The Congressional Budget Office (CBO) on Monday projected that the number of uninsured people would grow by 14 million in 2018 under the Republican ObamaCare replacement bill, with that number rising to 24 million in a decade.
The long-awaited analysis from the nonpartisan congressional scorekeeper is likely to shake up the debate in Congress over the measure, which could come up for a vote in the House next week.
The estimate of the drop in coverage is larger than even many analysts had predicted.
The report finds that the 24 million people would become uninsured by 2026, largely due to the proposed changes in Medicaid. The bill both ends the extra federal funds for the expansion of Medicaid and caps overall federal spending for the program, both of which CBO says would lead to people losing coverage.
The report finds 7 million fewer people would be insured through their employers by 2026, both because some people would choose not to get coverage and some employers would decline to offer it.
Premiums in the individual market for health insurance would increase before 2020 and decrease after that, according to the CBO report.
CBO finds that people's out-of-pocket costs, including deductibles, "would tend to be higher" under the GOP bill than under ObamaCare because of a loosening of requirements on insurers. High deductibles have been one of the GOP's main lines of attack against ObamaCare.
The report also notes that financial assistance for low-income people under ObamaCare to help them pay their deductibles would be repealed.
"The CBO's estimate makes clear that TrumpCare will cause serious harm to millions of American families," Senate Democratic Leader Charles Schumer (D-N.Y.) said in a statement.
"Tens of millions will lose their coverage, and millions more, particularly seniors, will have to pay more for health care. The CBO score shows just how empty the president's promises, that everyone will be covered and costs will go down, have been."
In positive news for Republicans, the CBO finds the legislation would decrease the federal deficit by $337 billion over the 2017-2026 period, mostly through the elimination of ObamaCare’s Medicaid expansion and the law’s subsidies to help people buy insurance.
The savings could help House Republican leaders sell the legislation to skeptical conservatives.
Speaker Paul Ryan (R-Wis.) in a statement pointed out that the CBO's analysis finds decreased premiums, deficit reduction and tax relief.
“I recognize and appreciate concerns about making sure people have access to coverage," Ryan added. "[O]ur plan is not about forcing people to buy expensive, one-size-fits-all coverage. It is about giving people more choices and better access to a plan they want and can afford."
CBO found that some of the reduction in coverage would be from people choosing not to buy coverage because of the repeal of the individual mandate under ObamaCare. But the report also finds that people would go without coverage because of cuts to Medicaid and a drop in financial assistance under the bill.
Republicans had expected that the CBO would show a rise in the number of uninsured people and preemptively went on the offensive against the nonpartisan agency, whose director, Keith Hall, was appointed by the GOP.
The CBO report states that the elimination of ObamaCare's individual mandate would prompt fewer healthy people to sign up for insurance, which could cause premium costs to increase 15 to 20 percent in 2018 and 2019.
But starting in 2020, the increase in average premiums would be offset by a number of provisions in the GOP plan: grants to states, a younger mix of enrollees and the elimination of some insurer requirements.
The report notes that the GOP plan would substantially reduce premiums for younger people while raising them for older people, mostly because of the provision that would allow insurers to charge older people more.
By 2026, premiums in the individual market for a 21-year-old could be 20 to 25 percent lower, while premiums for a 64-year-old would be 20 to 25 percent higher.
By 2026, the CBO says, average premiums for single policyholders in the individual market would be about 10 percent lower than under ObamaCare.
The GOP bill repeals ObamaCare’s subsidies to buy coverage, replacing them with smaller tax credits, as well as repealing the law’s Medicaid expansion after 2019.
The GOP plan, if enacted, would block all Medicaid reimbursements to Planned Parenthood for one year.
Defunding Planned Parenthood for one year would result in several thousand births in the Medicaid program and increase spending for Medicaid by $21 million in 2017 and by $77 million over the 2017-2026 period, the report found.
The CBO notes that the defunding Planned Parenthood would primarily impact women living in areas without other health care clinics.