The legislation introduced last week by Senate Majority Leader Mitch McConnell was already in jeopardy, despite expressed optimism by President Donald Trump.
With Democrats uniting in opposition to the draft, Republican leaders have struggled to rally enough support from within their ranks to get the bill over the line.
McConnell has said he wants a final vote on the bill Friday, before a brief recess for lawmakers for the July 4 Independence Day holiday, but some in the party have balked at the short timeline.
The report by the Congressional Budget Office will no doubt sow deeper concerns about the viability of the legislation, which is aimed at fulfilling Trump’s pledge to repeal the Affordable Care Act, or Obamacare, the landmark reform of his Democratic predecessor Barack Obama.
“The Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law,” the CBO said in its much-anticipated report.
The estimated increase in the number of uninsured under the bill that passed the House of Representatives last month was 23 million.
According to the CBO, the Senate legislation would also slash federal spending by some $321 billion over the 2017-2026 period, a net savings of $202 billion over the House measure.
The CBO said that the bill’s abolition of the provision requiring individuals to have insurance would lead to 15 million more uninsured people next year alone.
It also warned that some insurance premiums for individuals would be 20 percent higher next year than under current law, mainly because eliminating mandated coverage would prompt comparatively fewer healthy people to sign up.
The White House quickly dismissed the CBO report, citing what it called its “history of inaccuracy.”
– Republican holdouts -Five Senate Republicans publicly opposed the bill as drafted, even before the new CBO score.
After the score’s release, the prospect for advancing the bill was in doubt, as two Republican senators, Rand Paul and Susan Collins, said they would not vote for a motion to proceed to the legislation.
Should three Republicans join all Democrats in opposition, the bill would stall in the Senate unless McConnell returns with enough changes to draw some back on board.
“I want to work w/ my GOP & Dem colleagues to fix the flaws in ACA,” Collins, a moderate from Maine, said on Twitter, in a noteworthy expression of support for fixing, and not replacing, Obamacare.
“CBO analysis shows Senate bill won’t do it. I will vote no on mtp (motion to proceed).”
With Republicans in a 52-48 majority, McConnell can afford only two defectors. In the event of a tie, Vice President Mike Pence would still give Republicans a win.
Some Republicans have expressed concerns with the way the bill slashes the expansion of Medicaid, America’s public health program for the poor and disabled.
Thirty-one states have expanded Medicaid to include millions of people whose income is up to 38 percent above the poverty level.
Despite potential roadblocks, Trump said Republicans were working “very hard to get there, with no help from the Democrats.”
Over the weekend, Trump spoke “extensively” with Republicans, including Paul, Ted Cruz and Ron Johnson, the White House said.
But frustration with the legislation was clear.
“It’s a terrible bill,” said Paul. “Twenty-five percent of the people like it, 75 percent of people don’t like it.”
The plan would create a new system of federal tax credits to assist people buying health insurance, while allowing states the ability to drop many benefits required under the ACA, such as maternity care and emergency services.
Republicans have introduced slight changes to the legislation, including a provision that penalizes those who let their insurance lapse for 63 days or more.
The six-month “lockout” is aimed at nudging people into maintaining insurance at all times.
– ‘Giant ‘Stop’ sign’ -But misgivings about the measure have grown, particularly in states that expanded Medicaid.
Senate Democratic Minority Leader Chuck Schumer assailed the legislation, saying the CBO score confirms it is “every bit as mean as the House bill” and should be read by Republicans “like a giant ‘Stop’ sign.”
“Trumpcare will lead to higher costs and less care, and will lead to tens of millions of Americans without insurance,” he added.
Concern echoed outside Congress too, with the nation’s largest association of physicians joining other groups in sternly opposing the effort.
“Medicine has long operated under the precept of… ‘first, do no harm,'” the American Medical Association wrote to Senate Republicans.
“The draft legislation violates that standard on many levels.” DM
"By scepticism...we arrive first at suspension of judgement, and second at freedom from disturbance." ~ Sextus Empiricus