Senate should retain mandate

There are all sorts of problems with the massive tax cut legislation the Senate is expected to vote on this week. Wealthy individuals and corporations benefit more than the poor and the middle class; by 2027, about half of all taxpayers would see a tax increase; and the federal deficit would balloon by $1.5 trillion. But it is particularly galling for Republicans to add a provision to repeal the requirement for most individuals to have health insurance in order to help pay for tax cuts.

This is the latest attack on the Affordable Care Act, which Senate leaders fortunately have failed to muster enough votes to repeal. If there is any doubt that the law is far more popular outside Washington or that Americans want access to health coverage, look at the early surge in sign-ups for coverage in 2018 despite virtually no promotion and numerous other efforts by the Trump administration to sabotage the act. In a more pragmatic, bipartisan climate, Congress would be looking for ways to improve the health care law, which has its flaws but has significantly lowered the uninsured rate.

Instead, the Senate is out to undermine it by repealing the individual mandate that requires most Americans to have health coverage or pay a penalty. In other debates in other years, the discussion was about how to make the individual mandate more effective to increase coverage. Now, the nonpartisan Congressional Budget Office estimates that repealing the mandate would mean nearly 13 million more Americans would go without health coverage by 2027. That’s moving backward, not forward.

The bottom line here is money. To comply with Senate rules, the tax cut bill cannot add more than $1.5 trillion to the federal deficit so it can be approved by a majority vote and without any support from Democrats. If 13 million fewer Americans sign up for health coverage, the CBO estimates the federal government would save $338 billion in insurance subsidies and on Medicaid. The savings may wind up being smaller, but the goal remains to save enough to help meet the limit on the impact of the tax cuts on the federal deficit. The more sensible approach would be to reduce the tax cuts for businesses and the wealthy to lower the cost, but common sense is in short supply in Washington.

Instead, Senate Republicans are determined to push ahead to lower corporate taxes, eliminate the estate tax that affects only a tiny portion of small farms and closely held businesses — and encourage more Americans to go without health insurance while premiums rise up to 10 percent each year over current projections to pay for covering a smaller pool of sicker people. That’s fundamentally wrong, and more enlightened Republican senators such as Susan Collins of Maine should insist that the repeal of the individual mandate has to be removed from the tax cut legislation before they will support it.

This is a tax cut bill, not a health care bill.