On Wednesday, the CBO confirmed what Republicans didn’t want to hear: Their changes to the bill had made only modest improvements to the number of people who could lose coverage (23 million instead of 24 million) and to the average cost of premiums, but they had made insurance all but unaffordable for people with preexisting conditions in states that wriggled out of Obamacare’s requirements. “Less healthy people would face extremely high premiums, despite the additional funding that would be available under H.R. 1628 to help reduce premiums,” the CBO wrote.
Republicans professed surprise. Representative Mark Meadows of North Carolina, the conservative House Freedom Caucus chairman who helped write the waiver amendment, initially doubted reporters who showed him CBO’s findings on Wednesday. Then, according to both the Independent Journal Review and the Washington Examiner, he grew emotional as he recalled losing both his father and his sister to cancer. “If anybody is sensitive to preexisting conditions, it’s me,” the congressman said. “I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself.”
Meadows suggested he’d be open to having the Senate add more money to bolster the high-risk pools. “In the end what we’ve gotta do is make sure there is enough funds there to handle preexisting conditions and drive down premiums,” Meadows told the reporters. “If we can't do those three things then we will have failed.”
Another supporter of the bill, Representative Pete Sessions of Texas, told reporters he assumed no state would take advantage of the waivers—a sentiment other House Republicans voiced in justifying their votes for the legislation. The CBO disagreed, projecting that as much as one-sixth of the nation’s population resides in states that would seek the maximum exemptions from Obamacare’s federal mandates.
The idea behind a high-risk pool is that instead of forcing younger, healthier people to pay higher premiums to cover the costs of the sickest, most expensive consumers of health care in a general insurance market, the government would heavily subsidize people with preexisting conditions in the separate pool while spending less money on the broader population. Some health policy analysts have said this arrangement could work—but only if the government provides enough funding for the high-risk pools. And in that regard, the money Republicans set aside in the AHCA wasn’t nearly enough. In a report released last week, the Urban Institute found that under the most conservative projection, the high-risk pools in the GOP bill would need at least $359 billion over 10 years—about three times as much as Republicans allocated. It could potentially be much more.
Not everyone was taken aback by the CBO’s findings. Ryan largely embraced them, saying he was “comforted” that the report confirmed that the GOP had achieved its goal of lowering average premiums and reducing the deficit (a requirement for the Senate’s budget rules). As for people with preexisting conditions, the speaker reminded reporters that states have been running high-risk pools for years—including in his own Wisconsin—and would be contributing substantially to their funding as well. “Remember, the states will also do some of the lifting,” Ryan said. “We will have federal resources and state resources, which taken together will improve the situation.”