CBO score estimating 22 million uninsured adds to difficult math for Senate health care bill

The Senate GOP’s health care bill would lead to 22 million more uninsured Americans by 2026, according to a Congressional Budget Office analysis released Monday. That’s slightly better than the CBO score for the House version of the bill. But there's a rising tide of opposition that may make it difficult to get it passed. Lisa Desjardins and Julie Rovner of Kaiser Health News join John Yang.

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    It was a big day in the fight over health care reform in the United States and the Senate's push to replace Obamacare.

    John Yang digs in to the details.


    Late today, the Congressional Budget Office issued its analysis of the Senate health care bill. It found that, by 2026, 22 million more Americans would be uninsured than under current law. It would also reduce the federal deficit by $321 billion over that period.

    Now, that estimate of uninsured Americans is slightly lower than the CBO projection for the House version, which passed in May. But a rising tide of opposition is adding to the difficult dynamics of trying to pass the Senate bill this week.

    Joining me now to break all this down, Julie Rovner. She's the chief Washington correspondent for Kaiser Health Care News. And our own Lisa Desjardins.

    Lisa, Julie, thanks for joining us.

    Julie, let me start with you.

    Drill down a little bit for us in that number of uninsured. And also what did it say about the effect on premiums?

  • JULIE ROVNER, Kaiser Health News:

    Well, basically, what the CBO said is that even though the Senate bill is different in many, many ways from the House bill, they end up in roughly the same place in terms of number of people who would be uninsured.

    Basically, both of the bills would double the percentage of people without insurance compared to the Affordable Care Act. One of the sort of remarkable things that it found is that it would do it for different reasons and in different ways.

    For example, the Senate bill would peg its help with people paying premiums to a less valuable plan, a plan that would pay fewer of people's medical expenses. And what they found is that for a lot of low-income people, even if they get help paying the premium, they wouldn't buy insurance because they wouldn't have any help using their insurance.

    The deductibles and the other cost-sharing would just be too high.


    Lisa, you were just on a conference call with the CBO. What did you learn?


    I think that is the standout point here.

    We know who these uninsured people would be. The 22 million that you just spoke about, John, those are mostly low-income Americans and some on the edge of middle class. We're talking about $30,000 in income for an individual. So, that's not poverty. That's twice the level of poverty.

    The CBO found here that some of those groups, people making under $30,000 a year, would go from about 10 do 15 percent uninsured, maybe 20 percent, to maybe 40 percent of the people making $30,000 or less would be uninsured under this plan. So, that's a big hit to that one group.


    And, Lisa, of course, you're usually up on Capitol Hill for us. What does this report do to the calculus of trying to get 50 votes by the end of this week to pass this bill in the Senate?


    Today started, and it was already very tough math.

    In fact, many of my sources all day were saying they were not sure how Senate Leader McConnell could do it. This makes it even more difficult. We have had reaction in just the last hour. Rand Paul has now said that he's going to vote not just against the bill, but to even the idea of bringing it up.

    That's a procedural vote that we expect maybe Wednesday called motion to proceed. If they can't get 51 votes for even starting this debate on that bill, it's a very bad sign. We're seeing "makes me concerned" comments from Senator Cassidy of Louisiana. John McCain said this is obviously not good news.

    Across the board, this is definitely not helping Republicans. It's not clear how this gets across the finish line.


    And, of course, the 51st vote would likely be the vice president, who would break a tie.

    Julie, it wasn't just the CBO that came out today, but there were — so there was other bad news for this Senate bill today.


    Well, there was also a plethora of interest groups. Most of the health care industry has actually come out and said they really don't — they don't like the way this — the direction this bill was going.

    Some of them vehemently oppose it. Some, including like the National Governors Association — this is the bipartisan group which is barely agrees on anything — at least came out and said we don't think it should be done this fast.

    The National Association of Medicaid Directors, the people who would be involved in actually implementing the change to this bill, came out with a very, very strong statement saying that no amount of flexibility can make up for the dollar amount of cuts to the Medicaid program in this bill.

    According to the CBO, it's 26 percent over 10 years.


    And, Julie, the Senate made a change to this bill today. What did they do and why did they do it?


    That's right.

    The Senate — the original Senate draft that we saw last week required insurers to continue to sell to people who have preexisting health conditions, but there was nothing in it to encourage or urge healthy people to actually buy insurance.

    So they put in today or at least what the CBO scored what they call a six-month lockout. So, if you had any kind of break in coverage of more than 60 days in the previous 12 months, you would have to wait six months before you could get coverage under this new bill.


    So, Lisa, you say we need 50 votes in the Senate. They have got five already saying they're against it. You have got a lot on the fence. Who should we be watching? Who will tell us in the next 48 hours whether or not this is going to pass?


    Right now, almost every Republican senator is key.

    But the one I'm watching the most closely is Senator Shelley Capito of West Virginia. Think about her state. Mr. Trump, President Trump, won that state by 42 points. If he cannot get a bill across the finish line in a state with that much support, there's a real problem.

    She has serious health problems in that state, among them, the opioid epidemic. She wants more money in this bill for that. We will see if she gets it. But that might not be enough. She has a huge Medicaid population. She's not the only one, John.

    I really ran a lot of the statistics here. Think about this. Almost half of the Republicans in the Senate have states where 20 percent of their whole population is on Medicaid. That's something they're taking very seriously with this bill.


    Julie, are we likely to see more changes in this bill as they try to get to that 50-vote mark?


    Oh, absolutely.

    One thing that the CBO — I guess one piece of good news for the Republican in the Senate is that the Senate bill would save considerably more money than the House bill. So, in theory, they have money to play with. We would expect more money to be devoting towards helping the opioid epidemic. They could make more changes.

    The problem, the difficulty is that any change that moves towards the more moderate numbers will harden the opposition, the more conservative, and any change that make the conservatives happy will harden the opposition of the moderates. So, question, they only have two votes to spare.

    Finding 50 votes, not an easy thing.


    Well, it will be a drama all week as we get toward Friday and the self-imposed deadline.

    Julie Rovner, Lisa Desjardins, thank you very much.


    Thank you.

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