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Rick Bowmer / AP

The new Congressional Budget Office score for the American Health Care Act showed who the winners and losers will be, and how quickly its negative consequences will take effect if the House bill is enacted into law without major changes. What it doesn't do is assess the politics. But the implications are clear: The negative effects of the AHCA, and the juicy news stories about them, will play out over each of the next two election cycles. It's the political equivalent of tearing off a bandage slowly.

Probably the biggest effect before the 2018 mid-terms will be the rise in premiums across the non-group market which the CBO predicts after the repeal of the individual mandate. Older workers who buy their own coverage will also begin to pay more, as five-to-one age rating replaces the three-to-one age rating under Obamacare.

Then, before the presidential election in 2020, the new AHCA tax credit will kick in. There will be winners who get can get a better deal, mostly younger, higher-income people in low cost areas who may be happy with "skinnier" limited benefit plans that states may allow. But there will be losers too: mainly older and lower-income people who live in high cost, often rural areas.

Budget fights: As the Medicaid expansion begins to unravel, states that expanded Medicaid will have fights over whether to fill the federal funding gap with state funds. Medicaid will have to compete with school spending, higher education, corrections, environmental protection and other state priorities.

Sick people could face "extremely high" premiums in states that choose to waive Obamacare insurance protections, according to CBO, creating more media stories and political problems.

Each negatively affected voter has a family and friends who know about their experiences, creating a multiplier effect. Media coverage focusing on their stories will add to the narrative. The negative anecdotes are always louder than the positive ones.

What to watch: The next election is the mid-term in 2018, and mid-terms are all about turnout of slivers of the electorate; the most motivated voters. If the CBO's analysis of winners and losers under the AHCA is even close to right, it will morph quickly from the storyline Republicans want — they kept their promise to repeal "Obamacare" — to a reality with winners and losers.

It's hard to see how it will stoke turnout on the right once the reality painted by CBO sets in, and it could diminish it. And it may add energy to voters on the left and in swing districts that could decide control of the House.

Here's a look at how it could play out.

2018 ELECTIONS

Summer 2017:

  • Individual mandate eliminated. Insurers may raise premiums.

Nov. 1, 2017:

  • Open enrollment under the AHCA begins. Consumers in the individual market may find much higher premiums.

Nov. 1, 2018:

  • People with preexisting conditions, gap in insurance may start to face higher premiums in states waiving community rating.
  • Healthy people may see lower premiums.

2020 ELECTIONS

Spring/Summer 2019:

  • States may begin to close their Medicaid expansions to new enrollees.
  • Or they may raise taxes/make cuts elsewhere in budgets.
  • With new federal Medicaid spending limits, states may tighten eligibility and reduce benefits and provider payments.

Nov. 1, 2019:

  • ACA tax credits are replaced with less generous ones. Cost-sharing subsidies are repealed.
  • Winners: The young and higher income in low-cost areas..
  • Losers: Older and poorer in high-cost areas.

Jan. 1, 2020:

  • More states close Medicaid expansion to new enrollees.
  • States can waive essential benefits. Many insurers sell "skinny plans," and many healthy people buy them.

BEYOND 2020

  • Number of uninsured Americans continues to rise. CBO says reaching 51 million in 2026.

Go deeper

Updated 1 hour ago - World

17 U.S. and Canadian missionaries kidnapped in Haiti

Haitian soldiers guard the public prosecutor's office in Port-au-Prince this month. Photo: Richard Pierrin/AFP via Getty Images

American officials and authorities in Haiti are working to try and free 17 hostages from a U.S.-based missionary group who were kidnapped in Port-au-Prince over the weekend, AP reported Monday.

The latest: Christian Aid Ministries said in a statement Sunday, "The group of 16 U.S citizens and one Canadian citizen includes five men, seven women, and five children." The Ohio-based organization said they were on a trip to visit an orphanage when they were kidnapped Saturday.

China's economic growth slows

A worker assembles heavy truck engines in Hangzhou in eastern China's Zhejiang Province, on Monday. Photo: Long We/Costfoto/Barcroft Media via Getty Images

China's economy grew 4.9% in the third quarter of 2021 compared with a year earlier, the country's National Bureau of Statistics announced Monday.

Why it matters: The gross domestic product growth in the July-September period in the world’s second-largest economy marked the "weakest pace since the third quarter of 2020 and slowing from 7.9% in the second quarter," Reuters notes.

5 hours ago - World

Former spy Steele defends controversial Trump Russia dossier

Former U.K. intelligence officer Christopher Steele arrives at the High Court in London in July 2020. Photo: Tolga Akmen/AFP via Getty Images

The author of the "Steele Dossier," containing unverified claims about former President Trump told ABC News he stands by his controversial report, according to excerpts from an upcoming documentary released Sunday.

Why it matters: The FBI drew on former U.K. intelligence officer Christopher Steele's dossier as part of its investigation into the Trump campaign's alleged links to Russia's government, which led to former special counsel Robert Mueller's probe.

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