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A nonpartisan budget analysis out Monday estimates that 14 million Americans will lose healthcare coverage beginning next year under the American Health Care Act, the plan Republicans have crafted to replace the Affordable Care Act. By 2020, the Congressional Budget Office estimates that that number will climb to 21 million. And by 2026, 24 million more people will go without insurance than would have under the Affordable Care Act, bringing the total number of uninsured Americans to 52 million. That is a lot of people without insurance.

Republicans announced their plan last week, tossing out many of Obamacare’s signature features including a tax on people who don’t purchase insurance, the so-called individual mandate. Most of the increase in uninsured, the CBO said, would come from repealing penalties associated with that mandate—after all, some people only have health insurance today to avoid paying extra at tax season. Others Americans will skip healthcare coverage under the new system in response to higher premiums.

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Additionally, where the Affordable Care Act expanded Medicaid to cover millions of low-income Americans, the new legislation would “freeze” that coverage expansion beginning in 2020. Between 2018 and 2026, changes to Medicaid enrollment would contribute to the growing pool of uninsured people.

Republicans have been on the defensive about the CBO’s assessment of the American Health Care Act since the legislation was first announced.

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“In the past, the CBO score has really been meaningless,” White House economic advisor Gary Cohn said on Fox News Sunday. “They have said that many more people will be insured than are actually insured.”

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The CBO was indeed off in some of its assessments of the ACA. It initially estimated that it would bring coverage to 21 million by 2016, while as of last June, about 10.4 million people had signed up. Other estimates, like the insured rate for non-elderly adults, were more accurate. In 2010, the CBO expected that number to rise to 92% by 2016; it hit 89.7%.

The analysis estimates that enacting the AHCA would reduce federal deficits by $337 billion between 2017 and 2026. The tax credits that will replace health care subsidies under the new plan, the analysis said, would be “less generous for those receiving subsidies under current law” but other changes would lower average premiums to attract enough healthy people to stabilize the health care market, the CBO concludes. In the long term, average premiums for individuals would decrease as Medicaid expansion winds down. But in immediate future, those premiums could skyrocket as much as 20%. Meanwhile, the poor are more likely to be out of luck when it comes to health insurance, period.

The findings by the CBO may make it hard for Republicans to get the legislation through in its current form—especially as some of them have already been taking heat from constituents concerned about losing access to health care coverage.