Facebook Twitter Tumblr Close Skip to main content
A Project of The Annenberg Public Policy Center

The 24 Million Talking Point

The Line: The Republican health care bill would throw 24 million people off the health insurance they have now.

The Party: Democratic

After the House passed a GOP health care bill to replace the Affordable Care Act, Democrats criticized the legislation by saying it would take away insurance from 24 million Americans. An analysis by the Congressional Budget Office and Joint Committee on Taxation did say that 24 million fewer Americans would be insured under the American Health Care Act than under current law in 2026, and that 14 million fewer would be insured next year. But not all of them would “lose” insurance they have “today” or be “kicked off” their policies, as some Democrats have described it.

The CBO estimate includes some losing insurance, some deciding not to have it, others gaining it and others not having insurance in the future.

We wrote about this in mid-March, when Sen. Bernie Sanders and Reps. Richard Neal of Massachusetts and Frank Pallone Jr. of New Jersey made such claims. Since the GOP’s American Health Care Act was passed by the House on May 4, more Democrats also have spun the facts on the CBO analysis. (Note that the CBO analysis was done before new amendments, mainly those on state waiver provisions, were added to the legislation in April. The CBO numbers on insurance coverage could change once it conducts a new analysis.)

Sen. Kirsten Gillibrand of New York put out a statement on May 4 that said: “Up to 24 million Americans with insurance today could lose that coverage.” Sanders’ statement included this line: “This bill would throw 24 million Americans off of health insurance – including thousands of Vermonters.” And Ben Ray Luján, chairman of the Democratic Congressional Campaign Committee, said in his statement that Republicans had voted to “toss 24 million Americans off of their insurance.”

On May 5 on MSNBC’s “Morning Joe,” Rep. Tim Ryan of Ohio said Republicans were “celebrating kicking 24 million people off of their health care.” The day before, Rep. Steny Hoyer of Maryland said at a Democratic press conference: “And the bill that was originally introduced, and still exists, and passed the House today, will take 24 million people off the insurance rolls.”

But some of those 24 million would take themselves off the insurance rolls, according to the CBO.

In 2018, CBO said, “14 million more people would be uninsured under the [GOP] legislation than under current law,” most of that due to the immediate elimination of the individual mandate requiring most people to pay a tax if they don’t have insurance. CBO doesn’t provide specific numbers but says that “[s]ome of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

CBO expects higher average premiums in the individual market in 2018 and 2019, as healthy people decide to drop their insurance without that mandate penalty in place. As those healthy folks leave, overall costs in the individual market go up.

Later on, by 2026, CBO expects overall premiums to be about 10 percent lower in the individual market than they would be under current law, on average. But older Americans not yet eligible for Medicare would face higher premiums, because of the changes to the way insurers can price premiums based on age under the Republican plan.

These changes would “significantly” alter “particularly by income and age” who buys coverage on the individual market, CBO said. By 2026, there would be 2 million fewer on that market compared with current law.

Some would lose Medicaid coverage. CBO estimates 14 million fewer Americans would have Medicaid coverage under the GOP legislation, which phases out the Affordable Care Act’s Medicaid expansion and caps per-enrollee spending. An estimated 5 million of those are would-be Medicaid enrollees in the future. CBO expected that those people would gain Medicaid coverage under current law as other states expanded eligibility under the ACA. But under the GOP legislation, that won’t happen. The Republican plan cuts off enhanced federal funds for expanded eligibility for states that have not yet taken up the ACA option.

Employer coverage would decline as well, by 7 million people. But that’s a mix of those who decide not to accept an employer’s offer of coverage without an individual mandate, and those who are no longer offered insurance by their employers, CBO explained.

It is certainly true that the CBO analysis found the Republican bill would lead to 24 million fewer people having insurance, compared with current law. But as that analysis also made clear, not all of them would be tossed off their insurance, nor would they all lose insurance they have “today.”

Some of the other Democrats who have used this talking point include:

Rep. Tom Suozzi, May 4: Today’s ill-conceived legislation takes the first step toward destroying the ACA, and with it, stripping 24 million people of their health coverage. (Source: Press release.)

Rep. Jim Himes, May 4: If this bill were to become law, we would see an estimated 24 million Americans, possibly many more, thrown off their insurance. (Source: Press release.)

Sen. Chris Murphy, April 20: Last month, Republicans threw together a disaster of a bill that would jack up health care costs and strip insurance away from 24 million Americans. (Source: Press release.)

Rep. Diana DeGette, March 24: This bad bill would rip health insurance away from millions of people — 24 million over ten years, and 14 million next year alone. (Source: Denver Post.)

Rep. Jerrold Nadler, March 22: This bill would throw 24 million people off of coverage. Twenty-four million Americans would lose their health care, the security of mind that they have now. (Source: Congressional Record.)

Rep. Jared Polis, March 21:  It would throw 24 million people who currently have insurance out of insurance. (Source: Congressional Record.)

Rep. Nancy Pelosi, March 16: Is it an “act of mercy” to throw 24 million people out of health insurance so Republicans can hand billionaires a massive new tax giveaway? (Source: Press conference.)