A new analysis from the nonpartisan Congressional Budget Office found that the Senate’s plan to overhaul the Affordable Care Act would have much the same effect as the plan passed in May by the House—drastically changing how Americans get health insurance, especially older, sicker, and poorer people.

Key Findings in the CBO Report

  • Millions more will be uninsured. By 2026, 22 million more Americans would be uninsured under the GOP plan than if the ACA remained in place. That’s 1 million fewer than under the House bill, which the CBO analyzed last month. In total, 49 million people in the U.S. will be uninsured by 2026, compared with 28 million under the ACA.
  • Medicaid recipients are hit hardest. Fifteen million of the 22 million will be dropping from Medicaid, the government health insurance program for low-income, disabled, and elderly Americans, as well as children with special needs.
  • Premiums will rise quickly but then decline, in part because plans will be skimpier. The CBO estimates that insurance premiums—a major point of dissatisfaction for people now on ACA plans—will rise by an average of 20 percent in 2018 but would be 20 percent lower, on average, in 2026, than premiums would have been under current law. Most of that decline will stem from the fact that insurers will be offering much less comprehensive policies that will require greater out-of-pocket spending by consumers for expenses such as deductibles and co-pays. 
  • Cutting Medicaid and reducing subsidies will save the government big money. The GOP plan would save the federal government $321 billion over 10 years, mostly by reducing the number of people on Medicaid and changing how the government awards subsidies to people who buy insurance on their own.
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Consumer groups and many in the medical community were quick to respond to the CBO report, reiterating opposition to the Senate plan, as well as earlier legislation from the House.

“A more accurate name for the Senate bill would be ‘Pay More for Less Care,’” says Betsy Imholz, special projects director for Consumers Union, the policy and mobilization arm of Consumer Reports. “The CBO confirmed what every public interest, medical, hospital, and patient group has been saying—this bill would take insurance away from millions, decimate Medicaid, cost consumers more in premiums and out-of-pocket expenses, and leave the lucky few who can afford insurance with skimpy plans that aren’t required to cover basic care, including emergency, maternity, and prescription drug coverage.”

The CBO produced its analysis quickly even though the Senate, working secretly for weeks, unveiled the legislation for the first time last Thursday. Though there are some differences from the House’s plan, the Senate’s Better Care Reconciliation Act for the most part builds on the AHCA.

GOP leaders in both chambers say repealing the Affordable Care Act is necessary because premiums are rising on the health insurance exchanges and because states should have greater leeway in offering Americans more affordable healthcare options.

This isn’t likely to be the final version of the Senate legislation, which could be voted on as soon as Thursday. Additional amendments are expected to be added before the Senate finalizes the legislation, which means the CBO score doesn’t capture the whole impact of the proposed law.

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Already, an amendment has been added since the legislation was unveiled last week, a provision would lock people out of buying insurance for six months if they lacked coverage for more than about two months in the prior year.

The waiting period is designed to address a glitch in the original Senate plan. The Senate’s plan would would have ended the ACA’s individual mandate that almost all Americans have health insurance. But it also would require insurers to accept anyone who applies.

That would put a strain on insurance companies because they need a large number of healthy people as customers to help pay for those who are sick. The new amendment, it’s hoped, would stop people from waiting until they get sick to purchase a health plan.

Even if there are more last-minute changes, the overall effect the BCRA will have on Americans’ health insurance is clear, healthcare experts say.

“The Senate legislation will cause a lot of people to lose their healthcare coverage, but doing that will save the federal government a lot of money,” says Chris Sloan, a senior manager in the policy practice at Avalere Health, a healthcare consulting firm.

Sloan says that although premiums may be lower on average, the CBO analysis also projects much higher out-of-pocket costs for expenses such as deductibles, thousands of dollars you must pay before your insurance starts to kick in.

“You may be able to afford your premiums, but your out-of-pocket costs will be so high, a lot of people won't be able to afford to use their health insurance,” Sloan says.