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(J. Scott Applewhite / AP)

Most Republicans have one goal in repealing and replacing the Affordable Care Act: bring down premiums. So how did they do? The CBO verdict on the American Health Care Act is mixed: average individual market premiums would go down, and young and healthy people would be better off, but sick people could end up paying drastically more than they do under the ACA. Some would be priced out of the market.

What Republicans are saying: They're happy with the overall premium reductions. "This CBO report again confirms that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit," House Speaker Paul Ryan said in a statement.

What's changed since the last CBO report: The biggest thing is that the House added state waivers to the bill, which would allow states to opt out of the ACA's essential health benefits and the requirement that sick people be charged the same premiums as healthy people. Whether states take those waivers has a big impact on whose premiums increase or decrease, and by how much.

In the short term, before most of the House bill provisions take effect, CBO estimates premiums will rise by 20 percent in 2018, and by another 5 percent in 2019. But they'd decrease after that — with some really big exceptions.

How waivers impact premiums: CBO divided states into three different categories:

  • States that don't take waivers: This is about half the population, and CBO estimates premiums in the individual market would decrease by 4 percent for these people, on average. But since the House bill allows insurers to charge older people more than the ACA does, premiums would be substantially reduced for younger people and would rise for older people.
  • States that use the waivers to make modest changes to ACA regulations: These states, which contain about a third of the population, would see bigger premium reductions. CBO estimates that premiums would be 20 percent less in 2026 than under current law, "primarily because, on average, insurance policies would provide fewer benefits." Again, younger people would benefit more than older people.
  • States that use waivers to make substantial changes to ACA regulations: This group contains about one-sixth of the population. Premiums would be lower than under current law, but people with pre-existing conditions "would face extremely high premiums." Premium variation would be very large.
  • It's not just premiums: People who live in states that take waivers could also see substantial rises in their out-of-pocket costs, as less benefits may be covered.

CBO also predicted how premiums would vary with age and income compared to under the ACA:

  • Older, lower-income people would pay "much larger" premiums.
  • Younger, lower-income people would pay about the same or smaller premiums.
  • Higher-income people of most ages would pay lower premiums, on average.

Go deeper

10,000 trees near giant sequoia groves to be removed after fires

A firefighter looks up at a giant sequoia tree after fire burned through the Sequoia National Forest near California Hot Springs, California, on Sept. 23. Photo: Patrick T. Fallon/AFP via Getty Images

"Upwards of" 10,000 trees near giant sequoia groves have been "weakened by drought, disease, age, and/or fire" and must be removed in the wake of California's wildfires, the Sequoia and Kings Canyon National Parks announced.

Why it matters: The damage to these trees, considered "national treasures," and work to remove them means a nearby key highway must remain closed to visitors as they have "the potential to strike people, cars, other structures, or create barriers to emergency response services," per a statement from the national parks.

Obama stumps for McAuliffe, urges Virginians not "to go back to the chaos"

Photo: Win McNamee/Getty Images

Former President Barack Obama framed a Nov. 2 gubernatorial race as a bellwether for the Democratic Party and the country, telling a crowd at a campaign event for Terry McAuliffe on Saturday that "I believe you, right here in Virginia, are going to show the rest of the country and the world that we're not going to indulge in our worst instincts."

Why it matters: With just over a week to go before Election Day in the Commonwealth, McAuliffe is bringing out the big guns. The 44th president appeared on the campus of Virginia Commonwealth University to urge supporters to get to the polls.

Bryan Walsh, author of Future
5 hours ago - Politics & Policy

Axios AM Deep Dive: America’s murder surge

Photo illustration: Sarah Grillo/Axios. Photo: Erik McGregor/LightRocket via Getty Images

Homicides rose at the fastest rate in at least six decades last year. This Axios AM Deep Dive, led by Future correspondent Bryan Walsh, looks at the state of gun crime.