House GOP leaders’ health policy package could lead to 100,000 fewer people per year having health insurance through 2035, but would save the government $35.6 billion. That’s according to a Tuesday report from the Congressional Budget Office, a nonpartisan agency that analyzed provisions in the health package lawmakers are expected to consider on Wednesday. The legislation includes several conservative policies but not an extension of enhanced Obamacare subsidies that go away after this year. The bill released on Friday would appropriate funding for cost-sharing reduction payments to help low-income customers pay their health care bills. The appropriation would result in an average decrease of Obamacare premiums of 11 percent for an average benchmark plan. The Affordable Care Act, as drafted in 2010, originally reimbursed insurers for the payments, but the first Trump administration cut them off in 2018. Since insurers are required to offer the cost-sharing payments, they raised premiums on their silver tier plans. Obamacare pegs subsidies to the silver plan rate, which rose as a result, effectively holding harmless people enrolling in them who are eligible for subsidies. Consumers could also use the higher subsidies to reduce their premiums for Obamacare plans in other tiers, such as the more-expensive gold level, or less-expensive bronze. If Congress were to fund the cost-sharing reductions itself, it would reduce the subsidies available to consumers and prompt about 300,000 of them to drop coverage even as premiums drop overall, CBO said. The House bill only funds the cost-sharing reduction for plans that do not cover abortion. Thirteen states and the District of Columbia mandate abortion coverage. CBO estimates premiums would not decrease in them as a result. The bill would also expand association health plans, in which small businesses band together to purchase more affordable insurance. The package, which would enable self-employed people to purchase such plans, would expand association health plans by about 700,000 people per year through 2035. Democrats say the expansion is meant to sabotage Obamacare’s exchanges by enticing people to leave for association health plans. Republicans maintain that their goal is to offer Americans cheaper health insurance options. In addition to insurance changes, the law boosts oversight of the pharmacy benefit managers who negotiate drug prices on behalf of insurers and large employers. The bill requires PBMs to disclose more information to group health plans, including data related to enrollees’ prescription drug use and rebates the PBM negotiates with drugmakers. CBO expects drug prices to go down as a consequence. Next steps: The House Rules Committee is expected to consider the full package on Tuesday. Several GOP moderates hope to add an amendment extending enhanced Obamacare subsidies, but it is likely to be ruled out of order because the proponents have not proposed a way to pay for them. The CBO has previously estimated that a subsidy extension through 2035 would cost $350 billion. A House floor vote is planned for Wednesday. Lead Art: House Speaker Mike Johnson has endorsed a package of conservative-friendly health policies the CBO said will lower federal spending but increase the uninsured. | Francis Chung/POLITICO

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