GOP us­ing tax bill to un­der­cut health law

In­di­vid­ual man­date re­peal would free up $300B, but 13M would lose in­sur­ance.

Star Tribune - - FRONT PAGE - By MIKE DEBO­NIS and DAMIAN PALETTA • Wash­ing­ton Post

WASH­ING­TON – Se­nate Repub­li­can lead­ers are adding a pro­vi­sion to their tax bill that would un­der­mine the Af­ford­able Care Act, a ma­jor change of strat­egy as they now try to ac­com­plish two of their top do­mes­tic pri­or­i­ties in a sin­gle piece of leg­is­la­tion.

Se­nate Ma­jor­ity Leader Mitch McCon­nell, R-Ky., said Tues­day that the tax bill will now seek to re­peal the Af­ford­able Care Act’s in­di­vid­ual man­date, a cen­tral piece of the health care law that com­pels most Amer­i­cans to buy health in­sur­ance or pay a fine.

Re­peal­ing the man­date would free up more than $300 bil­lion in gov­ern­ment fund­ing over the next decade that Repub­li­cans could use to fi­nance their pro­posed tax cuts, but it would cause 13 mil­lion fewer peo­ple to have health in­sur­ance, ac­cord­ing to pro­jec­tions from the non­par­ti­san Con­gres­sional Bud­get Of­fice.

At­tempt­ing to use the tax bill to re­peal the man­date marks an abrupt shift in strat­egy as Repub­li­cans at­tempt to use a slim Se­nate ma­jor­ity to pass a


• Drop­ping the ACA’s in­di­vid­ual man­date would save the fed­eral gov­ern­ment $300 bil­lion over a decade, as it would spend less on sub­si­dies.

•The move would lead to 13 mil­lion fewer peo­ple hav­ing health in­sur­ance in a decade.

•GOP lead­ers have dif­fer­ent ideas on what they would do with the freed-up money.

mas­sive over­haul of the U.S. tax code. And it scram­bles an al­ready com­pli­cated cal­cu­lus as GOP lead­ers look to as­sem­ble the 50 votes they’d need to turn their tax bill into law.

Us­ing the bill to at­tack for­mer Pres­i­dent Barack Obama’s sig­na­ture leg­isla­tive achieve­ment likely rules out the al­ready slim pos­si­bil­ity of sup­port from Se­nate Democrats, and the prospect of adding mil­lions to the ranks of the unin­sured will likely trouble some of the same mod­er­ate Repub­li­cans who voted down pre­vi­ous re­peal ef­forts.

“We’re op­ti­mistic that in­sert­ing the in­di­vid­ual man­date re­peal would be help­ful” to the tax ef­fort, McCon­nell said Tues­day af­ter meet­ing with party mem­bers dur­ing a closed-door lunch.

Pres­i­dent Don­ald Trump pressed Congress to in­clude the re­peal in their tax ef­forts in a Twit­ter post Nov. 1, but it was re­ceived coolly by GOP lead­ers who feared the same health care pol­i­tics that had sunk their pre­vi­ous ACA re­peal at­tempts would tor­pedo their tax ef­fort. Trump and many GOP law­mak­ers have sup­ported us­ing the tax bill to re­peal the man­date, a part of the health care law that cre­ates penal­ties for some Amer­i­cans who don’t buy health in­sur­ance. But up un­til Tues­day, Repub­li­cans had re­sisted mak­ing the change, wor­ried that in­ject­ing health care pol­i­tics would im­peril the tax bill.

The change could un­nerve less-con­ser­va­tive Repub­li­can sen­a­tors, who voted against pre­vi­ous Se­nate ef­forts to re­peal large parts of the ACA.

Sen. Su­san Collins, R-Maine, one of the Repub­li­cans who op­posed pre­vi­ous at­tempts to roll back the health care law, said she was con­cerned about in­clud­ing the man­date re­peal while the Se­nate was still ad­dress­ing a health care com­pro­mise ne­go­ti­ated by Sens. La­mar Alexan­der, R-Tenn., and Patty Mur­ray, D-Wash.

“I per­son­ally think that it com­pli­cates tax re­form to put the re­peal of the man­date in there, par­tic­u­larly if it’s done be­fore the Alexan­der-Mur­ray bill passes be­cause of the im­pact on pre­mi­ums,” Collins said. “I’m go­ing to see what the bill says.”

Sen. John Thune, R-S.D., chair­man of the Se­nate Repub­li­can Con­fer­ence and a mem­ber of the fi­nance com­mit­tee that is draft­ing the tax bill, said re­peal will al­low the GOP to fur­ther cut taxes for mid­dlein­come fam­i­lies. “It’ll be dis­trib­uted in the form of mid­dlein­come tax re­lief,” Thune said. “It will give us even more of an op­por­tu­nity to re­ally dis­trib­ute the re­lief to those mid­dlein­come co­horts who could re­ally ben­e­fit from it.”

The up­dated tax bill could in­clude pro­vi­sions of the new bi­par­ti­san health care agree­ment, ac­cord­ing to Collins and Sen. Bob Corker, R-Tenn.

Sen. Mi­nor­ity Leader Chuck Schumer said in­clud­ing a re­peal of the man­date in the tax bill would tor­pedo Demo­cratic sup­port for the Mur­ray-Alexan­der bill. “We don’t need to trade it for a tax bill, and we won’t,” he said.

Re­peal­ing the man­date would un­der­mine other key parts of the Af­ford­able Care Act. The health care law banned in­sur­ance com­pa­nies from dis­crim­i­nat­ing against peo­ple with pre-ex­ist­ing health con­di­tions. But in order to pre­vent peo­ple from wait­ing to buy in­sur­ance un­til they got sick, the law also im­posed fi­nan­cial penal­ties for in­di­vid­u­als who did not main­tain health in­sur­ance cov­er­age.

Health ex­perts say elim­i­nat­ing the man­date would desta­bi­lize the in­di­vid­ual in­sur­ance mar­kets set up by the ACA, as they would be full of peo­ple with high health care costs but have far fewer of the healthy peo­ple in­sur­ance com­pa­nies de­pend on to stay prof­itable. In re­sponse, in­sur­ance com­pa­nies would likely ei­ther mas­sively raise pre­mi­ums or pull out of the mar­ket­places en­tirely.

A pow­er­ful group of stake­hold­ers, in­clud­ing the ma­jor health in­sur­ance and hos­pi­tal in­sur­ance lob­bies and two in­flu­en­tial doc­tors’ groups, wrote a let­ter to lead­ers from both par­ties ar­gu­ing that they should re­tain the man­date.

“There will be se­ri­ous con­se­quences if Congress sim­ply re­peals the man­date while leav­ing the in­sur­ance re­forms in place: mil­lions more will be unin­sured or face higher pre­mi­ums, chal­leng­ing their abil­ity to ac­cess the care they need,” the groups wrote.

Re­peal­ing the man­date would free up rev­enue, as fewer peo­ple with health in­sur­ance would mean the gov­ern­ment would spend less on in­sur­ance sub­si­dies, ac­cord­ing to CBO pro­jec­tions. But Repub­li­cans gave dif­fer­ing ex­pla­na­tions for what they would do with that money.

McCon­nell said the re­peal would al­low them to en­sure cor­po­rate tax cuts re­main per­ma­nent and also to lower taxes for mid­dle-class fam­i­lies. “It’s pretty ap­peal­ing to us and it will be in the ver­sion that comes out of the fi­nance com­mit­tee this week,” he said.

Trump has said the re­peal should be fo­cused on get­ting in­come tax rates down for the wealthy, with any left­over money go­ing to­ward cut­ting taxes for the mid­dle class.

Sen. Rand Paul, R-Ky., said that he would in­tro­duce his own amend­ment to the tax bill that would re­peal the in­di­vid­ual man­date and use the sav­ings to lower taxes for mid­dle-class fam­i­lies.

TOM BREN­NER • New York Times

Se­nate Fi­nance Com­mit­tee Chair­man Or­rin Hatch, R-Utah, gave open­ing state­ments at a markup on the tax bill Tues­day.

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