President Trump vowed to have health care coverage for everybody, to cut costs and to leave Medicaid alone during his historic romp to the White House, but the Republican health care plan he has endorsed would flout each of those promises.
The Congressional Budget Office says 24 million fewer people will hold insurance a decade from now under the Republican bill. More than half of those would be driven off Medicaid as a result of spending caps Republicans would impose. Meanwhile, rates would increase for older Americans.
The CBO numbers are proving to be a major hurdle for Republican leaders looking to shore up support on Capitol Hill, but also for a White House that struggled to square the changes with Mr. Trump’s campaign promises.
White House officials have tried to discredit the CBO’s conclusions, saying the analysts didn’t take into account steps the administration plans to take through regulations, or other bills Congress might pass in addition to the American Health Care Act.
But press secretary Sean Spicer did retreat from Mr. Trump’s push to get “insurance for everybody,” saying Obamacare failed by trying to mandate universal coverage and the Republicans’ goal is to try to entice people — if they want it.
“The idea is actually if you could bring down costs and choices and allow people to find a plan that fit their budget — that was tailored to their needs — there’s actually a higher likelihood that they will find something that they want at a price that they can afford,” Mr. Spicer said.
Democrats, though, said the president is breaking his promises and that the people likely to be hurt the most are low-income Trump voters in red states.
“It puzzles me. These are basically lower-income, working people, and they’re the ones who are going to get hit when Medicaid expansion goes away. I don’t quite get it,” said Sen. Tim Kaine, the Virginia Democrat who lost to Mr. Trump as Hillary Clinton’s running mate in November.
“Also, the promise that nobody will lose coverage — and then those that do are the people who supported you,” he said. “So, I can’t quite figure it out.”
Meanwhile, a growing number of Senate Republicans called for a do-over, saying the bill is dead on arrival without major changes.
Centrist Republicans are spooked by potential coverage losses detailed in the CBO score, particularly when the plan reels in the vast expansion of Medicaid in 2020. Conservatives said they are now even more certain that the plan by House Speaker Paul D. Ryan, Wisconsin Republican, is an entitlement that is too expensive and muddles their campaign promise of a swift Obamacare repeal.
“I’ve got significant concerns about the House bill and, as drafted, the House bill would not pass the Senate,” said Sen. Ted Cruz, Texas Republican. “The most important objective that it fails to accomplish is lowering health insurance premiums.”
The CBO said premiums would come in 10 percent lower than Obamacare by 2026, though Mr. Cruz said comparing likely rate hikes under a Republican plan to where a flailing Obamacare program will land is not a benchmark for victory.
The White House said Tuesday that it is negotiating a “manager’s amendment” to smooth over Republican concerns, though didn’t say what that would entail.
The legislation faces its next test in the House Budget Committee on Thursday, but Republican senators urged the lower chamber to slow down and get it right on the first try.
Sen. Tom Cotton, Arkansas Republican, said regulatory action could be subject to court challenges and that step three would involve “some mythical legislation in the future that is going to garner Democratic support and help us get over 60 votes in the Senate.”
“There is no three-step plan. That is just political talk,” he told radio host Hugh Hewitt.
Other Republicans said they would offer fixes if the House bill reaches the Senate.
Sen. John Thune, South Dakota Republican, said he is considering ways to ramp up tax-related assistance in the plan for older and low-income people in the individual market — a move that could assuage some Republicans while alienating those who say the plan already creates another entitlement.
As written, the Republican plan allows insurers to charge older customers up to five times more than younger ones, rather than the 3-1 ratio under Obamacare.
CBO analysts said a 21-year-old making $26,500 would save $250 in premiums in 2026 under the Republican plan compared with Obamacare’s subsidies, while a 64-year-old making the same income would pay nearly $13,000 more, eating up more than half of his or her income.
A 21-year-old making $68,200 would save more than $3,500, and a 64-year-old making that much would save $700.
The differences enraged the AARP, an influential lobby for older Americans, and it could upset voters ages 50 to 64 who backed Mr. Trump over Democratic nominee Hillary Clinton by nearly 10 percentage points, according to exit polls.
“If there was ever a war on seniors, this bill, TrumpCare, is it,” said Senate Minority Leader Charles E. Schumer, New York Democrat.
Republicans weren’t ready to concede, saying the administration could take other steps to make it easier for seniors to afford coverage.
Mr. Trump wants to eliminate coverage requirements that drove up the cost of Obamacare plans, expand tax-advantaged savings accounts that help people cover their medical costs and allow insurers to sell their products across state lines.
“It depends, I think, on what kinds of options can be created by rules and regulations,” said Sen. Roy Blunt, Missouri Republican. “And CBO is notoriously bad at trying to anticipate what a marketplace will look like or how people will react to it.”
Still the Republican plan clearly cuts Medicaid despite Mr. Trump’s campaign promise.
The House bill freezes Obamacare’s expansion of the program in 2020 and then caps federal funding to the states. The CBO says those changes would produce the biggest savings and drops in coverage, slashing spending by $880 billion and nudging 14 million into the uninsured pool.
“The GOP bill would hurt Trump’s core constituencies. Many working-class people who currently are on Medicaid will lose their health coverage and be in a worse position financially,” said Darrell West, director of governance studies for the Brookings Institution. “That should make Trump very nervous because those are the kinds of voters who made him president. Turning his back on those people will drive down his poll numbers and make it more difficult to pass legislation.”
The White House says it is pleased with the bill.
“This is the only vehicle that seeks to achieve what people on our side of the aisle have been talking about since 2010. This is it,” Mr. Spicer said. “If we don’t get this through, the goal of repealing Obamacare and instituting a system that will be patient-centered is going to be unbelievably difficult.”
Obamacare’s critics said in that way, Mr. Trump is fulfilling one of his core promises.
“Nothing is easy in health care. Once you get entitlement programs in place, they’re very hard to get rid of,” said Sally Pipes, a health care economist and president and CEO of the Pacific Research Institute. “I think people voted for President Trump because they didn’t like Obamacare. They wanted to repeal and replace what was there.”
• Dave Boyer, Seth McLaughlin and David Sherfinski contributed to this report.
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