President Obama’s signature health-care initiative will cost a bit less than expected thanks to last month’s Supreme Court ruling, but the court’s decision is also likely to leave millions of poor people without access to health insurance, congressional budget analysts said Tuesday.
In its June 28 ruling, the court upheld the bulk of the Affordable Care Act, but struck down its plan to require states to expand their Medicaid programs to cover poor people who earn as much as 138 percent of the federal poverty level.
As a result of the court’s decision, the nonpartisan Congressional Budget Office now expects that some states will refuse to fully expand their Medicaid programs or will not do so immediately when most provisions of the law take effect in 2014.
In those states, people who earn 100 percent to 138 percent of the federal poverty level will be eligible to receive government subsidies to obtain private insurance on newly created insurance exchanges. But people who earn less than the full poverty level could be left in the cold, the CBO said.
By 2022, the CBO forecasts that the court ruling will cut state Medicaid and child health rolls by about 6 million people, while increasing enrollment in the insurance exchanges by about 3 million people. The number of people without any form of health insurance, meanwhile, would rise by about 3 million people, the CBO said.
The upshot for the federal budget would be positive, the CBO said. While spending on subsidies for people in the exchanges would increase by about $210 billion over the next decade, spending on Medicaid and children’s health would decline by $289 billion.
Factoring in other changes, the total cost of the coverage expansion would be $1.168 trillion, the CBO said, compared with an original estimate of $1.252 trillion — a net reduction of $84 billion.
The CBO said the entire package of tax changes and health insurance provisions would also continue to reduce the nation’s budget deficit over the next decade. In a separate report, the agency said a Republican plan to repeal the Affordable Care Act in its entirety would increase deficits by $109 billion during the next decade.
In updating their estimates, the CBO analysts did not attempt to predict how each state would respond to the court ruling. Instead, the report said, they “have projected the approximate shares of the affected population residing in states that will fall into different broad categories — ranging from no expansion to an expansion encompassing the income threshold established by the ACA.”
In its June 28 ruling, the court upheld the bulk of the Affordable Care Act, but struck down its plan to require states to expand their Medicaid programs to cover poor people who earn as much as 138 percent of the federal poverty level.
As a result of the court’s decision, the nonpartisan Congressional Budget Office now expects that some states will refuse to fully expand their Medicaid programs or will not do so immediately when most provisions of the law take effect in 2014.
In those states, people who earn 100 percent to 138 percent of the federal poverty level will be eligible to receive government subsidies to obtain private insurance on newly created insurance exchanges. But people who earn less than the full poverty level could be left in the cold, the CBO said.
By 2022, the CBO forecasts that the court ruling will cut state Medicaid and child health rolls by about 6 million people, while increasing enrollment in the insurance exchanges by about 3 million people. The number of people without any form of health insurance, meanwhile, would rise by about 3 million people, the CBO said.
The upshot for the federal budget would be positive, the CBO said. While spending on subsidies for people in the exchanges would increase by about $210 billion over the next decade, spending on Medicaid and children’s health would decline by $289 billion.
Factoring in other changes, the total cost of the coverage expansion would be $1.168 trillion, the CBO said, compared with an original estimate of $1.252 trillion — a net reduction of $84 billion.
The CBO said the entire package of tax changes and health insurance provisions would also continue to reduce the nation’s budget deficit over the next decade. In a separate report, the agency said a Republican plan to repeal the Affordable Care Act in its entirety would increase deficits by $109 billion during the next decade.
In updating their estimates, the CBO analysts did not attempt to predict how each state would respond to the court ruling. Instead, the report said, they “have projected the approximate shares of the affected population residing in states that will fall into different broad categories — ranging from no expansion to an expansion encompassing the income threshold established by the ACA.”