Republicans' ObamaCare replacement bill that passed the House would result in 23 million fewer people with health insurance over 10 years, the nonpartisan Congressional Budget Office said in an analysis released Wednesday.
The total is slightly less than the CBO’s accounting of a previous version of the bill.
The CBO also found that an amendment allowing states to waive certain regulations would mean premiums would be somewhat lower than in the previous version of the bill, and slightly more people would get coverage, because they are buying plans that cover fewer healthcare services.
The bill would reduce the deficit by $119 billion over 10 years — less than the $150 billion reduction the CBO predicted in the previous version of the bill.
The CBO found that a controversial amendment from Rep. Tom MacArthur (R-N.J.) would have a significant effect. That provision allows states to waive rules governing what an insurance plan must cover, and allows states to let insurers charge people more based on their health.
In states that let insurers charge sick people more, some people with pre-existing conditions would lose coverage because they could not afford the premiums, despite extra funding provided in the bill meant to mitigate that, CBO said.
“Unless you’re a healthy millionaire, TrumpCare is a nightmare,” said Sen. Charles Schumer (D-N.Y.). “This report ought to be the final nail in the coffin of the Republican effort to sabotage our healthcare system.
The Trump administration immediately pushed back on the analysis. Tom Price, Trump's health chief, said the CBO is "wrong again” minutes after it released its score on the healthcare bill.
"History has proven the CBO to be totally incapable of accurately predicting how healthcare legislation will impact health insurance coverage," a White House official said. "What’s more alarming is yesterday’s HHS report based on data from the Obama Administration showing that average individual market premiums more than doubled since 2013."
GOP Sen. James Lankford (R-Okla.) also appeared to cast doubt on the CBO's findings, noting it previously overestimated how many would sign up under ObamaCare's insurance exchanges.
"The first question we've had to ask is how did they get to that number actually," he told CBS, referring to the number of Americans who would become uninsured under the House bill.
The CBO projected that a substantial number of people would live in states that took advantage of the new waivers for ObamaCare regulations.
It projects that one-sixth of the population would live in states that took full advantage and waived both rules. People with pre-existing conditions in those states would have difficulty affording coverage, the CBO found.
"Over time, it would become more difficult for less healthy people (including people with preexisting medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly,” the report said.
MacArthur, author of the waiver amendment, dismissed the CBO's conclusion that it would hurt people with pre-existing conditions.
"I don't agree with them that waivers will destabilize [the market]. I think waivers will cover people with preexisting conditions because they'll have to create risk pools," MacArthur told reporters Wednesday.
"I respect the CBO's role, but just because a group of auditors down the block have created a model that has a lot of ifs, ands and maybes, looking out ten years, doesn't make that the gospel. That is somebody's opinion at CBO. I have a different opinion."
Rep. Phil Roe (R-Tenn.), co-chair of the GOP Doctors Caucus, said he thinks the pre-existing conditions issue "has been put to rest," saying he felt "very comfortable" with the bill that will be sent to the Senate.
He said the CBO made estimates that didn't come true during the ObamaCare debate.
"They do the best they can with the data they have, but they've been wildly wrong with these predictions," Roe said.
Premiums for healthy people would be lower, but with a wide variation, the CBO found.
Overall, premiums would increase for two years before they decreased — by 20 percent in 2018 and 5 percent in 2019. After 2020, premium costs would depend on which states get waivers and how much funding they get from the proposal's Patient and State Stability Fund.
Many GOP lawmakers had already expressed concern about price spikes for older people under the bill. In the updated version price spikes would also be dramatic in states that got waivers from the ObamaCare rules.
Premiums could rise as much as 800 percent for a 64-year-old making $26,500, the CBO found — from $1,700 to $13,600.
Rep. Mark Meadows (R-N.C.), the chairman of the conservative Freedom Caucus, rejected the CBO's claim that the bill could destabilize the market for sicker people.
"I don't know how you can get anymore unstable then what we are right now. A lot of states are down to one carrier. I'm not sure how you can get less stable that than. I guess we go to negative one providers in a state?" Meadows told reporters.
Rep. Fred Upton (R-Mich.) led a last-minute effort to add $8 billion to the bill to reduce premiums in states that waived ObamaCare rules. However, the CBO found that money would not be enough to help very much.
The funding "would not be sufficient to substantially reduce the large increases in premiums for high-cost enrollees," the analysis said.
Some parts of the bill remain unchanged from previous versions.
The measure would still have a large cut to Medicaid, estimated at $834 billion over 10 years. CBO estimates that cut would lead to 14 million fewer people being covered under the program.
The Joint Committee on Taxation estimated that the bill would cut taxes by $663 billion over 10 years by repealing levies used to pay for ObamaCare. Much of those tax cuts would go to higher earners.
Overall, the bill repeals the core parts of ObamaCare, including its subsidies, mandates, taxes and Medicaid expansion, and puts in place a new system with a new tax credit to help people buy coverage. That tax credit would provide less help on average than financial assistance under ObamaCare, though.
Jessie Hellmann and Rachel Roubein contributed.