WASHINGTON – Republican Sen. Joni Ernst of Iowa, an advocate of repealing and replacing Obamacare, complained the present law’s medical deductibles and copayments make it worthless.

Ernst argued the estimated 20 million Americans who received insurance under the law “is very misleading because while they have an insurance card now they can’t go to the doctor” due to high out-of-pocket costs.

But the nonpartisan Congressional Budget Office’s analysis of the House GOP plan undercut her talking point this week by estimating deductibles and copay expenses to individual policyholders would go even higher than is the case now.

That’s so, the analysis said, because the House Republican plan eliminates an annual $100 million subsidy to insurance companies to reduce deductibles and copayments for lower-income Americans.

And when you add in the replacement plan’s lower subsidies for policy premiums, it amounts to a “double whammy” of higher expense to individuals who are least able to pay more for medical care, according to America’s Health Insurance Plans, the national trade organization for health insurers.

Increased deductibles and copayments were among the expenses that led Congress’s budget office to estimate the Republican proposal would raise the number of people without health insurance by 24 million within a decade.

Obamacare deductibles were one of the biggest complaints people raised in focus groups held by the Kaiser Family Foundation on the law last year, said Cynthia Cox, a Kaiser health policy analyst. “I don’t think they’re going to be very happy” if deductibles go up even higher under the Republican plan, she said.

Hardest hit, the budget office said, would be poorer Americans and those nearing retirement, many of whom now get coverage under an expansion of the Medicaid law that took place in 2012.

The House Republican plan would phase out Obamacare’s Medicaid expansion that covered 12 million people. It would also eliminate income-based tax credits that helped lower income people pay for coverage, and end the penalty for people who do not have health insurance.

On a positive note, the Congressional Budget Office estimated that the Republican plan to reduce federal funding of health care would trim $337 billion from the national debt over the next decade, and eventually reduce insurance premiums for individual policyholders – goals set by President Donald Trump and GOP leaders.

But before experiencing premium reductions averaging 10 percent after 2020, the budget office said, they would go up by 15 percent in 2018 and 20 percent in 2019 when compared with Obamacare.

Trump and Republican leaders have challenged the credibility of those estimates, insisting their plan will expand health care insurance choices, increase access and lower costs through greater competition among insurers.

The president has described the fight over the GOP plan as “a big fat beautiful negotiation” that will end with Republican solidarity and might even woo support from some Democrats.

The budget office analysis “confirms that our plan reduces premiums and taxes on you and your family over time, makes headway to address our federal deficit, and puts your healthcare decisions back in your hands,” Rep. Susan Brooks, R-Ind., said in a statement. “One of the many reasons Obamacare failed is that it focused on forcing Americans into coverage they did not want and could not afford,” Rep. Buddy Carter, R-Ga., said in a statement.  

Sonya Poe of Dallas County, Texas, offered a specific example of the potential double-whammy effect of higher premiums and deductibles. She said her 61-year-old mother’s premium cost could double from $6,000 a year under the GOP plan because of fewer and lower subsidies.

She said her mother is undergoing treatment for breast cancer.  And if her deductibles were to go up as well, “she would not have access to health care” to cover her mammograms or check-ups after her chemotherapy ends in December, Poe said.  She and her sisters would try to help, “but it would then put all of us in a bind. We are all employed, but we all have families and financial responsibilities as well.” The House plan continues under question from conservative Republicans, who see it as continuing a federal entitlement program instead of turning health care costs over to the states. Sen. Rand Paul of Kentucky describes the plan as “Obamacare Lite” because it features tax credits or rebates, though they are lower than the present law.

Democrats, as expected, blasted the Republican plan in the wake of the Congressional Budget Office analysis of its impact. Rep. Dave Loebsack, D-Iowa, said it “rips health care coverage from millions of Americans… Any increase in out-of-pocket costs for Iowans would itself make quality healthcare less accessible and further demonstrates that this plan provides less coverage for more money.” Sen. Bob Casey, D-Pa., said that “under Trumpcare, middle class families will see their premiums go up, older Pennsylvanians will face an age tax and fewer Pennsylvanians will be insured.”

Congress’s budget office estimated 52 million Americans would lack insurance by 2026 under the Republican plan, including 28 million already expected to be without insurance under Obamacare.

Kery Murakami is CNHI’s Washington reporter. Contact him at kmurakami@cnhi.com.