The Senate Republican health care bill would leave 22 million more Americans uninsured in 2026 than under President Barack Obama's health care law, the Congressional Budget Office estimated Monday, complicating GOP leaders' hopes of pushing the plan through the chamber this week.
Minutes after the report's released, three GOP senators threatened to oppose a pivotal vote on the proposal this week, enough to sink it unless Senate Majority Leader Mitch McConnell, R-Ky., can win them over. The bill will fail if just three of the 52 Republican senators oppose it, an event that would deal a humiliating blow to President Donald Trump and Senate leaders.
The 22 million additional people without coverage is just a hair better than the 23 million who'd be left without insurance under the measure the House approved last month, the budget office has estimated. Trump has called the House version approved last month "mean" and told Senate Republicans to approve legislation with more "heart."
In good news for the GOP, the budget office said the Senate bill would cut the deficit by $202 billion more over the coming decade than the House version. Senate leaders could use some of those savings to attract moderate support by making Medicaid and other provisions in their measure more generous, though conservatives would prefer using that money to reduce federal deficits.
The White House lambasted the nonpartisan budget office in a statement, saying it has a "history of inaccuracy" projecting coverage. But Democrats said the report confirmed their own analysis of the GOP measure.
"This bill is every bit as mean as the House bill," said Senate Minority Leader Chuck Schumer, D-N.Y.
Of the 22 million without coverage by 2026 under the Senate plan, 15 million would be without it next year, the budget office said. That could be a particular concern to moderate Sen. Dean Heller, R-Nev., who faces perhaps the toughest 2018 re-election race of any Senate Republican and has said he can't support the measure if huge numbers of people lose coverage.
The budget office report said coverage losses would especially affect people between ages 50 and 64, shy of when they qualify for Medicare, and with incomes below 200 percent of the poverty level, or around $30,300 for an individual.
Moderate Sen. Susan Collins, R-Maine, said she would vote against a GOP procedural motion, expected Wednesday, to begin formally debating the legislation. She tweeted that she favors a bipartisan effort to fix Obama's 2010 statute but added, "CBO analysis shows Senate bill won't do it."
In addition, conservative Sen. Rand Paul, R-Ky., said he would oppose that motion unless the bill was changed. And fellow conservative Ron Johnson, R-Wis., said he had "a hard time believing" he'd have enough information to back that motion this week.
Those two — plus fellow conservatives Mike Lee of Utah and Ted Cruz of Texas — have said the current measure doesn't do enough to erase Obama's law and reduce premiums. All four said last week they'd oppose the bill without changes, as did Heller.
Most of the disgruntled senators have left the door open to backing the measure if it's changed, and McConnell plans to seek revisions aimed at winning more votes. But taking steps to mollify moderates could alienate conservatives.
"It's going to be very close, but we're working with each one of them in trying to accommodate their concerns without losing other support," said No. 2 Senate GOP leader John Cornyn of Texas.
Vice President Mike Pence invited four GOP senators to dinner Tuesday to discuss the bill, his office said: Lee and Sens. James Lankford of Oklahoma, Tom Cotton of Arkansas and Ben Sasse of Nebraska.
The Senate plan, aimed at rolling back much of Obama's 2010 statute, would end the tax penalty that law imposes on people who don't buy insurance, in effect erasing Obama's so-called individual mandate. It would let states ease Obama's requirements that insurers cover certain specified services like substance abuse treatments, and eliminate taxes on wealthier people and medical companies that Obama's law used to expand coverage.
It would also phase out extra federal money that law is providing to 31 states to expand Medicaid to additional low-income earners. And it would put annual caps on overall Medicaid money the government until now has automatically paid states, whatever the costs.
CBO said that under the bill, most insurance markets around the country would be stable before 2020. It said that similar to the House bill, average premiums around the country would be higher over the next two years — including about 20 percent higher in 2018 than under Obama's statute — but lower beginning in 2020.
But the office said that overall, the Senate legislation would increase out of pocket costs for deductibles and copayments. That's because standard policies would be skimpier than currently offered under Obama's law, covering a smaller share of expected medical costs.
In another troublesome finding for the legislation, the budget office warned that in some rural areas, either no insurer would be willing participate in the individual market or the policies offered would be prohibitively expensive. Rural America was a stronghold for Trump in the presidential election.
The American Medical Association, the nation's largest doctors' group, said it opposed the Senate bill, saying some people would lose coverage and others would find it too costly. In a letter to Senate leaders, they said the measure violates the physicians' dictum, "First, do no harm."