Worried about the number of Americans who still don’t have health insurance? If House Republican leaders get their way, the number will be much bigger -- maybe even twice as big.
That may sound ridiculous. But health care analysts tell The Huffington Post that it’s a fair interpretation of the proposed 2016 budget that Rep. Tom Price (R-Ga.), the chairman of the House Budget Committee, released on Tuesday.
Price's document includes two familiar ideas for transforming major government health care programs: repealing the Affordable Care Act, a.k.a. Obamacare, and transforming Medicaid into a “block grant” program. It’s difficult to be terribly precise about the impact these changes would have, at least without some kind of formal economic modeling. But it's possible to do a rough calculation using estimates from independent experts and the Congressional Budget Office of previous proposals with similar elements, including the budgets that Rep. Paul Ryan (R-Wis.) issued when he was in charge of the budget committee.
Start with the likely impact of Obamacare repeal. The health care law -- beloved by some, hated by others -- makes Medicaid available to all low-income people in participating states, provides discounted private insurance to people buying on their own, and lets young adults stay on their parents’ plans. As a result, the number of people without health insurance today is down to 35 million, according to CBO. Over the next several years, that number is set to drop even further, to about 26 million. Without the law in place, by CBO’s reckoning, the ranks of the uninsured at this point would have been around 50 million -- and that number is projected to remain steady or increase slightly over the next decade. Taking the ACA off the books, as Price and his GOP allies hope to do, would likely boost the number of uninsured back up to that level or close to it.
Yes, the House Republican budget does call for an Obamacare “replacement.” But the budget provides almost no details about what that replacement might look like and earmarks no funds for that purpose. It’s merely a vow to find some other means of expanding coverage and then somehow pay for it -- something Republicans have been promising, and failing, to do for as long as the Affordable Care Act has been on the books. Even if Republicans did agree on a replacement, it would likely reach only a fraction of the uninsured people that the ACA does.
And Obamacare repeal is only the first way in which Price’s health care agenda would increase the number of uninsured. Turning Medicaid into a block grant, as the House budget seeks to do, would mean ending the program’s current guarantee: that, as more people fall into the program’s eligibility guidelines, the federal government will provide more money. Under a block grant scheme, by contrast, the federal government would start giving states fixed sums of money with which to administer the program. Given the funding levels Price’s budget appears to set, the money almost certainly wouldn’t keep up with demand for the program.
In reality, these block grants are huge budget cuts by another name. States would find it impossible to maintain the Medicaid rolls at those funding levels, and start removing people from the program as a result. How many? Price’s budget doesn’t provide the same level of detail that Ryan’s early budgets did. But the proposals appear to be very similar. And an estimate of Ryan’s 2012 scheme, put together by researchers from the Urban Institute and published by the Kaiser Family Foundation, suggested that by 2022, turning Medicaid into a block grant would reduce the number of people receiving insurance through the program by between 14.3 million and 20.5 million.
Again, this would be on top of the people who would lose insurance thanks to repeal of Obamacare. Add the numbers together and, come 2022, something like 60 or 70 million people who would have gotten insurance through either Medicaid or Obamacare would no longer have it. Few of these people would be able find insurance through other means. The result could be close to twice as many uninsured Americans as the estimated 35 million who lack insurance today -- or possibly even more. (And it’d certainly be more than twice as many as the 26 million who, according to the CBO, would remain uninsured in 2022 under the status quo.)
According to Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, "It is likely that tens of millions of people will lose health coverage and become uninsured (or remain uninsured) under the House budget plan -- 25 million more people uninsured through the repeal of the ACA coverage expansions and many millions more would likely become uninsured under the proposal to convert Medicaid to a block grant."
William Allison, a spokesman for the House Budget Committee, told HuffPost such changes are necessary -- and worthwhile, given the troubles that the Affordable Care Act and the Medicaid program have created.
“Obamacare is harming individuals, families and physicians," he said. "Folks are facing higher premiums and being kicked off their preferred plans, losing access to doctors they know and trust, while taxes and regulations are stifling medical innovation. Our budget would repeal in its entirety this disastrous law, and lay the groundwork for patient-centered health care reforms that would increase coverage, lower costs and provide better outcomes for patients and families.”
To be clear, the budget is merely a spending blueprint that Congress sets for itself. Even if Senate Republicans go along with what Price and House Republicans want, both chambers would still have to pass spending bills that carry out those instructions, and then President Barack Obama would have to sign them. Neither is going to happen. But the annual budget documents are statements of priorities -- about the kinds of trade-offs in public policy that party leaders find acceptable.
Republicans boast that their budget would mean smaller government, lower taxes and less regulation -- changes that, they say, would be good for the country as a whole. Maybe that's true and maybe that isn't; it's a judgment call, obviously. But one clear cost of those changes will be depriving not just millions, but tens of millions, of the health insurance they currently stand to keep.