Member Article

Earlier this year, the Congressional Budget Office (CBO) released its report on the direct spending and revenue effect of H.R. 1628, the American Health Care Act of 2017 (AHCA), as passed by the House of Representatives. CBO made this estimate in conjunction with the Joint Committee on Taxation.  Their estimates predict that the AHCA will:

• Reduce the cumulative federal deficit by $119 billion
• Increase the number of uninsured by 14 million in 2014, growing to 23 million by 2026
• Significantly raise the premiums for older people and lower the premiums for younger age groups, due to a change, effective in 2019, in the rules governing how much more insurers will be permitted to charge older people than younger people
• Lower Medicaid spending by $834 billion over 10 years
• Reduce the number of people on Medicaid by 14 million by 2026
• Increase Medicare disproportionate share payments to hospitals by $43 billion over 10 years due to a jump in uninsured patients
• Substantially increase out-of-pocket costs in states that waive ACA requirements on essential health benefits, particularly for maternity, mental health, and substance abuse services.

If the CBO estimates are accurate, acute care hospitals may see a large increase in the numbers of uninsured patients seeking costly emergency department screening and care, which hospitals are obligated to provide without regard to patients’ ability to pay under the Emergency Medical Treatment and Active Labor Act.  And behavioral health service providers are likely to see a major decrease in demand for their services.  Under current law, regulations require minimum standard for benefits, including behavioral health benefits, that insurance must cover.  Under the Act, however, states would be allowed to obtain waivers to modify the requirements governing essential health benefits. Many states are expected to obtain those waivers, and demand for behavioral health services will likely decrease if these services are not covered by insurance.

It’s important to keep in mind, however, that “Trumpcare” could look significantly different before any legislation is signed into law by the President.

Sen. Lamar Alexander, chairman of the Health Education and Labor Committee responded to the CBO Report with the following statement: "It's informative to know the estimated impact of the House health care bill, but the Senate is writing its own bill, which will receive its own score from the Congressional Budget Office before the Senate votes."

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