Oba­macare in tax bill

Repub­li­can lead­ers plan to use Se­nate mea­sure to take aim at the ACA’s in­di­vid­ual in­sur­ance man­date.

The Denver Post - - FRONT PAGE - The Wash­ing­ton Post By Mike DeBo­nis and Damian Paletta

WASH­ING­TON» Repub­li­can Se­nate lead­ers Tues­day said they would seek a re­peal of the Af­ford­able Care Act’s in­di­vid­ual man­date through their tax bill, a ma­jor change of strat­egy as they try to ac­com­plish two of their top do­mes­tic pri­or­i­ties in a sin­gle piece of leg­is­la­tion.

Re­peal­ing the man­date, which com­pels most Amer­i­cans to buy health in­sur­ance or pay a fine, would free up more than $300 bil­lion of govern­ment fund­ing over the next decade that Repub­li­cans could use to fi­nance their pro­posed tax cuts, but it would re­sult in 13 mil­lion fewer peo­ple hav­ing health in­sur­ance, ac­cord­ing to pro­jec­tions from the non­par­ti­san Con­gres­sional Bud­get Of­fice.

The CBO also has pro­jected that re­peal­ing the in­di­vid­ual man­date would drive up in­sur­ance pre­mi­ums for many Amer­i­cans by roughly 10 per­cent.

The in­jec­tion of health pol­icy into the tax de­bate in­tro­duces a volatile vari­able into what was a chal­leng­ing po­lit­i­cal en­ter­prise for Repub­li­cans. And it’s un­clear whether it will help or hurt the bill’s chances.

By free­ing up hun­dreds of bil­lions of dol­lars, Se­nate lead­ers have more flex­i­bil­ity as they at­tempt to as­suage the con­cerns of anx­ious mem­bers from across their cau­cus.

Se­nate GOP lead­er­ship has come un­der pres­sure to boost the tax plan’s ben­e­fits for the mid­dle class as non­par­ti­san pro­jec­tions have shown that the wealthy and big cor­po­ra­tions would ben­e­fit most. At the same time, lead­ers are strug­gling to en­sure that the leg­is­la­tion does not add too much to the bud­get deficit in the long run, threat­en­ing the bill’s vi­a­bil­ity un­der the pro­ce­dures they in­tend to use to pass it.

“We’re op­ti­mistic that in­sert­ing the in­di­vid­ual man­date re­peal would be help­ful,” Se­nate Ma­jor­ity Leader Mitch McConnell, R-Ky., said Tues­day af­ter meet­ing with party mem­bers dur­ing a closed-door lunch.

Elim­i­nat­ing the in­di­vid­ual man­date and hav­ing far fewer peo­ple signed up for in­sur­ance saves money be­cause many of those peo­ple re­ceive fed­eral sub­si­dies to buy cov­er­age.

But the elim­i­na­tion would cause sub­stan­tial po­lit­i­cal prob­lems of its own.

The at­tack on for­mer Pres­i­dent Barack Obama’s sig­na­ture leg­isla­tive achieve­ment is likely to rule out the slim pos­si­bil­ity of sup­port from Democrats, and the prospect of adding mil­lions to the ranks of the unin­sured could trou­ble mod-

er­ate Repub­li­cans who voted down pre­vi­ous re­peal ef­forts.

Sen. Su­san Collins, RMaine, one of the Repub­li­cans who op­posed ear­lier at­tempts to roll back the health-care law, said Tues­day that in­clud­ing the re­peal mea­sure “com­pli­cates” the tax ef­fort.

How­ever, she sug­gested she might be able to sup­port it if the Se­nate also passes a bipartisan bill to pre­serve other as­pects of the Af­ford­able Care Act.

Sen. John McCain, RAriz., who along with Collins and Sen. Lisa Murkowski, R-Alaska, voted down an Af­ford­able Care Act re­peal ef­fort this sum­mer, de­clined to say whether he’d back a tax bill that in­cluded re­peal.

“I want to look at the bill in its en­tirety be­fore you start pluck­ing out parts of it to see whether I sup­port it or not,” he said Tues­day in the Capi­tol.

Repub­li­cans con­trol 52 votes of the 100-seat Se­nate, so the de­fec­tion of three mem­bers would imperil any changes to the bill. Repub­li­cans are try­ing to pass the tax-cut bill through a process known as rec­on­cil­i­a­tion, which re­quires only 50 votes — plus a tiebreak­ing vote from Vice Pres­i­dent Mike Pence — to pass the bill.

Pence praised the re­peal ef­fort Tues­day at a Wall Street Jour­nal event in Wash­ing­ton, not­ing that Pres­i­dent Don­ald Trump is a vo­cal sup­porter of the ef­fort and say­ing that the man­date’s elim­i­na­tion would amount to a tax cut for the mid­dle class.

Re­peal­ing the man­date would un­der­mine the Af­ford­able Care Act’s sys­tem for at­tempt­ing to get low­in­come peo­ple and other in­di­vid­u­als into pri­vate health in­sur­ance plans. The health-care law banned in­sur­ance com­pa­nies from dis­crim­i­nat­ing against peo­ple with pre­ex­ist­ing health con­di­tions.

But to pre­vent peo­ple from wait­ing to buy in­sur­ance un­til they got sick, the law also im­posed fi­nan­cial penal­ties for in­di­vid­u­als who did not main­tain cov­er­age.

Health ex­perts say elim­i­nat­ing the man­date would desta­bi­lize the in­di­vid­ual in­sur­ance mar­kets set up by the Af­ford­able Care Act, as they would be full of peo­ple with high health­care costs but have far fewer of the healthy peo­ple in­sur­ance com­pa­nies de­pend on to stay prof­itable.

In re­sponse, in­sur­ance com­pa­nies prob­a­bly would raise pre­mi­ums mas­sively 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 of both par­ties, ar­gu­ing that they should re­tain the in­di­vid­ual 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.

Repub­li­cans ap­pear to have di­ver­gent plans for how they would use the fund­ing saved by re­peal­ing the man­date.

Se­nate Fi­nance Com­mit­tee Repub­li­cans met late Mon­day to see whether each mem­ber would agree to in­clud­ing the health­care lan­guage, and their sup­port was unan­i­mous.

They plan to use the sav­ings to off­set fur­ther tax cuts, in­clud­ing an even greater ex­pan­sion of the child tax credit, a move Ivanka Trump and Sen. Marco Ru­bio, R-Fla., have called for.

The pres­i­dent 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 Tues­day morn­ing 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.

Broadly, both the Se­nate bill and House bill would sharply cut the cor­po­rate tax rate and cut in­come tax rates for in­di­vid­u­als, while seek­ing to fi­nance those cuts by elim­i­nat­ing or scal­ing back some pop­u­lar tax de­duc­tions.

What the de­duc­tion roll­backs don’t cover would be fi­nanced by $1.5 tril­lion in deficit spend­ing over a decade.

The House and Se­nate bills would lower taxes for many Amer­i­cans, but non­par­ti­san an­a­lysts have con­cluded that the elim­i­na­tion of cer­tain de­duc­tions would have mil­lions pay higher taxes, par­tic­u­larly if they live in states such as New York, New Jersey or Cal­i­for­nia.

The House and Se­nate must pass match­ing ver­sions of the tax-cut bill for Trump to be able to sign them into law. The House bill does not in­clude a re­peal of the in­di­vid­ual man­date.

House con­ser­va­tives mounted a last-ditch ef­fort Tues­day to in­clude a re­peal be­fore the full cham­ber votes on the bill, sched­uled for Thurs­day. Rep. Mark Walker, R-N.C., the leader of the Repub­li­can Study Com­mit­tee, hud­dled in the of­fice of House Speaker Paul Ryan, R-Wis., Tues­day af­ter­noon with House Rules Com­mit­tee Chair­man Pete Ses­sions, R-Texas, whose panel will make any final changes to the bill Tues­day night be­fore it heads to the floor.

But House Repub­li­can aides who were not au­tho­rized to speak pub­licly on the in­ter­nal dis­cus­sions said Repub­li­can lead­ers are loath to make such a ma­jor change to the bill at this late stage and pre­fer to see whether the Se­nate could pass a bill with the re­peal pro­vi­sion be­fore bring­ing the is­sue up in the House.

In the Se­nate, the sud­den shift in the tax bill threat­ens to un­der­mine a com­pro­mise health mea­sure ne­go­ti­ated be­tween Sens. Patty Mur­ray, D-Wash., and La­mar Alexan­der, RTenn. The agree­ment would re­sume pay­ments that help low-in­come Amer­i­cans af­ford health in­sur­ance, which the Trump ad­min­is­tra­tion halted in Oc­to­ber.

To win sup­port for the up­dated tax bill, the Se­nate could take up the Alexan­der-Mur­ray bill along­side it, ac­cord­ing to Sens. John Thune, R-S.D., and Bob Corker, R-Tenn.

The bills can­not be com­bined un­der the rules of rec­on­cil­i­a­tion.

Se­nate Mi­nor­ity Leader Charles Schumer, D-N.Y., said in­clud­ing a re­peal of the man­date in the tax bill would tor­pedo Demo­cratic sup­port for the Mur­ray-Alexan­der com­pro­mise.

“We don’t need to trade it for a tax bill, and we won’t,” he said.

And Mur­ray, D-Wash., the top Demo­crat on the Se­nate Health, Ed­u­ca­tion, La­bor and Pen­sions Com­mit­tee, told re­porters she was stunned that Repub­li­cans would again seek to undo the Af­ford­able Care Act.

“The elec­tions last week clearly showed that the Amer­i­can peo­ple are pay­ing at­ten­tion, and they don’t want their health care taken away,” Mur­ray said, ref­er­enc­ing a string of state-level elec­tions in Vir­ginia, New Jersey and else­where in which Democrats trounced Repub­li­cans. “I don’t think (Repub­li­cans are) lis­ten­ing.”

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