Twenty-two million Americans would lose insurance over the next decade under the healthcare bill drafted by US Senate Republicans, a nonpartisan congressional office said on Monday, likely making it more difficult for the already fraught legislation to win support for speedy passage.
Senate Majority Leader Mitch McConnell is trying to reconcile the demands of moderate Republicans concerned about people losing their insurance with those of conservative senators who say the bill does not do enough to repeal Obamacare.
The assessment by the Congressional Budget Office (CBO) that an additional 15 million people would be uninsured by 2018 likely complicates McConnell's goal of scheduling a vote on the bill before the July 4 recess that starts at the end of this week.
Republicans have a 52-seat majority in the 100-seat Senate and Democrats are united in opposition. McConnell can lose just two Republican senators, relying on Vice President Mike Pence to cast a tie-breaking vote.
"If you are on the fence ... this CBO score didn't help you, so I think it's going to be harder to get to 50, not easier,” Republican Senator Lindsey Graham said of the bill's prospects.
The CBO score is also likely to amplify criticism from industry groups such as the American Hospital Association and American Medical Association, which said earlier on Monday that the Senate's bill violated the doctors' precept of "first, do no harm."
The CBO is only able to assess the impact of legislation within a 10-year window, but it said that insurance losses are expected to grow beyond 22 million due to deep cuts to the Medicaid insurance program for the poor and disabled that are not scheduled to go into effect until 2025 under the bill.
Republicans view Obamacare as costly government intrusion and say that individual insurance markets are collapsing. The legislation expanded health coverage to some 20 million Americans, through provisions such as mandating that individuals obtain health insurance and expanding Medicaid.
The CBO score on the bill was released just hours after Republicans unveiled revisions to the original Senate bill, adding a measure that would penalise people who let their insurance coverage lapse for an extended period, following criticism that the original bill would result in a sicker – and more expensive – insurance pool.
Trump called House bill 'Mean'
At least four conservative Republicans – Senators Ted Cruz, Rand Paul, Ron Johnson and Mike Lee – have expressed opposition to the Senate legislation, saying it does not go far enough in repealing Obamacare.
Several moderate Republicans have warned against replacing Obamacare with legislation that is similar to the version passed by the House of Representatives, saying it would cause too many people, especially those with low incomes, to lose health coverage.
The CBO estimated that the House bill would cause 23 million people to lose insurance. In a meeting with Senate Republicans, Trump had called the House bill "mean" and asked them to come up with "more generous" legislation.
The White House in a statement on Monday criticised the CBO for issuing a "flawed report" and said its assessments should not be "trusted blindly."
As he did during the House negotiations, Trump has personally pushed for a Senate bill, calling fellow Republicans to mobilise support.
Industry groups have been critical of the Senate bill's proposal to put the Medicaid healthcare program for the poor on a budget.
The American Medical Association said this could "fail to take into account unanticipated costs of new medical innovations or the fiscal impact of public health epidemics, such as the crisis of opioid abuse currently ravaging our nation."
Health insurance companies have expressed concern about the bill's plan to cut Medicaid and the impact on state governments as well as the prospect of losing Obamacare's mandate on individuals to buy insurance.
Under Senate rules, the bill must replicate savings projected in a House version of the legislation that passed last month and it cleared that critical hurdle, with the CBO estimating it would decrease the budget deficit by $321 billion over 2017-2026.
The revision to the bill that imposes a penalty for prolonged lapses in insurance coverage addresses the original bill's provision to drop the Obamacare penalty on those who do not have insurance. Experts had warned that cancelling the fine could lead to a sicker pool of people with insurance because young and healthy people would not face consequences for failing to purchase insurance.
The revised bill would impose a six-month waiting period for anyone who lets their health insurance lapse for over 63 days and then wants to re-enroll in a plan in the individual market.
The 15 million people the CBO estimates would be uninsured by 2018 is largely due to the repeal of the penalty associated with being uninsured. The CBO did not evaluate the revised version of the bill that included the new waiting period, which could provide healthier people with an incentive to maintain insurance coverage.
Insurer Blue Cross and Blue Shield said in a statement that it was encouraged by the steps in the revised bill to make the individual insurance market more stable, including strong incentives for people to stay covered continuously.
If the Senate passes a bill, it will either have to be approved by the House, the two chambers would have to reconcile their differences in a conference committee, or the House could pass a new version and bounce it back to the Senate.