Senate tax bill may come with a few side effects for health care
The Republican tax overhaul that squeaked through the Senate early Saturday morning would reach deep into the nation’s health care system, with a clear dagger to a core aspect of the Affordable Care Act and broader ripple effects that could threaten other programs over time.
The measure would abolish the government’s enforcement of the ACA requirement that most Americans carry insurance coverage. It would not end the individual mandate itself but would eliminate tax penalties for flouting that requirement. The result could cause an extra 13 million people to become uninsured and drive up insurance premiums in marketplaces created under the law, according to an estimate by Congress’ nonpartisan budget analysts.
At the same time, the frenzied negotiations to line up support for the huge legislation within the Senate’s slender majority improved the prospects for temporarily reviving payments to ACA insurers that President Donald Trump ended this fall.
In becoming the last GOP senator to announce support for the tax bill, Sen. Susan Collins, Maine, said late Friday afternoon that Senate Majority Leader Mitch McConnell, R-Ky., had “committed to support” two separate measures by the end of the year.
One is a bipartisan plan that would restore for two years “cost-sharing reduction” payments to cover the expense of discounts that the ACA compels insurers to give lower-income customers on deductibles and other out-of-pocket costs. Trump cut off the monthly payments as of October, erroneously terming them “bailouts” to the insurance industry. The plan, forged by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., also would expand consumers’ ability to buy inexpensive “catastrophic” health plans through ACA marketplaces and make it easier for states to secure federal permission to carry out the law’s basic ideas in different ways.
An attempt to pass the plan faltered in the Senate earlier in the fall, but Collins said Friday that McConnell was now willing to support its passage, along with a newer plan that would give states two years of money for various “reinsurance” funds intended to help insurers blunt premium increases. Neither measure has been considered by the House.