ASHINGTON — The official scorekeepers in Washington have weighed in on the GOP’s health care plan and put the stakes of the debate in full view: Millions more Americans would be uninsured if the legislation were approved, and federal spending on Medicaid, the largest health insurance program in the nation, would be dramatically reduced.

Republicans have preemptively argued that the Congressional Budget Office, which released its analysis of the American Health Care Act on Monday, sometimes gets its estimates wrong. But for now, the CBO’s report is the official projection of what would happen under President Trump and the GOP’s plan.

The estimated coverage losses and federal spending reductions would have major consequences for US medicine. Here’s what you need to know.


Millions more uninsured

The GOP bill nixes some of the Affordable Care Act’s changes to the individual insurance market (such as the individual mandate, the penalty for not buying insurance) and transitions from the current law’s income-based tax credits to age-based credits. Taken together, the CBO analysis projected that:

  • 14 million more Americans would be uninsured in 2018-19, largely due to the repeal of the ACA’s individual mandate;
  • 24 million more would be uninsured by 2026, following significant changes to the Medicaid program;
  • In total, the number of Americans expected to be living without health insurance in 2026 would be 52 million, versus 28 million under Obamacare.

Big reductions in Medicaid

The bill starts to phase out the generous federal funding for states that expanded Medicaid under Obamacare. As a result, CBO projects that some states would eventually end the expansion. The plan also fundamentally overhauls federal spending on the program, which is jointly funded by the states. Instead of an open-ended federal commitment, states would begin receiving a set amount of money from the federal government for each person enrolled in Medicaid.

Combined, CBO estimates that:

  • Federal spending in Medicaid would decrease by $880 billion by 2026;
  • 14 million fewer people would be enrolled in Medicaid, versus what would be expected if the current system remained.

Cuts to Planned Parenthood, more births

The GOP bill is designed to cut federal funding for Planned Parenthood, a long-time Republican goal. The CBO estimated federal spending would decrease by $178 million in 2017 and $234 million over the next 10 years.

As a result, 15 percent of people who “would probably reside in areas without other health care clinics or medical practitioners would lose access to care” due to the elimination of federal funding for Planned Parenthood.

The analysis also predicted “several thousand” additional births due to reduced access to pregnancy-related care. More births would lead to more federal costs because Medicaid already pays for roughly 45 percent of all births, and because many of the children born would also become eligible for Medicaid.

That would cost the program $77 million, and “possibly other federal programs.” The cuts to Planned Parenthood as a whole, however, would still result in a net savings of $156 million over the next decade.

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