Critics of GOP health bill get ammunition from budget score

WASHINGTON (AP) — Critics of GOP health care legislation got fresh ammunition from a report that estimates the bill would increase the ranks of the uninsured by 14 million people next year alone, and 24 million over a decade.

The findings from the nonpartisan Congressional Budget Office could make prospects for the legislation backed by President Donald Trump even tougher, with a few House and Senate conservatives already in open revolt and moderate Republicans queasy about big cuts to the Medicaid safety net for the poor.

But with the legislation headed for votes in the House Budget Committee within days and floor action next week, its supporters at the White House and on Capitol Hill showed no sign of retreat. Instead, they attacked the parts of the CBO report they didn't like, while touting the more favorable findings, including smaller deficits from their bill and lower premiums over time.

"I'm pretty encouraged by it, it actually exceeded my expectations," House Speaker Paul Ryan of Wisconsin said on Fox News Channel shortly after the report was released Monday evening.

Ryan said the CBO findings about millions losing coverage were to be expected, because the GOP legislation removes the penalty in former President Barack Obama's Affordable Care Act aimed at coercing people into buying coverage.

"If we're not going to force someone to buy something they don't want to buy they're not going to buy it, and that's kind of obvious," Ryan said.

The GOP legislation would use tax credits to help consumers buy health coverage, expand health savings accounts, phase out an expansion of Medicaid and cap that program for the future, end some requirements for health plans under Obama's law, and scrap a number of taxes.

Ryan pointed to other CBO figures, including that the GOP bill reduces federal deficits by $337 billion over a decade, and begins to bring down insurance premiums by around 10 percent starting in 2020, though that comes only after premiums sharply rise in 2018 and 2019.

Democrats scoffed at Ryan's positive spin, calling the CBO analysis damning evidence that Republicans are interested only in giving hundreds of billions of dollars in tax breaks to the rich, which their bill would accomplish, while yanking health coverage from the poor.

"I hope they would pull the bill. It's really the only decent thing to do," House Democratic Leader Nancy Pelosi said. "How can they look their constituents in the eye when they say to them '24 million of you will no longer have coverage.'"

At the White House, Health and Human Services Secretary Tom Price rejected portions of the CBO's findings, in comments that seemed to contradict Speaker Ryan.

"We believe that the plan that we're putting in place is going to insure more individuals than currently are insured. So we think the CBO simply has it wrong," Price said

It was unclear exactly what impact the CBO news would have on the debate. Republicans were already planning to move forward with no Democratic votes, aiming for action by the full House next week and the Senate the week after that. Senate prospects look particularly dicey, given the GOP's slim 52-48 majority and vociferous objections from several Republicans including Rand Paul of Kentucky and Tom Cotton of Arkansas.

Senators were just beginning to absorb the CBO findings Monday night. The approaching winter storm had delayed the arrival of House members to the Capitol.

"It's awful. It has to be a concern," Sen. Bill Cassidy, R-La., said of the budget office findings. "President Trump said he wanted as many people covered as under Obamacare."

"At the end of the day, we should pause and try to improve the product in light of the CBO analysis rather than just rejecting it," said Sen. Lindsey Graham, R-S.C.

Price planned to meet with GOP senators Tuesday to discuss the issue.

All along Republican leaders have assumed that once it comes time to vote, few if any Republicans will dare vote "no" on the repeal and replacement of "Obamacare" that their party has been promising for seven years. They are relying on Trump's popularity with conservative voters to close the deal, and Trump on Monday announced he would be traveling to Kentucky for a rally early next week.

But the Congressional Budget report seemed likely to increase some Republicans' discomfort with their approach, especially those representing states that expanded Medicaid coverage under Obama's law. Roughly 14 million fewer people would have Medicaid coverage over a decade as the GOP bill cuts $880 billion from the federal-state health program for the poor and disabled, the CBO said.

Trump pledged during the presidential campaign that he would not cut Medicaid, but the bill would violate that pledge, as well as fail to meet Trump's stated goal of "insurance for everybody."

The CBO report also undercuts a central argument that Trump and other Republicans have cited for swiftly rolling back Obama's health care overhaul: that the health insurance markets created under the 2010 law are unstable and about to implode. The congressional experts said that largely would not be the case and the market for individual health insurance policies "would probably be stable in most areas either under current law or the (GOP) legislation."

Associated Press writers Matthew Daly, Alan Fram, Stephen Ohlemacher, Mary Clare Jalonick, Richard Lardner and Andrew Taylor contributed to this report.