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The latest version of Senate Republicans' legislation to repeal and replace the Affordable Care Act would leave 22 million Americans without health insurance coverage by 2026, the U.S. Congressional Budget office said on Thursday. (Alexander, 7/20)

The reworked bill would increase average premiums over the next two years, but reduce them starting in 2020 by 30 percent, the report estimated. But the policies would typically offer less coverage. And because the GOP measure would also eliminate federal subsidies that let insurers lower out-of-pocket costs for low-earners, the changes “would contribute significantly to a decrease in the number of lower-income people with coverage,” the budget office said. (Fram and Werner, 7/20)

The Senate Republican health bill promises lower premiums for consumers. To get there, it would require patients in standard plans to spend as much as about $13,000 upfront on their own care. The deductibles would be so high, in fact, that they’d violate maximums set in U.S. law, an analysis by the nonpartisan Congressional Budget Office said Thursday. Under Obamacare, by comparison, an individual in a standard plan would have a deductible of roughly $5,000. (Tracer and Edney, 7/20)

And it would increase costs for millions of sick and elderly Americans, the budget office estimates. Those costs could soar even further under another provision of the bill that would allow insurers to offer slimmed-down health plans that don’t offer the basic set of health benefits — including prescription drugs, maternity care and mental health services — currently mandated by the Affordable Care Act, also known as Obamacare. (Levey, 7/20)

Compared with earlier versions, it would give more money to states to help pay for insurance for high-cost patients and would preserve some Affordable Care Act taxes. It would still eliminate the law’s requirement that most Americans carry health insurance, phase out the law’s expansion of Medicaid and transform the rest of Medicaid funding. According to Congress’s nonpartisan budget scorekeepers, this version would have a greater impact on lowering the federal deficit — a $420 billion reduction between next year and 2026, compared with $321 billion under the previous form of the bill. The change is largely because the new plan would keep more Affordable Care Act taxes. (Goldstein, 7/20)

That gives Senate Majority Leader Mitch McConnell an additional $99 billion to dole out in funding sweeteners to entice balky Senate moderates to support the bill when McConnell hopes to hold a vote on the legislation next week. (Meyer, 7/20)

The impact of the new report is uncertain, however, as the CBO didn’t include a full analysis of an amendment from Sen. Ted Cruz (R., Texas) that would allow for cheaper but more bare-bones insurance plans because that analysis requires more time. (Armour, 7/20)

Senators have said it could take weeks for the CBO to score the Cruz amendment, raising the likelihood those numbers will not be available when the Senate votes next week. CBO officials said Thursday they are working on scoring the proposal, but wouldn’t speculate on when it might be finished. (Weixel, 7/20)

The provisions in the latest version of the Senate bill are much like the version scored at the end of June: It would end the individual and employer mandates, it would roll back the Affordable Care Act's Medicaid expansion and cut spending to that program by hundreds of millions of dollars, and roll back some taxes. However, this bill would not roll back Obamacare investment income taxes and payroll taxes that hit higher-income Americans. (Kurtzleben, 7/20)

Speaker Paul Ryan (R-Wis.) ripped the nonpartisan Congressional Budget Office (CBO) on Thursday, arguing the estimate that 22 million more people would be left uninsured over the next decade by a plan to repeal and replace ObamaCare is a "bogus" number. Speaking to reporters at an event at a New Balance factory in Lawrence, Mass., the GOP leader said the CBO's estimate simply means that many Americans would no longer buy health insurance because the government would no longer be forcing them to purchase insurance. (Bowden, 7/20)