The CBO’s AHCA Report (Tables)

The figures have yet to be double-checked, so do not use them at references at this point in time.

  • Table 1: Summary of the direct spending and revenue effects of the AHCA, the budget reconciliation recommendations committees on Ways and Means and Energy and Commerce, Merch 9, 2017.
  • Table 2: Estimate of the direct spending and revenue effects of the AHCA, the budget reconciliation recommendations of the house committees on Ways and Means and Energy and Commerce, March 9, 2017.
  • Table 3: Net budgetary effects of the insurance coverage provisions of the AHCA.
  • Table 4: Illustrative example of subsidies for nongroup health insurance under current law and the AHCA, 2026.
  • Table 5: Effects of the AHCA on health insurance coverage for people under age 65.

Table 1

Table 1 - Summary of the direct spending and revenue effects of the AHCA, the budget reconciliation recommendations committees on Ways and Means and Energy and Commerce, Merch 9, 2017.
(Billions of Dollars, by Fiscal Year.)
2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2017–21 2017–26
Changes in direct spendinga
Coverage Provisions
Estimated Budget Authority -6.6 -12.5 -22.9 -97.6 -139.1 -157.4 -173.8 -186.9 -199.4 -210.5 -278.6 -1,206.7
Estimated Outlays -6.6 -27.5 -25.6 -92.2 -138.6 -158.5 -175.2 -188.5 -201.3 -212.0 -290.7 -1,226.2
Non Coverage Provisions
Estimated Budget Authority 0.3 -0.5 -0.7 0.6 -1.7 -0.2 1.0 1.1 0.7 0.0 1.3 3.8
Estimated Outlays -0.1 0.3 -0.1 0.8 1.8 0.5 0.8 1.5 1.3 0.3 2.7 7.1
Total Changes in Direct Spending
Estimated Budget Authority -6.3 -13.0 -23.6 -97.1 -137.4 -157.6 -172.8 -185.8 -198.7 -210.5 -277.4 -1,202.8
Estimated Outlays -6.7 -27.2 -25.7 -91.7 -136.9 -158.0 -174.3 -187.0 -200.0 -211.7 288.1 -1,219.1
Changes in Revenuesb
Coverage Provisions -3.8 -13.7 -16.8 -25.5 -33.6 -36.4 -38.9 -40.4 -41.0 -40.7 -93.5 -290.9
Non Coverage Provisions -2.1 -37.5 -41.8 -57.6 -65.1 -70.2 -76.0 -83.1 -79.7 -78.7 -204.2 -591.9
Total Changes in Revenues -5.9 -51.2 -58.6 -83.1 -98.7 -106.6 -114.9 -123.5 -120.6 -119.4 -297.6 -882.8
Increase or Decrease (-) in the Deficit from Changes in Direct Spending or Revenues
Coverage Provisions -3.8 -13.7 -16.8 -25.5 -33.6 -36.4 -38.9 -40.4 -41.0 -40.7 -93.5 -290.9
Net Increase or Decrease (-) in the Deficit -0.8 24.0 33.0 -8.6 -38.2 -51.3 -59.4 -63.5 -79.4 -92.4 9.4 -336.5

Sources: Congressional Budget Office; staff of the Joint Committee on Taxation.

Notes: The costs of this legislation fall within budget function 550 (health), 570 (Medicare), 600 (Income Security), and 650 (Social Security). AHCA = American Health Care Act; numbers may not add up to totals because of rounding.

a. For outlays, a positive number indicates an increase (adding to the deficit) and a negative number indicates a decrease (reducing the deficit).

b. For revenues, a negative number indicates a decrease (adding to the deficit).

Table 2

Table 2 - Estimate of the direct spending and revenue effects of the AHCA, the budget reconciliation recommendations of the house committees on Ways and Means and Energy and Commerce, March 9, 2017.
(Billions of Dollars, by Fiscal Year.)

(Coming soonish ^ND.)

Table 3

Table 3 - Net budgetary effects of the insurance coverage provisions of the AHCA.
(Billions of Dollars, by Fiscal Year.)
2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 Total, 2017–26
Medical Outlays -3 -18 -26 -68 -94 -111 -124 -135 -146 -155 -880
Subsidies for Coverage Through
Marketplaces and Related Spending and Revenuesa,b -5 -11 -16 -62 -87 -91 -95 -99 -102 -106 -673
Small-Employer Tax Creditsb,c * * * * -1 -1 -1 -1 -1 -1 -6
Tax Credits for Nongroup
Insuranceb,d 0 0 0 30 44 47 52 58 63 68 361
Pentalty Payments by Employersc 2 16 20 15 16 18 19 20 22 23 171
Pentalty Payments by Uninsured People 3 3 3 3 4 4 4 4 4 5 38
Patient and State Stability Fund Grants 0 0 12 15 10 9 9 8 8 8 80
Medicaree 0 1 3 4 6 6 6 6 6 6 43
Other Effects on Revenues and Outlaysd,f -1 -5 -5 -4 -4 -4 -6 -10 -14 -18 -70
Total Effect on the Deficit -3 -14 -9 -67 -105 -122 -136 -148 -160 -171 -935
Memorandum:
Decreases in Mandatory Spending -7 -27 -26 -93 -139 -158 -175 -188 -201 -212 -1,226
Decreases in Revenues -4 -14 -17 -26 -34 -36 -39 -40 -41 -41 -291

Sources: Congressional Budget Office; staff of the Joint Committee on Taxation.

Except in the memorandum lines, positive numbers indicate an increase in the deficit, and negative numbers indicate a decrease in the deficit.

Numbers may not add up to totals because of rounding; AHCA = American Health Care Act; * = between -$500 million and zero.

a. Related spending and revenues include spending for the Basic Health Program and net spending and revenues for risk adjustment..

b. Includes effects on outlays and on revenues.

c. Effects on the deficit include the associated effects of changes in taxable compensation on revenues.

d. Includes costs for a new tax credit for continuation of coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

e. Effects arise mostly from changes in Disproportionate Share Hospital payments.

b. Consists mainly of the effects of changes in taxable compensation on revenues. CBO also estimates that outlays for Social Security benefits would decrease by about $3 billion over the 2017-2026 period.

Table 4

Table 4 - Illustrative example of subsidies for nongroup health insurance under current law and the AHCA, 2026.
(Dollars.)
Premiuma Premium Tax Creditb Net Premium Paid Actuarial Value of Plan After Cost-Sharing Subsidies (Percent)c
Single Individual With Annual Income of $26,500 (175 percent of FPL)d
Current Law
21y old 5,100 3,400 1,700 87
40y old 6,500 4,800 1,700
64y old 15,300 13,600 1,700
AHCA
21y old 3,900 2,450 1,400 65
40y old 6,050 3,650 2,400
64y old 19,500 4,900 14,600
Single Individual With Annual Income of $68,200 (450 percent of FPL)d
Current Law
21y old 5,100 0 5,100 70
40y old 6,500 0 6,500
64y old 15,300 0 15,300
AHCA
21y old 3,900 2,450 1,450 65
40y old 6,050 3,650 2,400
64y old 19,500 4,900 14,600

Sources: Congressional Budget Office; staff of the Joint Committee on Taxation.

All dollar figures have been rounded to the nearest $50; AHCA = American Health Care Act; FPL = federal poverty level.

a. For this illustration, CBO projected the average national premiums for a 21-year-old in the nongroup health insurance market in 2026 both under current law and under the AHCA. On the basis of those amounts, CBO calculated premiums for a 40-year-old and a 64-year-old, assuming that the person lives in a state that uses the federal default age-rating methodology, which limits variation of premiums to a ratio of 3 to 1 for adults under current law and 5 to 1 for adults under the AHCA. CBO projects that, under current law, most states will use the default 3-to-1 age-rating curve; under the AHCA, CBO projects, most would use an age-rating curve with a maximum ratio of 5 to 1.

b. Under current law, premium tax credits are calculated as the difference between the reference premium and a specified percentage of income for a person with income at a given percentage of the FPL. The reference premium is the premium for the second-lowest-cost silver plan available in the marketplace in the area in which the person resides. A silver plan covers about 70 percent of the costs of covered benefits. CBO’s projection of the maximum percentage of income for calculating premium tax credits in 2026 for someone with income at 175 percent of the FPL takes into account the probability, estimated in CBO’s March 2016 baseline, that additional indexing may apply. Under the AHCA, the premium tax credits offered for nongroup coverage would be indexed to the consumer price index for all urban consumers plus 1 percentage point. In 2026, CBO projects, those tax credits would be about 22 percent higher than the amounts specified in 2020.

c. The actuarial value of a plan is the percentage of costs for covered services that the plan pays. Cost-sharing subsidies are payments made by the federal government to insurers that reduce the cost-sharing amounts (out-of-pocket payments required under insurance policies) for covered people whose income is generally between 100 percent and 250 percent of the FPL. The cost-sharing subsidy amounts in this example would range from $1,100 for a 21-year-old with income at 175 percent of the FPL to $3,350 for a 64-year-old at the same income level. Under current law, cost-sharing subsidies have the effect of increasing the actuarial value of the plan from 70 percent for a typical silver plan to 94 percent for people whose income is between 100 percent and 149 percent of the FPL; 87 percent for people between 150 percent and 199 percent of the FPL; and 73 percent for people between 200 percent and 249 percent of the FPL. People whose income is 250 percent of the FPL or more would receive a standard 70 percent actuarial value when purchasing a silver plan. CBO projects that, under the AHCA, the elimination of required actuarial values and the structure of new tax credits would, by 2026, result in a reduction to about 65 percent in the average actuarial value of plans purchased in the nongroup market.

d. Income levels reflect modified adjusted gross income, which equals adjusted gross income plus untaxed Social Security benefits, foreign earned income that is excluded from adjusted gross income, tax-exempt interest, and income of dependent filers. CBO projects that in 2026, a modified adjusted gross income of $26,500 would equal 175 percent of the FPL and an income of $68,200 would equal 450 percent of the FPL.

Table 5

Table 5 - Effects of the AHCA on health insurance coverage for people under age 65.
(Millions of people.)
2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
Total Population Under Age 65 273 274 275 276 276 277 278 279 279 280
Uninsured Under Current Law 26 26 27 27 27 27 27 28 28 28
Change in Coverage Under the AHCA
Medicaida -1 -5 -6 -9 -12 -13 -13 -14 -14 -14
Nongroup coverage, including marketplacesb -2 -6 -7 -9 -8 -8 -6 -5 -4 -2
Employment-based coverage -1 -2 -2 -2 -2 -2 -3 -5 -5 -7
Other coveragec * * * -1 -1 -1 -1 -1 -1 -1
Uninsured 4 14 16 21 23 23 23 24 24 24
Uninsured Under the AHCA 31 41 43 48 50 50 51 51 51 52
Percentage of the Population Under Age 65 with Insurance Under the AHCA (%)
Including all U.S. residents 89% 85% 84% 83% 82% 82% 82% 82% 82% 81%
Excluding unauthorized immigrants 91% 87% 87% 85% 84% 84% 84% 84% 84% 84%

Sources: Congressional Budget Office; staff of the Joint Committee on Taxation.

Estimates are based on CBO’s March 2016 baseline, adjusted for subsequent legislation. They reflect average enrollment over the course of a year among noninstitutionalized civilian residents of the 50 states and the District of Columbia who are under the age of 65, and they include spouses and dependents covered under family policies.

AHCA = American Health Care Act; * = a reduction that falls between zero and 500,000 people.

a. Includes noninstitutionalized enrollees with full Medicaid benefits.

b. Under current law, many people can purchase subsidized health insurance coverage through the marketplaces (sometimes called exchanges) operated by the federal government, by state governments, or as partnerships between federal and state governments. People also can purchase unsubsidized coverage in the nongroup market outside of those marketplaces. Under the AHCA, people could receive subsidies for coverage purchased either inside or outside of the marketplaces.

c. Includes coverage under the Basic Health Program, which allows states to establish a coverage program primarily for people whose income is between 138 percent and 200 percent of the federal poverty level. To subsidize that coverage, the federal government provides states with funding that is equal to 95 percent of the subsidies for which those people would otherwise have been eligible by purchasing health insurance through a marketplace. Payments for that program would be rescinded by the AHCA in 2020.