Medicare-Medicaid agency gives a much more favorable score to the House health bill than the Congressional Budget Office did

House Speaker Paul Ryan speaks about the bill as Majority
Leader Kevin McCarthy and others watch. (CNN image)

By Melissa Patrick
Kentucky Health News

The Trump administration has come up with its own estimate of how many Americans would lose or forgo health coverage under the bill that House Republicans passed last month, and it's a lot lower.

An actuary for the Centers for Medicare and Medicaid Services concluded that 13 million fewer people would be covered by 2026, not the 23 million estimated by the Congressional Budget Office, and that the savings to the federal budget would be larger than the CBO score.

The bill, called the American Health Care Act, passed the House 217-213. In the Senate, Republicans are working on their own version behind closed doors, and Majority Leader Mitch McConnell has said he would like to see a bill voted on before the July 4 holiday recess, but he has not delivered a draft to the CBO for scoring.

Many of the provisions in the House bill are expected to carry over into the Senate bill, but McConnell has proposed that the Medicaid expansion, particularly important to Kentucky, be phased out through 2023, not ended in 2020, as the House voted.

About 470,000 Kentuckians are on expanded Medicaid, which covers people who earn up to 138 percent of the federal poverty line. Only 82,000 are enrolled in Obamacare plans subsidized by federal tax credits.

The June 13 report from the Medicare-Medicaid agency estimates that under the House bill, 43 million Americans would be uninsured in 2026, compared with 31 million under the current law. The CBO projected that 51 million would be uninsured under the AHCA, compared with 28 million if Obamacare remained in place.

CMS projects that between 2017 and 2026, the House bill would reduce federal spending by a net more than $328 billion, "primarily because of lower Medicaid spending." The CBO projected the bill would reduce federal deficits by much less: $119 billion.

The spending reductions in the CMS report are largely a result of getting rid of several Obamacare provisions, including: $160 billion from decreased subsidies; $42 billion from elimination of the Basic Health Program, which allows states to provide insurance to those who earn up to 200 percent of the poverty level; and $383 billion from ending the Medicaid expansion of Medicaid. This is significantly lower than the CBO's estimates of $834 billion in Medicaid cuts.

The CMS estimate also accounts for $135 billion in spending to create high-risk pools for people with pre-existing conditions and age-based subsidies, which will be available to all enrollees,

The report estimates that average net premiums -- the amounts paid after federal and state subsidies are accounted for -- for subsidized plans bought on government marketplaces will be 5 percent higher in 2026 under the AHCA and the average cost-sharing amounts will be 61 percent higher, when compared to Obamacare.

CMS estimates that the House bill would cut Medicaid enrollment by 8 million people by 2026. The CBO estimated that 14 million people on Medicaid would lose their coverage by 2026.