Reports suggest that Congressional Budget Office (CBO) cost estimates of the Senate’s Better Care Reconciliation Act (BCRA) give Majority Leader Mitch McConnell “a slush fund to buy moderate votes.” But, as this analysis shows, one major problem with the bill could not be solved with this extra money. Next year, the Senate bill would cause 15 million people to lose coverage and individual market premiums to rise by 20 percent, according to CBO. Both problems are structural to the legislation rather than funding related. In fact, the Senate bill tried to lower 2018 premiums through greater targeting of funding for reinsurance and failed; CBO did not change the premium increases in that year compared to its House bill estimates.
To put next year’s projected dramatic premium increases and coverage losses into perspective, we estimated how much more people in every U.S. county could expect to pay and how many individuals would lose coverage under TrumpCare in 2018.
The map below shows that, for example, a forty-year-old’s Health Insurance Marketplace premiums would increase from $494 in Blanco County, Texas to $2,376 in Yukon-Koyukuk County, Alaska. It also shows, when rolling over a county, its estimated loss of health insurance coverage. In 2018, an estimated 540 people would lose coverage in Blanco County while 180 people would lose coverage in Yukon-Koyukuk County, Alaska. An estimated 563,260 people could lose coverage in Los Angeles County, California.
Map. TrumpCare 2018 Premium Increase and Coverage Losses
Sources and Notes
County Coverage Loss Estimates: Estimates for total 2018 coverage loss (or increase in the number of uninsured) were based on CBO’s estimate of 15 million in that year (4 million in Medicaid, 4 million in employment-based coverage, and 7 million in the nongroup market). Data by county from the American Community Survey from the U.S. Census were obtained to estimate Medicaid and employment-based insurance coverage estimates by county. Estimates for Marketplace enrollment by county for 2017 were obtained from the Kaiser Family Foundation. The county coverage type data were used to calculate relative weights for each county. To estimate coverage losses from the BCRA, we assume that coverage losses within Medicaid, employer-sponsored coverage, and the individual market are proportional to county baseline enrollment in each category respectively. Total coverage loss by county represents the summation of county losses by enrollment category. The relative baseline conditions of other variables, such as local premiums and economies, are examples of additional factors that would affect the relative coverage losses across counties. These factors, however, are not considered in these estimates. Note: all numbers are rounded and may not sum to totals.
County Premium Increases: Estimated increases due to the BCRA were calculated based on the Kaiser Family Foundation data file entitled Tax Credits in 2020 for Single Coverage, available at: http://kff.org/interactive/tax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map/. The estimated total annual unsubsidized Marketplace premium under the Affordable Care Act for 2020 for a forty-year-old purchasing a silver plan was deflated to 2017 using the projections for direct purchase spending per enrollee from the National Health Expenditure Accounts. The county-level 2017 premium was then multiplied by the CBO projected increase of 20 percent.