Three weeks after members of Congress voted 217-213 to pass the so-called American Health Care Act, they—and we—finally know how much damage it will do, and it is not pretty. Congress’ own experts in the Congressional Budget Office said that the Republican health plan will cut 23 million people off of health insurance within a decade, while cutting taxes by $992 billion, overwhelming for the wealthy few and corporations. Remember, this is the plan then-presidential candidate Donald Trump promised would provide “insurance for everybody.”
The biggest hit to health coverage comes from the Republican plan’s attack on Medicaid. The House-passed bill cuts 14 million people off Medicaid within 10 years. Many of these are working people who earn so little they cannot afford to buy private coverage or whose employers do not offer them any health benefits. They also include some of the three in five senior nursing home residents whose care is paid for by Medicaid, the two in five kids who get access to medical care only because of Medicaid, and the nearly half of pregnant women whose childbirths are covered by it.
Working people who get health plans through their jobs also get hit: 3 million fewer people will have workplace coverage within a decade. That is because the Republican plan gets rid of the Affordable Care Act requirement that medium and large employers offer their full-time workers affordable, comprehensive health benefits or risk paying a penalty. It also makes permanent the so-called Cadillac Tax on decent, middle-class health benefits, which the CBO previously has estimated will cause some employers to stop providing health benefits.
This does not take into account the additional damage that Trump’s new budget will inflict on Americans’ health care. Released on Tuesday, his budget cuts an additional $610 billion from Medicaid over 10 years and likely will cause millions more people to lose health coverage. It also cuts $5.8 billion from the Children’s Health Insurance Program, which provides access to health care for 6.3 million children whose families do not qualify for Medicaid but do not earn enough to pay for private insurance.
How many more people will lose coverage is not nearly the whole story. The House Republican plan jacks up the cost of buying individual health insurance for many people, especially older Americans ages 50 to 64 with lower incomes. CBO estimates that a 64-year-old earning $26,500 in 2026 will see her out-of-pocket premium increase between 700% and 847% because of the Republican plan.
The House bill includes an age tax that lets insurers charge older Americans five times as much as young adults. It lets insurance companies set much higher premiums for some people who have medical conditions, like diabetes and cancer, to penalize them for going without coverage for two months or more, if a state chooses to allow this kind of price discrimination. It does not matter if you lost coverage because you lost a job or could not afford it. The House plan also cuts premium help for moderate- and low-income people, especially older people. It also eliminates any requirement that coverage be affordable, whether it is from an insurance company or your employer.
On top of this, the Republican plan also increases what many people have to pay on top of their premiums when they actually get medical care. It eliminates the ACA’s help paying deductibles, co-pays and co-insurance for people struggling to make ends meet. It lets states get rid of the basic benefit package of essential health benefits, meaning more kinds of treatment will not be covered at all, or there will be no limit on what you have to pay for those treatments out of your own pocket. It also pushes people into less comprehensive health plans that charge even bigger deductibles, co-pays and co-insurance.