Illustration: Annelise Capossela / Axios
We told you Wednesday about the CBO's topline estimate that 10.9 million people would lose coverage under the GOP reconciliation bill.
- Other important details are in a new, more comprehensive analysis that CBO prepared. Here are some takeaways.
1. Medicaid work requirements are the biggest source of coverage loss.
- CBO projects 4.8 million more uninsured people over a decade because of new work requirements.
- The freeze on new provider taxes would lead to an additional 400,000 uninsured.
- The provider tax freeze is causing concern within the Senate GOP ranks for the way it could upend the non-federal share of Medicaid financing and possibly hurt rural hospitals.
2. ACA marketplace changes also have a significant impact.
- A late change to the House-passed bill would fund cost-sharing reduction payments to insurers. That would have the effect of cutting federal ACA subsidies to enrollees, because it lowers the benchmark silver premium used to calculate those subsidies.
- CBO projects this change would cause 300,000 people to become uninsured.
- CBO notes that a projected 25% of marketplace enrollees live in states that would not accept the CSR funding, because those states require that abortion be covered. The CSRs are allowed under the bill to go only to insurers that limit abortion coverage.
- A separate ACA-related change would end automatic reenrollment and provisional eligibility for subsidies while eligibility checks are carried out. That would result in 700,000 more uninsured.
3. Expiring enhanced subsidies add another level of coverage loss.
- CBO projects an additional 4.2 million uninsured, on top of the 10.9 million from the reconciliation bill, if Congress allows enhanced ACA marketplace subsidies to expire at the end of this year.
- Democrats are adding that in to punctuate their argument that the GOP is inflicting pain to pay for continued tax breaks for the wealthy. Republicans have given no indication they plan to pass a premium subsidy extension.
- Only a handful of Republicans, including Sens. Lisa Murkowski and Thom Tillis, have expressed support for renewing the subsidies.
