periods.pdf.
[12] Congressional Budget Office, “Longer-Term Effects of the Better Care Reconciliation Act of 2017 on Medicaid Spending,” June 29, 2017, https://www.cbo.gov/system/files/115th-congress-2017-2018/reports/52859-medicaid.pdf.
[13] Ashley Kirzinger, et al., “Kaiser Health Tracking Pool: Future Directions for the ACA and Medicaid,” Kaiser Family Foundation, February 24, 2017, http://www.kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/.
[14] The Medicaid program includes services that states must cover — called mandatory services — and services they can cover at their option. Nursing home care is a mandatory service while most long-term services and supports provided in the home are optional.
[15] Edwin Park, “CRFB: Senate Bill Cuts Medicaid $2.6 Trillion in Second Decade,” Center on Budget and Policy Priorities, July 11, 2017, https://www.cbpp.org/blog/crfb-senate-bill-cuts-medicaid-26-trillion-in-second-decade.
[16] MaryBeth Musumeci and Katherine Young, “State Variation in Medicaid Per Enrollee Spending for Seniors and People with Disabilities,” Kaiser Family Foundation, May 1, 2017, http://www.kff.org/medicaid/issue-brief/state-variation-in-medicaid-per-enrollee-spending-for-seniors-and-people-with-disabilities/.
[17] David Grabowski, Jonathan Gruber, and Vincent Mor, “You’re Probably Going to Need Medicaid,” New York Times, June 13, 2017, https://www.nytimes.com/2017/06/13/opinion/youre-probably-going-to-need-medicaid.html.
[18] See, for example, Judith Feder and Nicole Lallemand, “If the Senate Repeal-and-Replace Bill Goes Forward, It Would Cut Medicaid Just as More Elderly Americans Need Long-Term Services and Support,” July 20, 2017, http://www.urban.org/urban-wire/if-senate-repeal-and-replace-health-care-bill-goes-forward-it-would-cut-medicaid-just-more-elderly-americans-need-long-term-services-and-support; and Matt Broaddus, “Population’s Aging Would Deepen House Health Bill’s Medicaid Cuts for States,” Center on Budget and Policy Priorities, March 24, 2017, https://www.cbpp.org/blog/populations-aging-would-deepen-house-health-bills-medicaid-cuts-for-states.
[19] MaryBeth Musumeci and Danielle Poindexter, “Medicaid Restructuring under the American Health Care Act and Children with Special Health Care Needs,” Kaiser Family Foundation, June 22, 2017, http://www.kff.org/report-section/medicaid-restructuring-under-the-american-health-care-act-and-children-with-special-health-care-needs-issue-brief/.
[20] For more information on Medicaid coverage for children with special health care needs, see Jessica Schubel, ‘House ACA Repeal Bill Puts Children with Disabilities and Special Health Care Needs at Severe Risk,” Center on Budget and Policy Priorities, June 14, 2017, https://www.cbpp.org/research/health/house-aca-repeal-bill-puts-children-with-disabilities-and-special-health-care-needs.
[21] Ibid.
[22] Martha Heberlein, “Analysis of Mandatory and Optional Populations and Benefits,” Medicaid and CHIP Payment and Access Commission, April 21, 2017, https://www.macpac.gov/wp-content/uploads/2017/04/Review-of-June-Report-Chapter-Analysis-of-Mandatory-and-Optional-Populations-and-Benefits.pdf.