The House Republican plan to replace Obamacare would leave 24 million additional Americans without health insurance by 2026 and cut $880 billion from Medicaid over a decade, according to a new, widely anticipated estimate from the nonpartisan Congressional Budget Office.
As a point of comparison, the Affordable Care Act extended insurance to an estimated 20 million Americans.
The Republican health care plan would cut spending on subsidies to help Americans purchase health insurance while rolling back the ACA's Medicaid expansion and capping per-person spending on the program, which insures lower-income Americans, going forward. It would also eliminate the requirement that Americans buy insurance or pay a tax penalty, as well as rules requiring employers to offer insurance to their workers.
The CBO expects that the law's combined effects would cause millions to lose coverage immediately, with losses growing over time. By 2018, 14 million fewer Americans would have health insurance—about 6 million fewer would purchase insurance on the individual market, while 5 million fewer would benefit from Medicaid. By 2026, Medicaid's projected enrollment would be 14 million lower than under current law.
The longer-term effects on the individual market are slightly more complicated. By 2020, 9 million fewer people would buy insurance on their own, compared with under Obamacare. By 2026, the losses would be down to 2 million, as “people would gain experience with the new structure of the tax credits and some employers would respond to those tax credits by declining to offer insurance to their employees.”
That's what passes for good news on the coverage front.
The CBO is slightly more sanguine about the legislation's effects on the federal budget. It would still shrink the 10-year deficit by $337 billion.* That's largely because it slashes that $880 billion from Medicaid, while shrinking spending on insurance subsidies by around $300 billion. That makes it possible for Republicans to pack in more than $590 billion in tax cuts, largely directed at the wealthy and health insurers, without swelling the national debt. So, you know, Trumpcare's got that going for it.
*Correction, March 13, 2017, at 5:30 p.m.: This post originally misstated that the CBO believes the Republican health care plan would shrink the 10-year deficit by $337. The estimate is $337 billion.