While certain changes helped gain votes in the House, the CBO said the alterations to the AHCA bill would undermine protections for the sick and destabilize insurance markets for about a sixth of the U.S. population. (Photo: Getty)

Changes Republicans made to their health bill to help pass it through the House would undermine insurance markets and result in millions more people without insurance, the Congressional Budget Office said, an assessment that will likely complicate the GOP’s effort to repeal Obamacare.

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The CBO, which acts as Congress’s actuarial arm, said Wednesday that the legislation would increase the number of uninsured by 23 million. The changes also mean that in some states, older or sicker people might not be able to afford health insurance plans. And women might be forced to pay $1,000 a month to buy coverage for maternity care.

The GOP bill, formally known as the American Health Care Act, passed the House earlier this month without a score from the CBO. The agency’s harsh assessment is likely to dampen the bill’s already grim prospects in the Senate, where GOP lawmakers possess only a slim majority.

“It’s informative to know the estimated impact of the House health-care bill — but the Senate is writing its own,” said Senator Lamar Alexander, a Tennessee Republican.

Senator Bill Cassidy, a Louisiana Republican, said the House bill failed to meet what he called the “Jimmy Kimmel Test,” a reference to the late-night talk-show host’s infant son, who was born with a heart defect, and the idea that any new health law should provide generous-enough insurance to cover critical medical needs.

Related: House may be forced to vote again on GOP’s ACA repeal bill

“Congress’s focus must be to lower premiums with coverage which passes the Jimmy Kimmel Test. The AHCA does not,” he said in a statement. His Republican colleague, Senator Susan Collins of Maine, likewise said that the GOP bill would “disproportionately affect older, low-income Americans.”

GOP amendments

Republicans in the House made several last-minute amendments to their bill to win over conservatives. The changes would allow states to apply for waivers to Obamacare’s rules on what benefits must be covered by plans, and how much insurers can charge based on people’s age.

Related: Senate GOP trying to craft ACA repeal

While those changes helped gain votes, the CBO said the alterations would undermine protections for the sick and destabilize insurance markets for about a sixth of the U.S. population. The changes could also lead to healthy people buying cheaper policies and sicker people being shunted into more expensive plans or unable to afford coverage, according to the report.

“The agencies expect that premiums would be substantially higher than previously estimated for less healthy people in some states and somewhat lower for the healthier people in those states,” the CBO said. Eventually, premiums could rise to the point that some plans would have no enrollment.

The GOP also allows states to waive certain insurance coverage requirements, such as maternity care. That would mean people would have to pay for those treatments on their own, or buy separate riders to cover them. An add-on policy that covers maternity care could cost $1,000 a month or more, CBO said — raising both up-front and out-of-pocket costs for women.

Hospitals, doctors

Industry groups — which have opposed the House Republican effort almost from the start — weren’t mollified by the new CBO assessment, either. The American Medical Association, the largest lobbying group for U.S. doctors, said that the House’s changes to the bill “offered no real improvements. Millions of Americans will become uninsured — with low-income families on Medicaid being hit the hardest.”

And the American Hospital Association, another powerful lobbying group, said that it could not support the bill, which “would jeopardize that coverage for millions of Americans.”

House Republicans passed the legislation in a 217-213 vote on May 4 without a final CBO score. Republicans said they disagreed with the CBO projection released Wednesday. The bill would replace large parts of Obamacare, which is formally know as the Affordable Care Act.

“The Affordable Care Act is on the brink of collapse and no bureaucratic government report can change that,” said Representative Tom MacArthur, the New Jersey Republican who wrote the amendment that made many of the changes. “For all their efforts, they are clearly not prophets.”

Health and Human Services Secretary Tom Price called the CBO’s estimates “wrong” and said the budget agency had incorrectly forecast the results of Obamacare.

“In reality, Americans are paying more for fewer health-care choices because of Obamacare, and that’s why the Trump Administration is committed to reforming health care,” Price said in a statement.

Deficit reduction

The House GOP’s bill would reduce the deficit by $119 billion over 10 years, CBO also said Wednesday. That figure is $32 billion lower than the estimated deficit reduction under an earlier version of the legislation.

Related: Trump reportedly wants to end insurer subsidies 

There are concerns that the House legislation could cause procedural obstacles for both chambers.

Under so-called reconciliation rules that let Republicans block Democrats’ efforts to filibuster a vote, $1 billion of the $119 billion in savings have to fall under the jurisdiction of each of the two Senate committees that oversee the legislation, the Finance Committee, as well as the Health, Education, Labor and Pensions Committee. It may take weeks for that determination to be made. If the House bill doesn’t pass that test, it could be sent back to the chamber for a re-vote. 

Committee thresholds

One outside budget expert, Edward Lorenzen, a senior adviser for the Committee for a Responsible Federal Budget, estimates the policies under the health committee’s jurisdiction could actually cost $12.4 billion, depending on how the Senate parliamentarian rules. The group is a non-profit, bipartisan policy organization that assesses budget and fiscal issues.

If the House bill fails to achieve the required $1 billion in savings from programs under jurisdiction of the Senate health panel, it could have to go back to the House for changes. 

Related: American health care ranking an ‘embarrassment’

“That means the House has to come back with a new bill and vote again,” Senate Minority Leader Chuck Schumer, a Democrat from New York, said Wednesday. “It doesn’t work.”

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