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The Congressional Budget Office released its report detailing the effects of the American Health Care Act on Wednesday evening, and several of Pennsylvania's top lawmakers and local activists were quick to try and shape the narrative about the report's findings.

The health care bill Republicans have pushed through the House would leave 23 million additional people uninsured in 2026 compared to President Barack Obama's health care law, according to the CBO. The GOP bill would lower average premiums, but in part that would be because coverage would typically be skimpier.

In a blow to Republicans, the nonpartisan analysts also were critical of 11th-hour provisions that GOP leaders had added to pick up votes and assure the bill's passage. Letting states get federal waivers so insurers could charge higher premiums for people with pre-existing medical conditions would mean those consumers would "ultimately be unable to purchase" comprehensive coverage at prices comparable to today's costs, "if they could purchase at all."

Wednesday's analysis seemed to offer political ammunition for both parties. Democrats have savaged the GOP bill for tossing people off their coverage, threatening their benefits and jeopardizing coverage for people with serious, costly to treat medical conditions. Many Republicans have said they are largely focused on steps that will reduce premiums.

'Imperfect,' but necessary: U.S. Rep. Scott Perry, R-Dillsburg, released a statement after the CBO's latest score on the AHCA in which he said the bill is "imperfect and doesn't go far enough to end the Affordable Care Act."

"But inaction wasn't — and still isn't — an option," Perry said. "The failed policies of the ACA are driving up the costs of both health care and medical insurance nationwide, and the pace is unsustainable."

Perry also pointed to discrepancies between projections and the actual number of people covered by the ACA in 2016.

"The CBO originally predicted that 21 million Americans would have ACA coverage in 2016; yet only about 10.4 million actually gained coverage," Perry said.

The CBO report confirms that the AHCA would lower premiums and reduce the deficit, but with the Senate working on its own health care bill, Perry cautioned "this process has a long way to play out."

Perry voted against the original version of the AHCA, but he voted in favor the version scored Wednesday by the CBO.

Swift backlash: Immediately after the CBO released its latest score on the American Health Care Act’s effects, Sen. Bob Casey, D-Pa., released a statement calling the AHCA “morally bankrupt." Casey summed up the CBO’s report with four words: “higher costs, less coverage.”

Casey called out the bill’s “age tax,” which could see older people paying higher insurance premiums than younger portions of the population, and its provisions regarding pre-existing conditions.

“Under the Republican scheme, Pennsylvanians in their 50s and 60s will be required to pay an ‘age tax’ for no other reason than the number of years they’ve lived,” Casey said in the statement. “Those with pre-existing conditions like cancer and diabetes risk losing their protections from discrimination and will pay higher prices for their care, if they can get someone to insure them.”

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Val Kater, a Chanceford Township resident and a member of Put People First Pennsylvania, said she and her organization think the repeal of #ACA is "painful" and "dangerous."

Due to the proposed $834 billion cuts to Medicaid, “nursing-home care for vulnerable seniors is in jeopardy, people with disabilities may lose their ability to live independently, and children with disabilities may lose critical school-based supports,” Casey said.

On Twitter, Casey followed up his statement by writing, “middle class, seniors and the sick pay more so the wealthiest can get a tax cut."

If passed in its current form, the American Health Care Act would force new costs onto local and state governments and “dramatically” stress their budgets, Casey said.

Casey called on President Donald Trump and congressional Republicans to work with Democrats and pass a plan that lowers premiums and reduces the cost of prescription drugs, instead of working to pass a tax cut for the wealthy.

“This health care bill is morally bankrupt and a disaster for children, middle-class families, seniors and individuals with disabilities,” Casey said in the statement. “And all of this — the higher costs and reduced protections for families — are done in order to finance a massive tax cut for the wealthiest.”

Sen. Pat Toomey, R-Pa., said the legislation passed by the House was a starting point and the Senate will be drafting its own plan, a spokesman said.

“Since its enactment, ‘Obamacare’ has caused premiums in Pennsylvania’s individual market to skyrocket by 120 percent,” Toomey spokesman Steve Kelly wrote in a statement. “Forty percent of all Pennsylvanians have a grand total of one choice in Obamacare’s individual market.”

'Giant Jenga puzzle': Marta Peck, an Indivisible York activist from York City, said she is in no way satisfied with the changes made in the latest version of the bill.

"It's still deficient in so many ways," Peck said, pointing to the bill's defunding of Planned Parenthood and the potential for states to create high-risk insurance pools for people with pre-existing conditions.

Creating a sound health insurance bill is like building "a giant Jenga puzzle" — it requires a "sophisticated process" of adding and removing numerous pieces without causing the whole thing to collapse, Peck said, adding that she saw that process in the drafting of the ACA but not the AHCA.

In recent months, Indivisible York has held numerous protests outside Perry's office in Springettsbury Township  to rally against the AHCA.

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Peck said the activist group will continue to stage protests and "die-ins" at Perry's office, even though they don't think it will work.

Indivisible York members "don't believe there is anything we can do that will accomplish our goal of getting us to change his mind, but we're going to keep working on it" to help other 4th District constituents better understand the legislation and its impacts, Peck said.

On Wednesday morning, the group delivered a petition asking Perry to hold another town hall on the AHCA. Peck said the petition had more than 600 signatures, and about a dozen members had a "very polite and very cordial" conversation with Perry's staff about scheduling the town hall.

'Reckless' legislation: In a written statement, Pennsylvania Gov. Tom Wolf called on those in the Senate to move away from the AHCA and work to improve the ACA, pointing to the GOP bill's potential to hurt the state's senior citizens.

"I will continue to fight to protect access to quality, affordable health care for all Pennsylvanians, especially our elderly and most vulnerable citizens with chronic health needs and pre-existing conditions," Wolf said. "I hope the U.S. Senate takes the impact of these attempted reforms to heart moving forward and shows more respect to the people they were elected to serve."

Pennsylvania Insurance Commissioner Teresa Miller called the AHCA "a reckless piece of legislation that will endanger health care for millions of Americans and further destabilize the insurance market."

"Instead of focusing of real reforms that can improve how the Affordable Care Act works for all Americans without hurting those who benefit from the law, House Republicans and the Trump Administration doubled down on a bill that jeopardizes affordable and robust coverage for older and low-income Pennsylvanians and the 5.4 million with pre-existing conditions — our most vulnerable citizens," Miller said.

What's next? Trump and Republicans celebrated House passage of the bill earlier this month in a Rose Garden ceremony, even as GOP senators signaled their opposition and signaled that the bill had little chance of becoming law.

The budget office raised concerns about a key legislative compromise that allowed the bill to narrowly pass the House on May 4, by a vote of 217-213.

To win needed votes after several embarrassing setbacks, Republican conservatives and moderates struck a deal that would let states get federal waivers to permit insurers to charge higher premiums to some people in poor health, and to ignore the standard set of benefits required by Obama's statute.

The CBO said states adopting those waivers run the risk of destabilizing coverage for people with medical problems. The agency estimated that about one-sixth of the U.S. population — more than 50 million people — live in states that would make substantial changes under the waivers.

"Over time, it would become more difficult for less healthy people (including people with pre-existing medical conditions) in those states to purchase insurance because their premiums would continue to increase rapidly," the report said.

The House bill also would reduce the federal deficit by $119 billion over the next decade, according to the new projection. That's slightly less than the $150 billion the office estimated in March.

The new estimates will serve as a starting point for GOP senators starting to write their own version of the legislation as they consider changing the House's Medicaid cuts, tax credits and other policies.

The report was the budget office's first analysis of the GOP health care overhaul that the House narrowly approved this month with only Republican votes. Two budget office reports in March on initial versions of the bill projected that 24 million people would lose coverage and that premiums would rise over the next two years but fall by 2026.

Pennsylvania Sen. Pat Toomey could not be reached for comment Wednesday.

The Associated Press contributed to this report.

— Reach Jason Addy at jaddy@yorkdispatch.com or follow him on Twitter at @JasonAddyYD.

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