The Republican legislation that would repeal and replace the Affordable Care Act – also known as Obamacare – would reduce the federal deficit by $119 billion. But that would come at the expense of 23 million people who would not be able to afford health insurance over the next decade.
That's according to a new analysis from the nonpartisan Congressional Budget Office released Wednesday.
In Kentucky, almost half a million people gained health insurance via the law -- most of them through the state's expansion of Medicaid to people making around $15,000.
What would the House GOP bill do?
The American Health Care Act would do away with subsidies for those who purchased health insurance plans via state-based and federal exchanges, and allow states to let insurers to once again deny insurance to people who are already sick or have had a lapse in coverage.
People without a health problem would be able to buy insurance based on their health. As a result, insurance for sick people would become even more expensive. The House Republican bill would also put in place tax credits for health insurance premiums based on age.
"If you start to make changes to make premiums more affordable, you get back to the original outline of the ACA," said Sara Collins, vice president of health care coverage and access at research group The Commonwealth Fund.
One in six people in the U.S. would live in an area where there are no insurers left or premiums would be so high that it would be unaffordable, according to the CBO report.
What about the 10 Essential Health Benefits?
States could also apply to do away with the 10 essential health benefits that people are now required to have covered. That includes mental health treatment, maternity coverage, prescription drugs and doctor’s visits. Kentucky would likely be one of those states, as Gov. Matt Bevin has already asked to make some benefits in Medicaid harder to get.
That would result in premium decreases because insurance companies could pay for less. But since insurance companies would be able to charge based on age and health status, premiums wouldn’t decrease by much for older, sicker people.
What does this mean for Congress' repeal and replace effort?
Because such a large number of people would become uninsured, the Senate will likely not use much of what the House version had. What might be similar is doing away with the Medicaid expansion program. But that will likely be a gradual tapering off, according to Mark Alderman, a Democratic campaign strategist.
As for the House bill: “It’s going absolutely nowhere,” according to Alderman. House Republicans have said as much.
What does this mean for Kentucky legislators who voted for the AHCA?
The Democratic Party in Kentucky will likely use Republican yes votes as ammunition during the next campaign season.
“This is about politics for my Republican colleagues, but it has life-or-death consequences for far too many Americans," said U.S. Rep. John Yarmuth of Louisville. Yarmuth is also ranking member of the House Budget Committee.
While Republicans might say that a reduction of national debt is the responsible thing to do, it’s important to look at where that reduction comes from. Part is rolling back Medicaid expansion – that would save money.
But the bill also does away with a tax on people making more than $200,000 a year that helps pay for the expansion.
Fourth District U.S. Rep. Thomas Massie, a Republican who voted against the AHCA, had no comment. Three other Republicans from Kentucky -- Reps. Andy Barr, James Comer, Brett Guthrie -- did not respond to a request for comment.
U.S. Rep. Hal Rogers, a Republican who represents Kentucky's 5th District, focused his comments on the CBO's prediction that the bill would lower the deficit.
"As predicted, the CBO score confirms that the American Health Care Act moves the nation toward a more affordable health care system that lowers health insurance premiums and reduces the federal deficit by $119 billion," Rogers said. "However, there is still work to do as the bill moves on to the U.S. Senate."
