WASHINGTON — A report released Monday by the Congressional Budget Office has set out what could be a decisive fault line in the Senate debate over health-care reform.

Proponents say the report shows health-care reform will do no harm to Americans’ pocketbooks. Critics say that report shows the US is about to undertake a massive and uncertain reorganization of the health-care industry for “no significant savings.”

In truth, there’s no fixed answer to what is emerging as the biggest question on health-care reform: How will proposed changes affect the premiums people pay for health insurance.

It depends on how people purchase insurance, according to the report.

For Americans with employer-provided insurance, changes in the cost of coverage will be modest. For those who buy insurance on their own - and qualify for government subsidies - costs could go down up to 59 percent.

‘A modestly positive impact’
Sen. Evan Bayh (D) of Indiana, who asked the CBO in October to report on the issue for the Senate debate, said that he could not vote for a bill that raised insurance costs for average Americans. Today’s report “alleviates a major concern,” he said.

“This study indicates that for most Americans, the bill will have a modestly positive impact on their premium costs. For the remainder, more will see their costs go down than up,” he said in a statement.

But critics found grist in the CBO report for their own talking points. After trillions in government spending, new taxes, and cuts to Medicare, most people “will end up paying more or seeing no significant savings,” said Senate GOP leader Mitch McConnell, in a floor speech on Monday. “This is not what the American people are asking for. And it’s certainly not reform.”

CBO tries to tread carefully
The CBO report is highly qualified. Any estimates of the impact of such substantial changes in the health insurance and health-care sectors must reflect “considerable uncertainty,” the report concludes.

But the nuances quickly fell out of the political firestorm around healthcare reform.

To the insurance industry, today’s report confirms that “the current health-care reform proposal fails to bend the health care cost curve and will result in double-digit premium increases for millions of Americans,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, in a statement.

Consumer groups applauded the report as “great news for health reform supporters.”

“Interestingly, CBO does not analyze the impact of critical cost containment reforms already in the Senate bill,” said Larry McNeely, a spokesman for US Public Interest Research Group.

Payment reforms that reward quality and care coordination, preventive and primary care, and an independent Medicare commission “will be just beginning to have their impact in 2016, the year CBO chose to analyze. In the following years, these cost-saving provisions should drive down premiums even further,” he said.

The report in detail
Among the conclusions of the report:

• For some 32 million Americans with non-group policies, premium costs would rise by an average of 10 percent to 13 percent if the Senate bill becomes law. But with government subsidies, more than half of this group would end up paying 56 percent to 59 percent less for their health insurance than they would have without reform.
• For those 134 million covered by large group insurance (from companies with more than 50 employees), premium costs could drop as much as 3 percent.
• For some 25 million expected to be covered by small group insurance, costs could increase up to 1 percent or decrease by 2 percent.
• Those facing a new 40 percent excise tax on high-premium plans - that is, over a threshold of $8,500 for single policies and $23,000 for family policies - can expect employers to “respond to the tax by offering policies with premiums at or below the threshold,” the CBO report concluded. The CBO and Joint Committee on Taxation estimate that 19 percent of employment-based policies would have premiums that exceeded the threshold in 2016.

See also:

Senate healthcare reform debate begins: public option topic No. 1

The Monitor’s series on health-care holdouts:

Ben Nelson says abortion funds mean ‘no’ vote

Mary Landrieu likes her $300 million

Blanche Lincoln wants to focus on jobs