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Latest repeal and replace bill would leave 15 million without insurance next year, CBO says

Senate Majority Leader Mitch McConnell of Kentucky walks to his office on Capitol Hill on Thursday. McConnell has thus far been unable to pass a law repealing or replacing the Affordable Care Act. His party’s latest bill would leave 15 million people uninsured next year, the Congressional Budget Office said Thursday.Andrew Harnik/Associated Press

WASHINGTON — The nonpartisan Congressional Budget Office said Thursday that the latest version of a Senate bill to repeal and replace the health care law would leave 15 million people without health insurance next year, rising to 22 million in 2026 — another blow to the legislative push that President Trump is trying to revive.

The increase in the number of people who are uninsured was the same as the 22 million more people who would be uninsured in 2026 under an earlier version of the bill that was analyzed in June.

The newest score of a replacement for the health care law came after a marathon bargaining session Wednesday night with balking senators that ended inconclusively. On Wednesday, the budget office released its analysis of a separate bill that would repeal large parts of President Obama’s signature health care law without a replacement. That analysis concluded that such a move would increase the number of people without health insurance by 32 million in 2026.

Meanwhile, the Trump administration has ended Affordable Care Act contracts that brought assistance into libraries, businesses, and urban neighborhoods in 18 cities, meaning shoppers on the insurance exchanges will have fewer places to turn for help signing up for coverage.

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Community groups say the move, announced to them by contractors last week, will make it even more difficult to enroll the uninsured and help people already covered reenroll or shop for a new policy. That’s already a concern because of consumer confusion stemming from the political wrangling in Washington and a shorter enrollment period. People will have 45 days to shop for 2018 coverage, starting Nov. 1 and ending Dec. 15. In previous years, they had twice that much time.

Some see it as another attempt to undermine the health law’s marketplaces by a president who has suggested he should let ‘‘Obamacare’’ fail. The administration, earlier this year, pulled paid advertising for the sign-up website HealthCare.gov, prompting an inquiry by a federal inspector general into that decision and whether it hurt enrollment.

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Now insurers and advocates are concerned that the administration could further destabilize the marketplaces where people shop for coverage by not promoting them or not enforcing the mandate compelling people to get coverage. The administration has already threatened to withhold payments to insurers to help people afford care, which would prompt insurers to sharply increase prices.

Senators were set to leave for the weekend Thursday afternoon after a demoralizing week of fruitless negotiations, capped by news that one of their most prominent colleagues, Senator John McCain, Republican of Arizona, has brain cancer. The majority leader, Senator Mitch McConnell of Kentucky, appears determined to force the Senate to vote next week on a procedural motion to begin debating health care, but he still is short of the 50 votes he needs.

The latest analysis may be incomplete. It did not include a provision that would allow insurers to offer low-cost, stripped-down insurance plans, an idea that has been pushed by Senator Ted Cruz, Republican of Texas, and could be critical to winning the votes of Cruz and another conservative, Mike Lee of Utah.

Cruz’s proposal was included in a version of the bill released last week, but it has been assailed by the insurance industry. While the provision was omitted from the latest version of the bill that was released Thursday, it remains under consideration to be part of the repeal legislation, a Republican congressional aide said.

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The budget office released its analysis as Senate Republicans are struggling to keep alive their longtime goal of repealing the health care law — and to settle on a strategy for achieving that aim. But its conclusions are not likely to help.

The budget office did have good news about the latest version’s fiscal impact: it would reduce federal budget deficits by a total of $420 billion over 10 years, about $100 billion more than an earlier version of the legislation. The change resulted mainly from the fact that Senate leaders decided to keep two taxes on high-income people that would have been eliminated by the previous version of the Senate bill.

The latest version of the Senate bill would increase average insurance premiums by 20 percent next year, the budget office estimates, but it would reduce premiums after 2019, so that in 2026 premiums for a typical “benchmark plan” would be 25 percent lower than under current law.

That is not all positive. One of the main reasons for the lower premiums is that the typical insurance plan would, according to the budget office, “pay for a smaller share of the total cost of covered benefits.” In other words, out-of-pocket expenses from deductibles and copayments would grow.

Moreover, the budget office said, even though average premiums for a standard benchmark plan would decline after 2019, many older people would face substantial increases in premiums.

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Material from the Associated Press was used in this report.