On Wednesday, the Congressional Budget Office (CBO) issued the new assessment of the American Health Care Act. It showed that the amendments made to the original bill costs $32 billion more and it reduced the number of uninsured under the original bill by only 1 million people.

The key points are that it saves $119 billion over ten years, it cuts Medicaid by $834 billion over that same period, will cause the number of uninsured to increase by 14 million people next year in 2018 and 23 million by 2026.  They also indicate that in about one-sixth of states the insurance markets would become unstable starting in 2020 because states could waive two current critical provisions of the ACA: a waiver on the essential benefits package and a waiver of allowing insurance companies to set premiums based on an individual’s health status.  CBO says that one of the areas for waiver of essential benefits would be mental health and substance abuse treatment.

The Child Welfare League of America has revised its letter of opposition based on the modifications and the new CBO analysis in the CWLA letter to senators, President and CEO Chris James-Brown says:

The Congressional Budget Office indicates that the amended House legislation will create instability in states where one-sixth of the population resides. That instability will be the result, in part, from states choosing to use state waivers of the essential benefits provisions of the ACA. The CBO goes on to state: Services or benefits likely to be excluded from the EHBs in some states include maternity care, mental health and substance abuse benefits, rehabilitative and habilitative services, and pediatric dental benefits.”

 All of these essential benefits are critical to addressing child maltreatment, reducing foster care placements, and strengthening reunification from foster care, adoptions, and kinship care placements.

She went on to say:

Congress can take actions to strengthen the ACA and create market stability rather than suggesting radical changes and administrative actions that will rattle the markets and push up the number of uninsured and underinsured while increasing costs for those who have coverage. Senators and other Members of Congress well know, also, the impact that opioids and other substances are having on your states and, in turn, on the number of children and youth subject to maltreatment and placed into foster care.”

Senate Republicans are continuing to meet on a regular basis, several times a week.  Leadership and members of the group of thirteen are sending mixed messages about that progress.  One thing is clear however, they are seeking to craft a bill that can pass with the minimal 50 senators it would take to pass with the support of the Vice President.