The Congressional Budget Office releases its estimates on the new AHCA bill.

On May 24, 2017, the Congressional Budget Office (CBO) released new scoring for the latest iteration of the American Health Care Act. In their findings, the CBO and the Joint Committee on Taxation (JCT) estimated that over the next decade, the federal deficits would be reduced by $119 billion and that by 2026 23 million more people would be uninsured compared to the current law. Most of that 23 million would occur within the first year, with the CBO estimating that in 2018, 14 million people would be uninsured under the new bill (H.R. 1628).

The bill was passed in the House on May 4, 217 to 213 with 20 Republicans voting against and no Democrats voting for. The first attempt to pass the AHCA ended with Speaker of the House Paul Ryan (R-Wis.) pulling the bill hours before it was about to be voted on because it lacked the numbers to pass.

The new version passed without an official CBO score, having had mostly cosmetic tweaks to garner more support. According to The Atlantic, the AHCA stops states from “enrolling new people under Medicaid expansion” and it “incentivized states to drop the expansion altogether.” The new bill would also introduce per-capita caps on federal spending, reducing the number of people covered and their benefits. The AHCA also removes the employer mandate, which forces employers to provide affordable health insurance to 95% of their full-time employees and children up to the age of 26.

The bill also removes the individual mandate, which penalizes people who don’t sign up for health insurance. What this does, essentially, is take the burden off of healthy people who might not necessarily need insurance. But without those people paying into the system, the onus is on the sicker, older people to pick up the deficit.

The new bill also introduces a set of waivers: one that would allow states to “modify the requirements governing essential health benefits” (Remember that from last time?) and one that would allow insurers to “set premiums on the basis of an individual’s health status.” Roughly 1/6 of the population resides in areas where states would utilize those waivers and the result would be increasing difficulty for less healthy people to purchase insurance on account of rising premiums.

The waivers were the result of an amendment from Representative Tom MacArthur. Business Insider reported that it was the MacArthur amendment that gathered the support of 20 members of the Freedom Caucus, the conservation caucus that largely withheld support for the first AHCA on account of it being too lenient.

A CNBC article quoted Dr. Andrew Gurman, president of the American Medical Association, as saying, “Today’s estimates from the nonpartisan Congressional Budget Office show that last-minute changes to the AHCA made by the House offered no real improvements.”

The bill will now go to the Senate, where it requires at least 50 votes for it, thus leading to Vice President Mike Pence acting as a tiebreaker. Even with majorities in both chambers of Congress, and a 52-percent majority in the Senate, there is still the likelihood that the AHCA will not pass. Or that if it does, it will have to be severely rewritten to get any support.

Bottom line, even after months of rewriting, the AHCA bill has barely improved and, if anything, has gotten crueler by allowing states waivers on essential health benefits. Older, sicker Americans will see increased premiums and restricted care, and younger, healthier Americans won’t see any incentive to buy insurance. The GOP was more concerned with cosmetic Band-Aids to get conservative support than they were with crafting a bill that would benefit their constituents.

There is one bright side to the AHCA passing: this is probably the first time in months that Paul Ryan hasn’t had violent diarrhea from Congressional stress. Unfortunately, Congress-related diarrhea is no longer covered under the new plan.