Changes that House Republicans have made to their health-care legislation would reduce savings in federal spending by half as much as their original plan and would still cause 24 million more Americans to be uninsured, according to congressional budget analysts.
The estimates by the Congressional Budget Office arrived late Thursday afternoon as House Speaker Paul Ryan, R-Wis., and the Trump administration were scrambling to corral enough support to put the legislation that erases major parts of the Affordable Care Act to a vote.
According to the CBO's projections, a set of amendments that House GOP leaders agreed to support Monday night would cut the federal deficit by $150 billion between 2017 and 2026. The original version of the American Health Care Act, as the bill is called, would have curbed the deficit by an estimated $337 billion in that period.
The changes would have less impact on savings because they would make it easier for Americans to deduct the cost of medical care from their income taxes and would accelerate by a year the repeal of several taxes that help pay for the ACA, including taxes on insurers, hospitals, high-income adults and tanning beds.
Other changes to the bill would increase federal spending for Medicaid, the estimate says, in part by altering payments states receive for their most expensive enrollees - people who are elderly or disabled.
The fresh analysis says the amendments would not affect the number of Americans who would be uninsured if the bill were to become law. Compared with the current law, the CBO projects that 14 million more people would be uninsured next year and 24 million more by 2026. Those were the same figures as in its first, much-anticipated report, issued last week, on the House GOP plans.
Nor would the amendments make much difference to the typical cost of health plans. For the next two years, insurance premiums for individuals buying coverage on their own would increase by 15 to 20 percent compared with the ACA - only marginally different than the 18 to 20 percent rise predicted for the bill's original version. In 2026, both plan versions would lead to a 10 percent reduction in average premiums, the CBO said.
The new forecast does not take into account any of the ideas for tipping federal health-care policy even further in conservative directions - which are being advanced by members of the House Freedom Caucus. The caucus, the chamber's faction on the hard right, is lobbying to eliminate a requirement that insurance plans include 10 basic health benefits in the policies sold to individuals and small businesses.
The updated analysis elicited no immediate response from Ryan or the GOP leaders of four House committees that have raced in recent weeks to assemble and approve the legislation.
Rep. Steve King, a conservative Republican from Iowa, put the deficit number in a broader context. "None of us that want to save money are happy about the direction that's going," King said, "but as a matter of principle, it's more important that we eliminate mandates than it is that we [save] $200 billion over 10 years."
Last week, Ryan talked up the portion of the first CBO analysis that predicted the large reduction in the federal deficit, while White House officials sought to tar the report's accuracy. The Freedom Caucus has complained that the legislation would still devote too much federal money to health spending.
Caucus members had not commented Thursday evening on the updated analysis and its finding that adjustments to the bill would leave the deficit in worse condition than the original version.
The bill is intended as a first stage in fulfilling Republicans' years-long pledge to unwind the 2010 law adopted by a Democratic Congress - and to replace all but its most popular parts with conservative policies. This stage focuses on the spending parts of the current law because congressional leaders are relying on a budget strategy called "reconciliation." If the House passes the bill, the strategy would allow the Senate to adopt it with a simple majority.