Changes Republicans made to their health bill to help pass itthrough the House would undermine insurance markets and result inmillions more people without insurance, the Congressional BudgetOffice said, an assessment that will likely complicate the GOP’seffort to repeal Obamacare.

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The CBO, which acts as Congress’s actuarial arm, said Wednesdaythat the legislation would increase the number of uninsured by 23million. The changes also mean that in some states, older or sickerpeople might not be able to afford health insurance plans. Andwomen might be forced to pay $1,000 a month to buy coverage formaternity care.

The GOP bill, formally known as the American Health Care Act,passed the House earlier this month without a score from the CBO.The agency’s harsh assessment is likely to dampen the bill’salready grim prospects in the Senate, where GOP lawmakers possessonly a slim majority.

“It’s informative to know the estimated impact of the Househealth-care bill -- but the Senate is writing its own,” saidSenator Lamar Alexander, a Tennessee Republican.

Senator Bill Cassidy, a Louisiana Republican, said the Housebill failed to meet what he called the “Jimmy Kimmel Test,” areference to the late-night talk-show host’s infant son, who wasborn with a heart defect, and the idea that any new health lawshould provide generous-enough insurance to cover critical medicalneeds.

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“Congress’s focus must be to lower premiums with coverage whichpasses the Jimmy Kimmel Test. The AHCA does not,” he saidin a statement. His Republican colleague, Senator Susan Collins ofMaine, likewise said that the GOP bill would “disproportionatelyaffect older, low-income Americans.”

GOP amendments

Republicans in the House made several last-minute amendments totheir bill to win over conservatives. The changes would allowstates to apply for waivers to Obamacare’s rules on what benefitsmust be covered by plans, and how much insurers can charge based onpeople’s age.

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While those changes helped gain votes, the CBO said thealterations would undermine protections for the sick anddestabilize insurance markets for about a sixth of the U.S.population. The changes could also lead to healthy people buyingcheaper policies and sicker people being shunted into moreexpensive plans or unable to afford coverage, according to thereport.

“The agencies expect that premiums would be substantially higherthan previously estimated for less healthy people in some statesand somewhat lower for the healthier people in those states,” theCBO said. Eventually, premiums could rise to the point that someplans would have no enrollment.

The GOP also allows states to waive certain insurance coveragerequirements, such as maternity care. That would mean people wouldhave to pay for those treatments on their own, or buy separateriders to cover them. An add-on policy that covers maternity carecould cost $1,000 a month or more, CBO said -- raising bothup-front and out-of-pocket costs for women.

Hospitals, doctors

Industry groups -- which have opposed the House Republicaneffort almost from the start -- weren’t mollified by the new CBOassessment, either. The American Medical Association, the largestlobbying group for U.S. doctors, said that the House’s changes tothe bill “offered no real improvements. Millions of Americans willbecome uninsured -- with low-income families on Medicaid being hitthe hardest.”

And the American Hospital Association, another powerful lobbyinggroup, said that it could not support the bill, which “wouldjeopardize that coverage for millions of Americans.”

House Republicans passed the legislation in a 217-213 vote onMay 4 without a final CBO score. Republicans said they disagreedwith the CBO projection released Wednesday. The bill would replacelarge parts of Obamacare, which is formally know as the AffordableCare Act.

“The Affordable Care Act is on the brink of collapse and nobureaucratic government report can change that,” saidRepresentative Tom MacArthur, the New Jersey Republican who wrotethe amendment that made many of the changes. “For all theirefforts, they are clearly not prophets.”

Health and Human Services Secretary Tom Price called the CBO’sestimates “wrong” and said the budget agency had incorrectlyforecast the results of Obamacare.

“In reality, Americans are paying more for fewer health-carechoices because of Obamacare, and that’s why the TrumpAdministration is committed to reforming health care,” Price saidin a statement.

Deficit reduction

The House GOP’s bill would reduce the deficit by $119 billionover 10 years, CBO also said Wednesday. That figure is $32 billionlower than the estimated deficit reduction under an earlier versionof the legislation.

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There are concerns that the House legislation could causeprocedural obstacles for both chambers.

Under so-called reconciliation rules that let Republicans blockDemocrats’ efforts to filibuster a vote, $1 billion of the $119billion in savings have to fall under the jurisdiction of each ofthe two Senate committees that oversee the legislation, the FinanceCommittee, as well as the Health, Education, Labor and PensionsCommittee. It may take weeks for that determination to bemade. If the House bill doesn’t pass that test, it could be sentback to the chamber for a re-vote.

Committee thresholds

One outside budget expert, Edward Lorenzen, a senior adviser forthe Committee for a Responsible Federal Budget, estimates thepolicies under the health committee’s jurisdiction could actuallycost $12.4 billion, depending on how the Senateparliamentarian rules. The group is a non-profit, bipartisan policyorganization that assesses budget and fiscal issues.

If the House bill fails to achieve the required $1 billion insavings from programs under jurisdiction of the Senate healthpanel, it could have to go back to the House for changes.

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“That means the House has to come back with a new bill and voteagain,” Senate Minority Leader Chuck Schumer, a Democrat fromNew York, said Wednesday. “It doesn’t work.”

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