Withholding the Affordable Care Act's cost-sharing reduction payments, which President Donald Trump has threatened to do, would increase federal deficits and increase gross premiums for certain ACA plans, the Congressional Budget Office said in a report released Tuesday. It would also mean that about 5% of people would be living in areas with no individual market insurers in 2018, the CBO found, but people in "almost all areas" would likely have access to individual market plans by 2020. The cost-sharing reduction payments pay back health insurers for the increased cost of certain plans on the ACA's marketplaces. The payments being withheld would mostly affect silver ACA plans, increasing gross premiums by 20% in 2018 and 25% by 2020, according to the report. Other people buying individual market plans might face slight increases over the next two years but net premiums would largely be similar to or less than what they would otherwise be, the report said. The federal deficit would increase by $194 billion between 2017 and 2026, the CBO said, due to changes in government spending that withholding the payments would prompt. The number of uninsured people would be slightly higher next year but slightly lower beginning in 2020. The CBO added a substantial caveat to all of its findings, noting that "those effects are uncertain and would depend on how the policy was implemented."
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