House Speaker Paul Ryan was bombarded with questions Thursday
Congressional Budget Office’s latest report on the GOP’s
Ryan pointed to the good news about the American Health Care Act
in the nonpartisan agency’s report, which estimated that premiums
would decrease for healthy people and that the federal budget
deficit would decline if the bill were to become law.
“I’m actually comforted by the CBO report because it shows, yeah,
we’re going to lower premiums,” Ryan said.
But the CBO’s analysis also contained some alarming projections.
It estimated that 23 million more people would be without health
insurance in 2026 compared with the current baseline. It also
found that people with preexisting conditions could face much
higher premiums because of waivers that states could use to get
around of some the Affordable Care Act’s regulations and that
some of the changes that helped get the bill through the House
could make some individual insurance markets “unstable.”
The CBO report also said the premium declines would come in part
because of people with preexisting conditions dropping out of the
market, as insurance would become too expensive. That would drive
down costs for healthy people but throw sicker people’s insurance
status into further question.
Ryan defended the idea, citing the fact that the new law would
require states seeking a waiver to have a so-called high-risk
pool in place, where sicker people would turn to purchase
“A state has to have a risk system in place” to get a waiver,
“and that risk system is specifically designed to make sure that
people with a catastrophic illness, who has a preexisting
condition, also gets access to affordable healthcare,” Ryan said.
“What we have learned is if we target resources at the state
level and the federal level to make sure we subsidize
catastrophic illnesses, what you end up doing is you end up
lowering premiums for everybody else. We think that’s so much
The Kaiser Family Foundation, a nonpartisan health-policy think
tank, however, has found that the high-risk pools Ryan cited that
existed before the passing of the Affordable Care Act were
woefully underfunded, had few people enrolled, and left out many
Additionally, health-policy experts have said the current version
of the AHCA does not have enough funding allocated to the new
high-risk pools to solve the problems. The CBO echoed a similar
sentiment in its report Wednesday.
Ryan argued that the CBO score did not take into account the
state-level funding for the high-risk pools, saying “the states
will do some of the lifting.”
But projections from GOP Sen. Bill Cassidy also showed that
many states would have to shoulder a much larger burden of
Medicaid costs because of the AHCA’s changes to funding for that
The AHCA is now in the hands of the Senate, which has already
said it will write its own version of the bill separate from the