The C.B.O., which cherishes its independence and nonpartisan status, doesn’t use words like “mean” or “kind.” It simply lays out its projections, which, in this case, showed that “the increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 22 million in 2026. . . . By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured,” compared to twenty-six million today.
The American population as a whole is also projected to expand during the next decade, so the raw numbers perhaps don’t tell the full story. But the C.B.O. analysis also projects a sharp rise in the uninsured rate—the proportion of people under the age of sixty-five who don't have health coverage. After the gains made since the introduction of the Affordable Care Act, that rate in 2017 is down to about ten per cent. If the Senate bill were enacted, the C.B.O. said, this rate would jump to eighteen per cent by 2026, which is about where it was when Barack Obama came to office.
Contrary to expectations in some quarters, the Senate legislation didn't even properly fix one obvious political problem of the House bill: the huge increases in premiums that some elderly people could face. Although the House’s tax credits would be replaced with direct subsidies, a sixty-four-year-old who earns $26,500 a year would see the annual premiums on his silver-level plan rise from $1,700 to $6,500. If he or she earned $56,800 a year, the premiums would jump from $6,800 to $20,500.
And who would be the winners? The very rich, of course. The bill would eliminate the investment tax and income surtax that the A.C.A. imposed on households earning more than a quarter of a million dollars a year. While many poor and middle-income Americans would be adversely affected, these lucky few would get a hefty handout.
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