The Senate’s new Better Care Reconciliation Act bill might have roughly the same effect on the number of people with health coverage as the health bill the House passed in May.

(Related: New Senate Health Bill Includes Waiver Wild Card)

Analysts at the Congressional Budget Office have published figures supporting that prediction in a new analysis of the BCRA bill.

A copy of the analysis is available here.

The analysts predict that, under the BCRA bill rules:

  • Individual and family enrollment could fall to 18 million by 2026, down from 19 million today. (The CBO predicted individual and family enrollment would be 19 million in 2026 under the House American Health Care Act bill rules.)

  • Group health enrollment could fall to 152 million, down from 155 million today. (The CBO predicted group health enrollment would be 149 million in 2026 under AHCA rules.)

  • The number of people with Medicaid or Children’s Health Insurance Program coverage could fall to 56 million in 2026, down from 67 million today. (The CBO predicted 57 million people would have Medicaid and CHIP coverage in 2026 under AHCA rules.)

  • The number of uninsured people could increase to 49 million in 2026, from 26 million today, and from 27 million if the current rules stay in effect and work as the CBO expects. (The CBO predicted the country would have 51 million uninsured people in 2026 under AHCA rules.)

  • The federal budget deficit would be about $321 billion smaller than it would be without BCRA-related changes in spending programs, tax programs and other programs. (The CBO predicted the AHCA bill that passed in the House would narrow the federal budget deficit by $119 billion.)

The CBO analysts predict that, especially in states that used a BCRA provision that would let them soften the current Affordable Care Act health insurance rules, the individual health insurance market would be stable.

Out-of-pocket costs and premiums might be very high, but most people would at least have the ability to buy individual coverage, the analysts predict.

In May, CBO analysts predicted the House health bill would leave consumers with health problems without access to individual commercial major medical coverage at any price in much of the country.

BCRA v. AHCA 

The BCRA bill is the Senate’s version of H.R. 1628, a bill that would replace the Affordable Care Act premium tax credit subsidy systems and repeal Affordable Care Act penalties, taxes and coverage purchase mandates. Members of the House passed another version of H.R. 1628, the American Health Care Act bill, by a 217-213 vote May 4.

Sen. John Cornyn, R-Texas, the Senate majority whip, has said Senate Majority Leader Mitch McConnell and other Senate leaders hope to have the Senate vote on the BCRA bill before members of the Senate leave for the Independence Day holiday.

Republicans hold just 52 seats in the Senate. McConnell has been struggling to get more conservative and more moderate Republicans to unite behind the same Affordable Care Act change bill.

The CBO Report

Here’s a look at what CBO analysts have been saying about actual health coverage enrollment, and about how enrollment might change under the House AHCA bill or the Senate BCRA bill.

Individual Major Medical

2013 (Mark Farrah Associates): 12.5 million

2017 (January 2017 CBO Report): 19 million

Affordable Care Act 2019 (Today’s CBO Report): 27 million

Affordable Care Act 2026 (Today’s CBO Report): 25 million

House AHCA 2019 (May 24 CBO Report): 19 million

House AHCA 2026: (May 24 CBO Report): 19 million

Senate BCRA 2019 (Today’s CBO Report): 19 million

Senate BCRA 2026: (Today’s CBO Report): 18 million

Crystal ball (Image: Thinkstock)

(Image: Thinkstock)

Employment-Based Coverage

2013 (February 2013 CBO Report): 154 million

2017 (March 2016 CBO Report): 155 million

Affordable Care Act 2019 (Today’s CBO Report): 152 million

Affordable Care Act 2026 (Today’s CBO Report): 152 million

House AHCA 2019 (May 24 CBO Report): 150 million

House AHCA 2026: (May 24 CBO Report): 149 million

Senate BCRA 2019 (Today’s CBO Report): 150 million

Senate BCRA 2026: (Today’s CBO Report): 152 million

Medicaid and Children’s Health Insurance Program:

2013 (March 2016 CBO Report): 36 million

2017 (March 2016 CBO Report): 67 million

Affordable Care Act 2019 (Today’s CBO Report): 67 million

Affordable Care Act 2026 (Today’s CBO Report): 71 million

House AHCA 2019 (May 24 CBO Report): 61 million

House AHCA 2026: (May 24 CBO Report): 57 million

Senate BCRA 2019 (Today’s CBO Report): 62 million

Senate BCRA 2026: (Today’s CBO Report): 56 million

Uninsured

2013 (March 2016 CBO Report): 58 million

2017 (Today’s CBO Report): 26 million

Affordable Care Act 2019 (Today’s CBO Report): 27 million

Affordable Care Act 2026 (Today’s CBO Report): 27 million

House AHCA 2019 (May 24 CBO Report): 43 million

House AHCA 2026: (May 24 CBO Report): 51 million

Senate BCRA 2019 (Today’s CBO Report): 43 million

Senate BCRA 2026: (Today’s CBO Report): 49 million

Where We Got These Enrollment Numbers

We used enrollment numbers from the most recent CBO report that gave the enrollment numbers in a given category.

Most of the 2013 figures come from the CBO’s February 2013 coverage effects report.

CBO analysts did not break out separate figures for commercial nongroup major medical enrollment for 2013. We filled in that gap with numbers from Mark Farrah Associates, a private research firm.

The CBO posted Affordable Care Act enrollment updates in March 2016 and January 2017.

The agency also gave 2017 enrollment numbers, and enrollment projections showing the possible effects of the House American Health Care Act bill, in a report posted May 24.

The agency gave some additional 2017 enrollment estimates, and projections showing the possible effects of the Senate’s BCRA bill, in the report released today.

Medicaid Spending

Medicaid pays for health care for poor people, and it also pays for nursing home care for people who meet state eligibility requirements.

The federal and U.S. states will spend a total of about $567 billion on Medicaid this year, according to the Centers for Medicare and Medicare Services.

The federal government will account for about $362 billion of 2017 Medicaid spending, and it’s now on track to spend about $4 trillion on Medicaid over the next 10 years.

CBO analysts predicted in May that the final version of the American Health Care Act bill that passed in the House would cut federal Medicaid spending by about $834 billion over the next 10 years, or by about 21%.

CBO analysts now predict that the Senate’s BCRA bill would cut federal Medicaid spending by about $772 billion over the next 10 years, or by about 19%. 

Affordable Care Act Rule Waivers

The Senate’s BCRA bills contains a shorter version of a House American Health Care Act bill provision that would let states get waivers from some Affordable Care Act health insurance rules.

Observers have been debating what kinds of rule waivers the BCRA bill would allow.

CBO analysts say they believe the BCRA waiver provision would let a state make rule changes that would result in fewer people having coverage, or in enrollees getting less comprehensive coverage with higher out-of-pocket costs.

The BCRA waiver provision would not let a state bring back medical underwriting or create new penalties for consumers who fail to maintain continuous coverage, the analysts write.

— Check out CBO Sees AHCA Cutting $337 Billion From the Deficit on ThinkAdvisor.