What CBO projected

The bill, which passed the House in a 215-214 vote in May, contains a variety of healthcare-related provisions, including implementing Medicaid work requirements for people up to age 64 who are without dependents or disabilities, banning new or increased state provider taxes, and requiring eligibility redeterminations every six months for adults covered under the Affordable Care Act's (ACA) Medicaid expansion.

While CBO had done preliminary scores of the bill, which had projected the budget impact of different measures and their effects on health insurance enrollment, CBO didn't have time to analyze measures that were added in last minute and hadn't yet accounted for how different pieces of the bill interact.

According to CBO's projections, 10.9 million more people would be uninsured in 2034 because of changes in the bill. Around 7.8 million people would lose Medicaid coverage while the rest of the losses would come from the ACA exchanges.

Among those losing coverage would be 1.4 million immigrants and others who don't have or aren't able to prove legal status. The bill imposes new restrictions on health insurance specifically targeted at states that use their funds to cover undocumented immigrants.

The bill also includes reforms to pharmacy benefit managers that would limit how they can receive money from drugmakers, impose transparency requirements, and prevent spread pricing in Medicaid, which CBO projects will amount to $640 million in government savings.

The bill would also increase payments to doctors by $8.9 billion over a decade by partially basing Medicare payment rates on medical inflation.

CBO also projected that cuts to the Supplemental Nutrition Assistance Program would lead to 4 million fewer people having food stamps each month.

Overall, CBO projects the bill would add $2.4 trillion to the nation's deficit over roughly the next decade. Specifically, the tax cuts in the bill would decrease revenues by more than $3.6 trillion over the timespan while accompanying cuts to federal spending would reduce outlays by $1.2 trillion.

"I would love for CBO to put out a report showing how they were off by $1.7 trillion on the 2017 tax cuts," said Rep. Jason Smith (R-Mo.), chair of the House Ways and Means Committee.

What's next

The bill is currently in the Senate, where senators will most likely make changes. However, the Senate is not expected to write an entirely new bill due to time constraints, as Republicans are aiming to pass the bill before July 4 or at the very least by the time the government reaches its borrowing limit, which is expected to be sometime around August.

After the bill passed the House, Sen. Thune (R-S.D.) and Senate Finance Committee Chair Mike Crapo (R-Idaho) said they had been working with the House Republicans who drafted the bill but still expect to make adjustments.

"When it comes over here, I think [Speaker Johnson] would like to see as little change to the product as possible, because they've cobbled together a delicate balance over there," Thune said. Still, "the Senate will have its imprint on it," Thune said.

Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska), and Josh Hawley (R-Mo.) have all expressed concerns about any cuts to Medicaid, with Hawley specifically vowing to oppose any bill that cuts the program.

Hawley on Tuesday expressed concerns about the limits on provider taxes proposed in the bill, which he described as essential for rural hospitals. He added that he doesn't understand why Congress would penalize rural hospitals and suggested his colleagues should instead focus on capping the price of prescription drugs if they want to reduce healthcare spending.

"That's the way to do it. If you want to get major savings in the healthcare sector … don't close rural hospitals," Hawley said. "Don't take away benefits from working people. Cap the costs. Cap the price that CMS is going to pay for prescription drugs."

Hawley also said he disliked the provisions in the bill that would impose cost-sharing up to $35 for services provided to enrollees under Medicaid expansion with incomes above the federal poverty level, which Hawley referred to as a "sick tax."

Meanwhile, some Republican senators including Sens. Mike Lee (R-Utah), Rand Paul (R-Ky.), and Ron Johnson (R-Wis.) are pushing for bigger cuts to be included in the bill.

Thune said Republicans are currently working through the various issues and could identify other possible cuts while also satisfying senators who want to soften the Medicaid provisions.

"We have an agenda that everybody campaigned on, most notably the president of the United States, and we're going to deliver on that agenda. And the legislation that was passed by the House will be approved here, strengthened in the Senate," Thune said. "When it's all said and done, we'll send it back to the House and hope that they can pass it and put it on the president's desk."