The Republican deal with itself: repeal the Obamacare individual mandate and stabilize the individual health insurance market?

“HEALTH CARE: The Senate plan calls for eliminating the individual mandate in the Affordable Care Act (”Obamacare”). This will gut the ACA just as much as outright repealing it as the Senate tried earlier in the year, and failed. Eliminating this mandate will cause 13+ million taxpayers, many of them Trump supporters, to lose their health insurance. The savings of some $338 billion by doing this will be used to pay for the tax plan and those wealthy Americans that will see their taxes go down. ..
MEDICARE and MEDICAID: Here is one that has not received much attention, but all those 65 and older that are on Medicare, take note: as a result of what the Republicans wish to force down voters’ throats, $25 billion will be slashed from Medicare. This is due to a 2010 law, called PAYGO (”pay-as-you-go) that requires ensuring any new legislation enacted during a term of Congress does not collectively increase estimated deficits. If there is an increase in the deficit (again, the tax plan will increase the deficit by $1.5 trillion) OMB (Office of Management and Budget) is required to order a sequestration to eliminate the overage. Medicare would not be immune from this. ..Medicaid subsidies would also get axed by $179 billion…(A)

“Senate Republicans’ proposed tax reform bill would increase Obamacare prices by an average of almost $2,000 per family in 2019, according to an analysis released Thursday.
And the tax bill would lead to 1.8 million more people lacking health insurance in California than currently, another 1 million people becoming uninsured in Texas, and more than 800,000 newly uninsured in New York and Florida each, the report said.
Cumulatively, 13 million more people nationally would become uninsured.” (B)

“ “I believe in the Affordable Care Act; it worked for me under the Obama administration,” said Sara Stovall, 40, who does customer-support work for a small software company. “But it’s not working as it was supposed to. It’s being sabotaged, and I feel like a pawn.”
Ms. Stovall said she might try to reduce her hours and income, so her family could qualify for subsidies on offer to poorer families to help pay for premiums.” (C)

“For those who are over the age of 64 or who live with the challenges of disability, this tax bill does not carry benefits. Instead it leads to a path towards poverty, unemployment, and potentially tragic loss of life.
The most significant proposal is the elimination of the medical tax deduction, as it will have immediate and devastating impact on the 8.8 million Americans who have claimed the benefit to help offset medical expenses, includes those dealing with the devastating consequences of medical crisis or disabilities.
Of those who claimed the deduction in 2015, nearly half earned less than $50,000 and almost 70 percent earned less than 75,000 annually, according to AARP…
In short, the medical expenses deduction has saved American families and lives by easing the financial burden on struggling individuals and families, and these middle class communities will feel the impact if it is discontinued….” (D)

“Were the ACA’s insurance mandate repealed absent a new policy to compel the purchase of coverage, the CBO projects that premiums would rise 10 percent for people who buy insurance on their own and more than 13 million Americans would lose or drop their coverage.
But a reduction in the number of people with insurance also translates to less taxpayer money spent to provide subsidies for premiums under the ACA. Ending the requirement as of 2019 would save the government an estimated $318 billion, helping to offset the cost of lowering the corporate tax rate….
The White House argues that the ACA’s insurance mandate isn’t popular and disproportionately affects low- and middle-income Americans who are forced to buy insurance that may be more expensive than they can afford.
“The President’s priorities for tax reform have been clear from the beginning: make our businesses globally competitive, and deliver tax cuts to the middle class,” White House spokesman Raj Shah said in a statement. “He is glad to see the Senate is considering including the repeal of the onerous mandates of Obamacare in its tax reform legislation and hopes that those savings will be used to further reduce the burden it has placed on middle-class families.”…
Insurers, hospital groups and disability advocates have spoken out forcefully against the health-care proposals in the bill. Hospitals and insurance groups wrote a letter to congressional leaders on Tuesday warning of dire health-care outcomes if the tax measure becomes law.
“Repealing the individual mandate without a workable alternative will reduce enrollment, further destabilizing an already fragile individual and small group health insurance market on which more than 10 million Americans rely,” said the letter, signed by six health-care groups, including the American Hospital Association and America’s Health Insurance Plans.” (E)

“A group of Republican senators met with President Trump at the White House on Thursday to push him to support a bipartisan ObamaCare fix, according to a Senate GOP aide….
Collins and another moderate, Sen. Lisa Murkowski (R-Alaska), have indicated that passing Alexander-Murray would help ease their concerns about the spike in premiums from repealing the mandate.
Getting Trump’s support for that measure would help ease its passage, especially through the House, where many Republicans are opposed to it as a bailout of insurance companies….
A major obstacle for the idea of pairing Alexander-Murray with repealing the mandate in tax reform, though, is that Democrats have rejected that trade. Senate Democratic Leader Charles Schumer (N.Y.) said this week that Democrats would block the Alexander-Murray bill if the GOP goes forward with repealing the mandate.
Several experts also say that Alexander-Murray, which is aimed at stabilizing markets by continuing key payments for insurers, would not cancel out the destabilizing effects of repealing the mandate, which could lead to a lack of healthy people signing up and a rise in premiums.
The Congressional Budget Office has found that repealing the mandate would increase premiums by 10 percent, but that markets would continue to be stable in almost all areas of the country. “ (F)

Alaska Republican Sen. Lisa Murkowski suggested Thursday that her vote on the current version of the Senate GOP tax overhaul is contingent on the passing of a separate bill to stabilize the individual health insurance market.
The tax legislation now includes a section to repeal the individual mandate in the 2010 health care law — a provision that opens up more than $300 billion in revenue — but could also threaten the viability of the overall law….
Murkowski believes legislation from the Senate Health, Education, Labor and Pensions leaders, Chairman Lamar Alexander and ranking member Patty Murray, is necessary before the mandate — which supporters of the law say is a critical foundation for the current insurance markets — is repealed.
“I think that there is a path and I think the path is a reasonable path,” Murkowski said of her support for the measure. “If the Congress is going to move forward with repeal of the individual mandate, we absolutely must have the Alexander-Murray piece that is passed into law.”
Without such a measure — which would, among other things, appropriate money for so-called cost-sharing subsidies — Murkowski says middle-class Americans may not receive the kind of tax relief the GOP is aiming to provide.
“There is a path forward. It just means that some who have said some nasty things about CSRs are maybe just going to have to acknowledge that, well, this might be the way that you thread this needle,” she said. “If that tax cut is offset by higher premiums, you haven’t delivered benefit.”
The Congressional Budget Office has estimated that removing the mandate could lead to millions more uninsured individuals over the next ten years and could raise health care costs for some, particularly sicker Americans.
Twelve Republican senators — along with every Democratic member — have come out in support of the Alexander-Murray bill, enough for it to pass under the regular 60-vote threshold in the chamber.” (G)

“Maine Sen. Susan Collins wants the Senate to strike a provision in the tax reform bill that would repeal the individual mandate because she fears it will cause what amounts to a tax increase on some families.
Speaking on CNN’s “State of the Union,” Collins, a crucial Republican swing vote in the Senate, said the measure, which would essentially cripple the Affordable Care Act by removing one of its key pillars, should be removed from the Senate’s version of the bill.
“I don’t think that provision should be in the bill,” she said. “I think the Senate should follow the lead of the House and strike it.”…
Collins said the measure must be taken out of the bill because it will end up causing families who have healthcare through the Affordable Care Act to pay more for their insurance.
“The fact is that if you do pull this piece of the Affordable Care Act out, for some middle-income families, the increased premium is going to cancel out the tax cut that they would get,” she said.” (H)

“On Sunday, Mick Mulvaney, President Trump’s budget director, said on CNN’s “State of the Union” that the administration supports repealing the mandate. Most people who owe the penalty earn less than $100,000 a year, he said, arguing that “there’s actually a benefit to folks” if the mandate goes away. But he added, “If it becomes an impediment to getting the best tax bill we can, then we’re O.K. with taking it out.”” (I)

(A) The GOP Tax Plan-A Wolf In Sheep’s Clothing, by Miles J. Zaremski, https://www.huffingtonpost.com/entry/the-gop-tax-plan-a-wolf-in-sheeps-clothing_us_5a102167e4b023121e0e92f4
(B) GOP tax bill would spike Obamacare premiums nearly $2,000 for families, trigger Medicare cuts, by Dan Mangan, https://www.cnbc.com/2017/11/16/gop-tax-bill-would-spike-obamacare-premiums-nearly-2000-for-families.html
(C) Middle-Class Families Confront Soaring Health Insurance Costs, by ROBERT PEAR, https://www.nytimes.com/2017/11/16/us/politics/obamacare-premiums-middle-class.html?_r=0
(D) The GOP tax bill will be a health care burden on American families, by JANNI LEHRER-STEIN, http://thehill.com/opinion/healthcare/360801-the-gop-tax-bill-will-be-a-health-care-financial-burden-on-american
(E) 4 ways the Republican tax plan could change health care, by Dylan Scott, https://www.vox.com/health-care/2017/11/16/15643218/voxcare-tax-plan-health-care
(F) Trump met Senate Republicans on ObamaCare fix, by PETER SULLIVAN, http://thehill.com/policy/healthcare/360955-trump-met-senate-republicans-on-obamacare-fix
(G) Murkowski Suggests Tax Vote Depends on Stabilizing Individual Health Insurance Market, by Joe Williams, https://www.rollcall.com/news/politics/murkowski-alexander-murray-necessary
(H) Susan Collins wants repeal of Obamacare mandate out of Senate tax reform bill, by Kyle Feldscher, http://www.washingtonexaminer.com/susan-collins-wants-repeal-of-obamacare-mandate-out-of-senate-tax-reform-bill/article/2641179
(I) Will Cutting the Health Mandate Pay for Tax Cuts? Not Necessarily, by KATE ZERNIKE and ABBY GOODNOUGH, https://www.nytimes.com/2017/11/19/health/tax-plan-obamacare-mandate.html?_r=0

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