UCSF Betty Irene Moore Women's Hospital in San Francisco;  an acute care room

H.R. 1628, Better Care Reconciliation Act of 2017

 CBO and the staff of the Joint Committee on Taxation (JCT) estimate that enacting the legislation — which would repeal or modify many provisions of the Affordable Care Act — would reduce federal deficits by $321 billion over the coming decade.

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of the Better Care Reconciliation Act of 2017, a Senate amendment in the nature of a substitute to H.R. 1628. CBO and JCT estimate that enacting this legislation would reduce the cumulative federal deficit over the 2017-2026 period by $321 billion. That amount is $202 billion more than the estimated net savings for the version of H.R. 1628 that was passed by the House of Representatives.

The Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law, slightly fewer than the increase in the number of uninsured estimated for the House-passed legislation. By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.

Following the overview, this document provides details about the major provisions of this legislation, the estimated costs to the federal government, the basis for the estimate, and other related information, including a comparison with CBO's estimate for the House-passed act.

Effects on the Federal Budget

CBO and JCT estimate that, over the 2017-2026 period, enacting this legislation would reduce direct spending by $1,022 billion and reduce revenues by $701 billion, for a net reduction of $321 billion in the deficit over that period (see Table 1, at the end of this document):

• The largest savings would come from reductions in outlays for Medicaid—spending on the program would decline in 2026 by 26 percent in comparison with what CBO projects under current law—and from changes to the Affordable Care Act’s (ACA’s) subsidies for nongroup health insurance (see Figure 1). Those savings would be partially offset by the effects of other changes to the ACA’s provisions dealing with insurance coverage: additional spending designed to reduce premiums and a reduction in revenues from repealing penalties on employers who do not offer insurance and on people who do not purchase insurance.
• The largest increases in deficits would come from repealing or modifying tax provisions in the ACA that are not directly related to health insurance coverage, including repealing a surtax on net investment income and repealing annual fees imposed on health insurers.

Pay-as-you-go procedures apply because enacting this legislation would affect direct spending and revenues. CBO and JCT estimate that enactment would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2027. The agencies expect that savings, particularly from Medicaid, would continue to grow, while the costs would be smaller because a rescinded tax on employees’ health insurance premiums and health plan benefits would be reinstated in 2026. CBO has not completed an estimate of the potential impact of this legislation on discretionary spending, which would be subject to future appropriation action.

Effects on Health Insurance Coverage

CBO and JCT estimate that, in 2018, 15 million more people would be uninsured under this legislation than under current law —primarily because the penalty for not having insurance would be eliminated. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 22 million in 2026. In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increases in the number of people without health insurance. By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.

Pages: 1 · 2

More Articles

• Emily's List Statement On Voting Rights Vs Senator Sinema's Lack of Support for Legislation on Voting Rights
• Updated Subsidy Calculator and 300+ FAQs Help Consumers Understand the ACA Marketplaces as Open Enrollment Begins
• Automatic Stabilizers: What Are They and Do They Help Workers Who Stay Home Due to the Corona Virus?
• The Uber and Lyft of Dog Walking Fight State Oversight
• 4.7 Million Uninsured People Nationally Could Get a No-Premium Bronze Plan in the ACA Marketplace, Though Deductibles Would be High
• Alice Rivlin Spoke About Inclusive Prosperity and the Need for Political Compromise; Vox Declared "Alice Rivlin shaped every major policy debate of the past 40 years"
• GAO Reports: Health Insurance Exchanges & College Students and Food Assistance
• The Donut Hole and Closing the Medicare Part D Coverage Gap: Trends, Recent Changes, and What’s Ahead
• Cost Estimate for the Conference Agreement on H.R. 1; Estimated Budgetary Effects
• About A Third Of Americans Unaware Of Obamacare Open Enrollment