Republican health reform bill would increase uninsured by 24 million in a decade, report finds

BMJ 2017; 356 doi: (Published 14 March 2017) Cite this as: BMJ 2017;356:j1315
  1. Michael McCarthy
  1. Seattle

Should the current Republican bill to replace the Affordable Care Act become law this year, 24 million more American people will be without health insurance by 2026 than would have been if the Affordable Care Act remained in place, an analysis has found.

The conclusion of the independent US Congressional Budget Office (CBO)1 is likely to stiffen opposition to the Republican bill, called the American Health Care Act. The act has already drawn criticism from most major US health organizations, including the American Medical Association and the American Hospital Association, and faces fierce opposition from Democrats.

“These are remarkable figures,” Nancy Pelosi, democratic leader of the House of Representatives, said after the CBO released its findings. “It speaks so eloquently to the cruelty of the bill.”

Members of the administration quickly dismissed the CBO’s report. ”It’s just not believable,” said Tom Price, director of Health and Human Services.

President Donald Trump has promised that his party’s reform of the 2010 Affordable Care Act would “expand choice, increase access, lower costs, and at the same time, provide better healthcare.”

The CBO analysis found that the Republican bill, now under consideration in the US House of Representatives, would save money, reducing the federal deficit by $337bn (£276bn; €316bn) between 2017 and 2026. But the report also found that under the law 14 million fewer people would have coverage in 2018, 21 million fewer by 2020, and 24 million fewer by 2026 than would have been covered if the Affordable Care Act remained intact.

The savings would come in part from reducing spending for Medicaid, the insurance plan for low income individuals and families and for those with disabilities, and by eliminating the subsidies that currently help low and moderate income consumers to purchase coverage on the health insurance exchanges created by the Affordable Care Act.

Since its passage, the Affordable Care Act has provided insurance to more than 20 million people who previously lacked coverage, helping to drive the rate of uninsured people in the US from 17% in 2013 to a historic low of 10.9% in 2016. However, should the Republican plan become law, the CBO analysis estimated that 52 million people in the US would not have health insurance by 2026, compared with the 28 million of uninsured people projected under the Affordable Care Act.

The CBO also found that, on average, premiums for individuals buying insurance in the non-group market would rise 15% to 20% in 2018 and 2019 but would then decline, and by 2026 they would be roughly 10% lower than they would be under the current law. However, because the proposed law allows insurers to charge older enrollees five times more than they charge younger enrollees—compared with just three times more under the Affordable Care Act—premiums would be reduced substantially for young adults but increased substantially for those who are older.

“Premiums in the non-group market would be 20-25% lower for a 21 year old and 8-10% lower for a 40 year-old—but 20-25% higher for a 64 year old,” the report said.

The CBO did not find that the individual non-group health insurance market was in a “death spiral,” as has been claimed by the current law’s opponents. “The non-group market would probably be stable in most areas under either current law or the legislation,” the report said.


  • Observations Will the Republican replacement for Obamacare become law? (doi:10.1136/j1291)


View Abstract

Log in

Log in through your institution


* For online subscription