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GOP plan could leave 23 million uninsured, estimate says

Those figures are similar to earlier estimates, but the new projections also predicted that a key amendment authored by Rep. Tom MacArthur, of South Jersey, could lead to price hikes for many people with pre-existing medical conditions or who need coverage for maternity care or substance abuse.

WASHINGTON — The health-care plan approved by House Republicans this month would increase the ranks of the uninsured by 23 million over the next decade, while lowering premiums overall and cutting federal spending, according to a much-anticipated analysis released Wednesday.

And while those figures are similar to earlier estimates, the new projections from the Congressional Budget Office also predicted that a key amendment authored by Rep. Tom MacArthur of South Jersey could lead to substantial price hikes for many people with preexisting medical conditions or who need coverage for maternity care or substance abuse.

The report provided fresh arguments as Senate Republicans struggle to craft their own bill to repeal and replace the Affordable Care Act, often called Obamacare. They have vowed to go in a different direction than the House, but have been unable to forge a compromise in their narrowly divided caucus.

As they negotiate, Democrats immediately pounced on the CBO projections of uninsured Americans while Republicans pointed to the predicted $119 billion deficit reduction. Both figures were similar to a March estimate, before MacArthur's amendment, which projected a 24 million increase in the uninsured and $150 billion in savings.

The plan's effects on individuals, however, might vary widely -- with younger and healthier people likely to save money, but older and sicker individuals facing price increases, particularly in states that might take advantage of MacArthur's proposal. (The CBO did not specify which states might do so.)

"The GOP legislation may save health insurance executives and hedge fund managers a whole lot of money – but it won't save lives," Sen. Bob Menendez (D., N.J.) said in a statement.

MacArthur, questioning the findings from "a group of auditors down the block" said he would put his knowledge from decades as an insurance executive up against the CBO's. He said fewer would be uninsured if prices fall.

"If we can drive premiums down and offer meaningful help … they will buy insurance," he said.

MacArthur's amendment, critical to winning enough GOP votes in the House, would allow states to seek waivers weakening price protections for people with preexisting medical conditions and ending mandates that force insurers to cover 10 "essential health benefits" such as maternity care, substance abuse treatment, and prescription drugs.

Axing those requirements could let states lower premiums, but price out people who have the greatest insurance needs, the analysis found.

It projected that one-sixth of the country lives in states that would take advantage of the MacArthur plan. There, "people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all," the CBO wrote.

In states that eliminated the essential health benefit requirements, people who need those services "would experience substantial increases in out-of-pocket spending," the report found, particularly in areas such as maternity care and mental-health and substance-abuse services.  A rider for maternity care might cost more than $1,000 a month, the CBO estimated.

In those states using the waivers, the insurance market would grow unstable starting in 2020, the CBO wrote.

But other states could see lower costs. In those that made no change, accounting for about half the population, the CBO projected, premiums would fall by 4 percent in 2026, with younger people seeing substantial drops but older people paying more. For another third of the population, living in states expected to make smaller changes, average premiums would be roughly 20 percent lower than under the current law, "primarily because, on average, insurance policies would provide fewer benefits," the report found.