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Congress says Obama’s health care expansion may be more modest

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The number of Americans projected to gain insurance from the U.S. health care law is eroding by at least 5 million people as the Obama administration struggles to implement the $1.3 trillion overhaul amid Republican opposition.

About 27 million people are expected to gain coverage by 2017, according to a report today from the Congressional Budget Office. The CBO had projected when the law passed in 2010 that 32 million uninsured people would be on a health plan within a decade, and a year later raised its estimate to 34 million.

Expectations are being pulled back as the expansion relies on governors to build a network of insurance marketplaces and expand Medicaid, the joint federal-state insurance program for the poor. At least 22 Republican governors have said they’ll refuse to participate in the health exchanges and a Supreme Court decision lets them also opt out of the Medicaid expansion.

There is concern “about a combination of factors, including the readiness of exchanges to provide a broad array of new insurance options, the ability of state Medicaid programs to absorb new beneficiaries, and people’s responses to the availability of the new coverage,” the CBO said.

In addition, as many as 8 million people will lose health care plans now offered through their employers, the CBO estimates. After the health law was passed, the CBO projected that about 3 million people who would otherwise have employer-sponsored insurance would lose that coverage.

Some of the losses should be offset by enrollment in plans offered through exchanges, the CBO said. The CBO says that 26 million people will be in exchange plans by 2018, an increase from a maximum of 24 million in an earlier estimate.

The federal government has said it will run exchanges in states that aren’t building their own, and all marketplaces will be ready to begin enrolling people by Oct. 1. The law requires most Americans to carry insurance beginning Jan. 1, 2014.

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