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More $$$, more uninsured: Donald Trump's health-care plan

Donald Trump
Chris Keane | Reuters
Donald Trump

It's going to be yuuuuuuuuuggggeeee — and could cost a whole lot of money, while leaving more people uninsured.

The health-care reform plan proposed by Republican presidential front-runner Donald Trump to completely repeal Obamacare would cost nearly a half-trillion dollars more over the course of a decade — and lead to nearly 21 million people losing their health insurance, the Committee for a Responsible Federal Budget said Monday.

Even if purported benefits from faster economic growth were factored in, the Trump health plan would still add about $270 billion in costs to the federal budget, the nonpartisan budget advocacy group said in an analysis.

"Mr. Trump's plan to repeal and replace Obamacare — based on the details available — would both add to the deficit and significantly reduce coverage," the group said.

The group did say that Trump's proposal to award Medicaid funds to state governments via block grants "could generate a wide range of savings" to the federal budget. But the analysis also noted that because "the Trump campaign has not provided any information on the size of their proposed block grants," it is "impossible to score any savings" for his plan.

However, the group did make several estimates for savings based on different scenarios for a Medicaid block-grant system, including indexing the grants to growing more slowly than the current law, indexing the grants to per-person gross domestic product and freezing the grants in nominal dollars.

"The amount of money this proposal would save (or cost) depends entirely on the size of that allotment, and how much it grows each year," the analysis said.

Under the most conservative scenario, the group said, moving to block grants could save the federal government no money at all. But under a more aggressive scenario, about $915 billion in Medicaid savings could be realized.

"If Mr. Trump intends to generate aggressive savings from block granting Medicaid, it could more than pay for the cost of repealing and replacing Obamacare — though perhaps at the cost of a further reduction in coverage," the analysis said.

Trump's campaign did not immediately respond to a request for comment on the report.

His plan is entitled "Healthcare Reform to Make America Great Again," and can be found at the Trump campaign's website.

It has seven main components: "Completely repeal Obamacare;" allow health insurance plan sales across state lines; block grant Medicaid to states; allow individuals to fully deduct health insurance premiums on their tax returns; liberalize the use of health savings accounts; require "price transparency" from all health providers; and "remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products."

The budget group's analysis assumes that Trump's stated promise "to completely repeal Obamacare" includes repealing the Affordable Care Act's regulation, subsidies that help low- and middle-income people buy insurance on government-run marketplaces, expansion of Medicaid to more poor people and savings for the Medicare program that covers mainly senior citizens.

"Although repealing the coverage provisions would save about $1.1 trillion, based on Congressional Budget Office (CBO) estimates ... repealing the legislation's tax increases and Medicare cuts would cost a combined $1.5 trillion," the analysis said.

"In total, this means repeal would cost $420 billion — or $200 billion including the economic benefits of repeal."

Another $70 billion in costs would come primarily from creating a tax deduction for people buying their own health insurance — which would put them on par with people who get insurance through their jobs.

"The total cost of Mr. Trump's repeal and replace health care plan would be $270 billion over a decade under dynamic scoring and nearly $500 billion under conventional scoring," the analysis said.

"Note that this analysis does not include Mr. Trump's call to negotiate aggressively for Medicare drugs, a policy that is not listed on his website," the analysis said. "He has previously claimed that $300 billion a year could be saved through negotiation, a claim we rated as false because Medicare will only spend an average of $111 billion each year on prescription drugs. Based on previous estimates by CBO, actual savings would likely be small or negligible."

The group noted that the CBO estimates that by 2018 about 27 million Americans will still lack health insurance coverage despite the existence of the Affordable Care Act, which to date has led to an estimated 20 million people gaining insurance.

"Repealing Obamacare would increase that [CBO estimate] by 22 million, whereas Mr. Trump's replacement plan would only increase coverage by 1.1 million," the analysis said. "In other words, the plan would increase the number of uninsured individuals by about 21 million and only cover about 5 percent of individuals that would lose coverage from Obamacare repeal."