If the U.S. Senate's health care bill passed today, by 2026 a total of 49 million Americans would not have health insurance.

That's according to the Congressional Budget Office's new estimate on the Better Care Reconciliation Act of 2017.

  • CBO estimate in for Senate health care bill
  • 22 million more uninsured by 2026 under bill
  • Residents in some states could see high premiums, out-of-pocket expenses
  • Reduces federal deficit by $321 billion over 10 years
  • READ the CBO report: Senate health care bill | House health care bill 

The Senate plans to vote on the bill Thursday, but five senators have already said they will not vote for the bill as it stands -- either because it's too conservative, or not conservative enough.

The White House responded to the report by saying "the CBO has consistently proven it cannot accurately predict how healthcare legislation will impact insurance coverage."

How many people would not be covered?

The CBO and Joint Committee on Taxation estimate in 2018 15 million more Americans would be uninsured that under current law. 

The bill gets rid of penalties for people who don't have insurance, and for large employers who don't provide insurance to people. The CBO estimates the loss of those mandates means people will either drop insurance, or companies will stop providing it. 

Then, in later years, when lower spending on Medicaid and substantially smaller average subsidies for coverage kick in, more people would lose health insurance

The report says by 2026, 22 million more Americans under age 65 will be without health insurance, in addition to the estimated 28 million projected to be without health insurance under current law. 

By comparison, the U.S. House version of the health care bill, the Affordable Health Care Act, results in 23 million more Americans uninsured by 2026.

"CBO and JCT expect that this legislation would increase the number of uninsured people substantially," the report says. "The increase would be disproportionately larger among older people with lower income -- particularly people between 50 and 64 years old with income of less than 200 percent of the federal poverty level."

In addition, starting in 2019, insurers will be required to impose a six-month waiting period before coverage can start for people who get insurance in the nongroup market if they have been uninsured for more than 63 days within the past year.

In other words, a person is gets loses their job and has no health insurance coverage for more than two months, if they try to buy individual insurance they have to wait six months for it to kick in.

Will the cost of my health care go up?

The CBO says the bill would likely lead to an increase in average premiums for individual insurance purchasers before 2020, and then lower average premiums after.

This is because insurance will pay for a smaller average share of benefits -- the so-called essential health benefits, which can include ambulatory services, emergency services, maternity care, mental health and substance use services and pediatric care.

In states that use waivers to let insurance modify those benefits, people who use services no longer included would see "substantial increases in supplemental premiums or out-of-pocket spending on health care, or would choose to forgo the services."

The CBO said close to half the population in states with those waivers who are buying insurance on the premium market, would have have higher out-of-pocket spending.

Also, in state's that take the bill's waivers, health benefits no longer defined as essential would not have to worry about annual and lifetime limits.

"For many lower-income people, the net premiums paid under this legislation would be similar to those under current law, but the plans they would purchase would have higher deductibles and other cost-sharing requirements," the report says.

In 2019, the bill would allow insurers to charge older people premiums that are up to five times higher than those charged to younger people in nongroup and small-group markets. The ACA only allows premiums that are three times higher.

Then, starting in 2020, the tax credits for insurance coverage would be changed. People with income below 100 percent of the federal poverty level who are not eligible for Medicaid would be eligible for a tax credit, while people with income above 350 percent of the FPL would no longer be eligible.

Younger people would start paying a lower amount for a plan than some older people.

The bill will also cap Medicaid payments for different groups who benefit from it. 

How will it affect the federal budget?

The report says the bill also reduces federal deficits by $321 billion over the next decade.

The largest savings come in reductions to funding for Medicaid. Savings are offset by additional spending to reduce premiums and tax cuts proposed in the bill.

The House version of the bill, the AHCA, reduces the deficit by only $119 billion by 2026.

Will it keep the Health Insurance Market stable?

The CBO also says the Better Care Reconciliation Act would not affect insurance market stability in most parts of the country. 

But the CBO also says that because of the legislation, there are parts of the country where no insurers would participate in the individual markets after 2019, or insurance would only be offered at very high premiums. In some cases this is because the loss or cut in insurance subsidies would lead to fewer people buying insurance.

Also, because states would be able to issue waivers to narrow essential health benefits, the CBO says insurance coverage for some services will become more expensive in these areas of the country and, in some cases, extremely expensive. 

"For example, if the EHBs were modified to drop coverage of services that have high costs and are used by few people, coverage for maternity care, mental health care, rehabilitative and habilitative treatment, and certain very expensive drugs could be at risk," the report says.

"On the basis of historical experience, CBO and JCT anticipate that the funding available to help provide coverage for those high-cost services would be insufficient in some cases even if a special program was designed for that purpose. Therefore, the agencies expect that insurance coverage for high-cost services would become extremely expensive in those areas, as it was in some places before the enactment of the ACA in 2010."

What else does it do?

Starting in 2019, a provision in the bill would remove the federal cap on the amount of money from premiums can go to insurers' administrative costs and profits. States may set their own cap. 

The CBO also touched on the block in federal funding to Planned Parenthood. The report estimates that 15 percent would lose access to family planning care, largely in areas without access to other health care clinics or medical practitioners who serve low-income populations -- people who would be enrolled in Medicaid.

"Because the Medicaid program pays the cost of about 45 percent of all births, CBO estimates that the additional births stemming from the reduced access under this legislation would add to federal spending for the program.

"In addition, some of those children would themselves qualify for Medicaid and possibly other federal programs. By CBO's estimates, during the one-year period in which the funding prohibition would apply, the number of births in the Medicaid program would increase by several thousand, increasing direct spending for the program by $79 million over the 2017-2026 period."

The bill also eliminates cuts in Medicaid allotments to states for payments to hospitals that treat a large share of uninsured and Medicaid patients.