Vice President for Health Policy
The House this week will consider the Senate-passed budget reconciliation bill, which would raise the number of uninsured Americans by at least 22 million starting in 2018, relative to current law, the Congressional Budget Office (CBO) estimates (see chart). Thus, the bill would reverse virtually all (at least 92 percent) of the historic health coverage gains that CBO expects health reform to achieve by 2018.
The budget reconciliation bill would, among other things:
The bill leaves in place health reform’s market reforms, including those that bar insurers from denying coverage to people with pre-existing health conditions or charging them higher premiums in the individual market. But without the individual mandate and the subsidies to make coverage more affordable, healthier people would likely drop or otherwise go without coverage. Losing most of the healthy people from the risk pool would substantially push up individual market premiums for everyone else, by making those still enrolled sicker and costlier to cover, on average. Higher premiums, in turn, would push even more healthy people out of the pool over time, driving up premiums still further.
As a result, CBO warns that the overall individual insurance market, particularly in smaller states, could destabilize, “leading to very low to no participation by insurers and consumers.” That would lead to even more uninsured people, on top of the 22 million increase that CBO already projects, relative to current law.