Un­able to kill ACA’s health man­date, GOP to add that mea­sure to its tax plan

The Buffalo News - - WASHINGTON NEWS - By Thomas Ka­plan and Jim Tanker­slee

WASH­ING­TON – Se­nate Repub­li­cans have de­cided to in­clude the re­peal of the Af­ford­able Care Act’s re­quire­ment that most peo­ple have health in­sur­ance into the sprawl­ing tax re­write, merg­ing the fight over health care with the high-stakes ef­fort to cut taxes.

The move to tuck the re­peal of the so-called in­di­vid­ual man­date into the tax over­haul is an at­tempt by Repub­li­cans to solve two prob­lems: math and pol­i­tics. Re­peal­ing the man­date, a long­stand­ing Repub­li­can goal, would save hun­dreds of bil­lions of dol­lars over the next decade. That would free up money that could be used to ex­pand mid­dle­class tax cuts or help pay for the over­all cost of the bill, which can add no more than $1.5 tril­lion to the deficit over 10 years. It could also help se­cure the votes of the most con­ser­va­tive sen­a­tors, en­abling law­mak­ers to pass the bill along party lines.

If it be­comes law, the re­peal would save more than $300 bil­lion over a decade but re­sult in 13 mil­lion fewer Amer­i­cans be­ing cov­ered by health in­sur­ance by the end of that pe­riod, ac­cord­ing to the Con­gres­sional Bud­get Of­fice. Repub­li­cans said on Tues­day that they would use the sav­ings – which stem from re­duced gov­ern­ment spend­ing to sub­si­dize health cov­er­age – to pay for an ex­pan­sion of the mid­dle-class tax cuts that law­mak­ers had pro­posed.

On Tues­day evening, the chair­man of the Se­nate Fi­nance Com­mit­tee, Or­rin G. Hatch, R-Utah, was ex­pected to re­lease an amend­ment that would add the re­peal of the man­date to the Se­nate’s tax plan. On the House side, mem­bers of the Rules Com­mit­tee met Tues­day evening, one day ear­lier than sched­uled, to pave the way for a floor vote on Thurs­day.

Democrats said the man­date re­peal would un­der­write tax cuts for the rich at the ex­pense of peo­ple who buy in­sur­ance on the in­di­vid­ual mar­ket.

“The peo­ple this is go­ing to hit are mid­dle-class peo­ple that os­ten­si­bly this whole bill was sup­posed to be about help­ing,” said Sen. Claire McCaskill, D-Mo., a mem­ber of the Fi­nance Com­mit­tee.

Av­er­age health in­sur­ance pre­mi­ums in the in­di­vid­ual mar­ket would in­crease by about 10 per­cent, but in­sur­ance mar­kets would re­main sta­ble in al­most all parts of the coun­try, the bud­get of­fice found.

Pres­i­dent Trump has urged his fel­low Repub­li­cans to re­peal the man­date in their tax bill, and in re­cent days, the idea has gained steam in the Se­nate Repub­li­can con­fer­ence as law­mak­ers try to come up with a plan that can re­ceive at least 50 votes.

“We’re op­ti­mistic that in­sert­ing the in­di­vid­ual man­date re­peal would be help­ful,” said Sen. Mitch McCon­nell, R-Ky., the ma­jor­ity leader.

But the move risks reignit­ing the con­tentious de­bate over health care that Repub­li­cans found them­selves mired in for much of the year. Pre­vi­ous ef­forts to dis­man­tle the Af­ford­able Care Act have failed, leav­ing Repub­li­cans with lit­tle leg­isla­tive suc­cess to show for their con­gres­sional ma­jor­ity.

“This is turn­ing a tax bill into a health care bill, with our col­leagues get­ting an hour’s worth of no­tice,” said Sen. Ron Wy­den of Ore­gon, the top Demo­crat on the Fi­nance Com­mit­tee.

In a let­ter Tues­day, groups rep­re­sent­ing doc­tors, hos­pi­tals and in­sur­ers urged con­gres­sional lead­ers to keep the in­di­vid­ual man­date in place. The groups, which in­cluded the Amer­i­can Med­i­cal As­so­ci­a­tion and Amer­ica’s Health In­sur­ance Plans, wrote that “elim­i­nat­ing the in­di­vid­ual man­date by it­self likely will re­sult in a sig­nif­i­cant in­crease in pre­mi­ums, which would in turn sub­stan­tially in­crease the num­ber of unin­sured Amer­i­cans.”

On Tues­day, Repub­li­cans were laser­fo­cused on speed­ing ahead with the tax re­write and showed no de­sire to slow down that ef­fort.

House Repub­li­can lead­ers plan to hold a vote on their bill Thurs­day and ex­pressed con­fi­dence that it would pass the House. Se­nate Repub­li­cans, who un­veiled their tax pro­posal last week, are planning to vote on their own ver­sion the week af­ter Thanks­giv­ing.

On Tues­day, Gold­man Sachs an­a­lysts raised their odds of a tax pack­age be­ing signed into law to 80 per­cent, from 65 per­cent.

“We feel very good where we are,” said House Speaker Paul D. Ryan, RWis.

To be pro­tected from a Demo­cratic fil­i­buster, the tax bill can add no more than $1.5 tril­lion to fed­eral bud­get deficits over a decade, and it can­not add to the deficit af­ter a decade. Elim­i­nat­ing the man­date start­ing in 2019 would re­duce fed­eral bud­get deficits by a to­tal of $338 bil­lion by 2027, the Con­gres­sional Bud­get Of­fice said last week.

Sen. John Thune of South Dakota, a mem­ber of the Repub­li­can lead­er­ship who also serves on the Fi­nance Com­mit­tee, said the sav­ings from re­peal­ing the man­date would be “dis­trib­uted in the form of mid­dle-in­come tax re­lief.”

Thune said he was con­fi­dent that the tax plan, with the man­date re­peal as part of it, could pass the Se­nate.

But not all sen­a­tors were as san­guine about its pas­sage and Repub­li­cans will need to care­fully cal­i­brate votes, given that they hold a nar­row 52-seat ma­jor­ity in the Se­nate.

“I per­son­ally think that it com­pli­cates tax re­form,” said Sen. Su­san Collins, R-Maine.

In tan­dem with re­peal­ing the in­di­vid­ual man­date as part of the tax bill, Thune said that Repub­li­cans were com­mit­ted to ad­vanc­ing a bi­par­ti­san mea­sure to sta­bi­lize health in­sur­ance mar­kets de­vel­oped by Sens. La­mar Alexan­der, R-Tenn., and Patty Mur­ray, DWash. That mea­sure, whose fate has been un­cer­tain, would in­clude two years of fund­ing for sub­si­dies to in­sur­ers – known as cost-shar­ing re­duc­tion pay­ments – that Trump de­cided to cut off last month. But Mur­ray re­jected any sug­ges­tion that the man­date re­peal could be paired with her leg­is­la­tion.

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