Three GOP Senators Oppose Health Care Bill, Enough to Block It

Senate Minority Leader Chuck Schumer said the CBO report makes it clear "this bill is every bit as mean as the House bill." He added, "I don't count Senator McConnell out, but this is such a bad bill that even his legislative wizardry is having a rough time here."

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The CBO estimated the Senate health bill would raise costs for many people currently enrolled in private insurance and slash Medicaid by billions of dollars. It would reduce the deficit by $321 billion over a decade, according to the nonpartisan agency, significantly higher than the $119 billion in estimated savings from the version passed by the House in May.

Complicating the efforts of GOP leaders to win over holdouts is the CBO's estimates that many Americans will face out-of-pocket costs and insurance premiums far higher than they are now.

The biggest increase in the uninsured would come from the bill's rollback of Medicaid, the state-federal program that covers the poor. The GOP bill cuts spending on Medicaid by $772 billion over a decade, which would result in 15 million fewer people enrolled in the program in 2026 than under current law. Another 7 million wouldn't have coverage in the individual insurance market.

The CBO estimated that the law would lower premiums in the long term, but raise out-of-pocket costs. Premiums would rise over the next several years and then fall, relative to current law. In 2026, average premiums would be about 20% lower than they would be under Obamacare. That's in part because coverage would be skimpier, and people would face higher deductibles and other cost-sharing.

For example, a 64-year-old making $56,800 in 2026 would have a $6,800 annual premium after an $8,500 subsidy for a silver-level plan covering 70% of their expected health costs under existing law. That person would face a $20,500 premium for the same coverage under the Senate bill and get no subsidy.

The CBO estimated that the individual health insurance markets would be stable in most parts of the country under both the Senate GOP plan and under the Affordable Care Act. Under the Republican plan, though, insurers might withdraw from some rural parts of the country, because they'd have too few customers to operate profitably.

"The reductions in subsidies would lead fewer people to decide to purchase insurance — and markets with few purchasers are less profitable for insurers," CBO said.

The political prospects for the overall bill remain unclear. Republican leaders are hoping to hold an important procedural vote on Tuesday or Wednesday to set up a vote on final passage at the end of the week.

While Heller and Collins have cited the cuts to Medicaid for their opposition, a bloc of four conservatives — Paul, Cruz, Johnson and Mike Lee of Utah — oppose the proposal for different reasons: They said the bill doesn't go far enough in undoing the Affordable Care Act.

— Read 4 ACA Change Paths That Just Got More Popular on ThinkAdvisor.