“….57 % of Americans now approve of Obamacare. Only 29 % approve of the GOP’s tax cuts.”

Reflect on those numbers for a moment. Republicans have managed to make tax cuts less popular than Obamacare. It’s impressive.
And yet last week, given an opportunity to tweak their bill before final passage, to make it something the American people might like a little better, the main change Republicans made was to lower the top tax rate — the rate paid by the richest Americans — even more.” (A)

“Doctors, hospitals, patient advocates and others who work in the nation’s healthcare system are growing increasingly alarmed at the Republican tax bill, warning that it threatens care for millions of sick Americans.
The legislation – which GOP leaders are rushing to pass this week – will eliminate beginning in 2019 the Affordable Care Act penalty on consumers without health coverage, a move many experts warn will weaken insurance markets in parts of the country.
The tax bill, which includes huge tax cuts for corporations, may also force tens of millions of dollars in cuts to the Medicare program under federal budget rules, though congressional leaders say they are confident they can waive the rules as they have in the past.
Most worrisome to many, the bill will open a $1.5-trillion hole in the federal deficit over the next decade. That will put substantial new pressure on government healthcare programs such as Medicare and Medicaid and has already ignited a renewed Republican campaign to cut them back.” (B)

“House Democrats are threatening to allow automatic spending cuts triggered by the Republican tax bill to take effect next year unless Speaker Paul Ryan ends an attempt to cripple Obamacare.
Under a 2010 law known as PAYGO, the $1.5 trillion reduction in government revenue caused by the Republican tax cut legislation would trigger years of across-the-board cuts to programs including Medicare starting next year. Ryan and Senate Majority Leader Mitch McConnell have vowed the cuts won’t be imposed, but they would need Democratic votes to waive the law.
Part of the price the Democrats want to extract is keeping the Obamacare mandate that individuals buy health insurance, which would be eliminated in the Republican tax bill heading toward final passage next week.
“Should you enact a tax bill by the end of the year that adds $1.5 trillion to the deficit and, as a result, triggers PAYGO cuts next month, any effort to mitigate those cuts must also remove these other catalysts of uncertainty,” the Democrats’ letter to Ryan said Friday. “At a minimum, that must include rejecting the elimination of the individual mandate as well as the use of reconciliation procedures next year for Medicare benefit cuts in order to fill the fiscal gap left by your tax bill.”” (C)

“Sen. Lamar Alexander acknowledges that the final tax bill set to pass this week will increase health insurance costs for those who use the federal exchanges. But he says his bipartisan bill to stabilize the insurance marketplace will offset the cost increase.
The tax bill ends the individual mandate for everyone to buy insurance, which would likely mean many healthy people would drop their coverage, making marketplace customers a sicker bunch more costly to insure.
Still, the Republican chair of the Senate’s health committee is glad to see the mandate go.
“That’s good news for most Tennesseans because it means you don’t have to pay a penalty for insurance you don’t want to buy. But it will also slightly create upward pressure on premiums,” Alexander said Friday after speaking to the Brentwood Rotary Club. “But the Alexander-Murray legislation will push rates down a lot further than repeal of the individual mandate will push them up.
According to Alexander, Senate Majority Leader Mitch McConnell has “pledged” to put the Alexander-Murray compromise into the spending bill that should be voted on later this week. Alexander believes he also now has support from President Trump, even though the president has previously called it a “bailout” for insurance companies.” (D)

“In other words, Senator Collins plans to vote for the Tax Cuts and Jobs Act when it reaches the Senate floor, probably tomorrow. But Collins is no dupe. Her support for the legislation is clearly the right position for any member of Congress purporting to represent the best interests of Maine’s 1.3 million residents. That the bill repeals Obamacare’s individual mandate is not a betrayal of her constituents, as some have suggested. It will instead remove a significant tax burden that falls disproportionately on the shoulders of Maine voters. As the Bangor Daily News reports, Mainers pay a larger than average share of the individual mandate’s tax penalty:Maine tax filers paid nearly $15.5 million in the ACA tax penalty in 2015, the most recent year for which the data are available. That’s about 5.25 percent of all tax filers in the state that year, a high share compared to other states. Nationwide, 4.5 percent of all tax filers paid the penalty in 2015.”….
This is why Senator Collins insisted on an amendment to the tax bill that would permit taxpayers to itemize deductions up to $10,000. The Wall Street Journal outlines the deal thus, “The House and Senate bills each allowed only property taxes to be used toward that cap. But under the agreement … that total could be used for property taxes and for either income or sales taxes.” Collins also extracted an amendment that would reduce the threshold for medical expense deductions from 10 percent to 7.5 percent of gross adjusted income, and a commitment from the Republican leadership to forestall any cuts to Medicare that would be automatically triggered by deficits.” (E)

“The expected repeal of the ObamaCare mandate to buy health insurance means that states will soon have to step in and decide whether to create their own mandates….
Outside experts and supporters of ObamaCare predict chaos in the insurance markets if the tax bill passes and the mandate is repealed.
Premiums are expected to rise significantly and insurers could leave the marketplace. The Congressional Budget Office estimated that about 13 million more people would be without insurance in 10 years.
States have the power to potentially blunt the damage if they choose to enact their own mandate penalties, but even officials in the most liberal states could face a bruising political battle.” (F)

“New rules from the Donald Trump administration that would allow cheaper, less regulated health plans into the individual insurance market have alarmed healthcare providers, insurance companies and consumer groups….
In addition, Trump wants “short-term, limited duration health plans” that may be cheaper but will cover less and attract healthy, younger purchasers away from individual health plans with richer benefits. By siphoning off healthier Americans to cheap plans Trump wants, those sold on public exchanges under the Affordable Care Act could become more expensive if a higher concentration of older and sick patients are enrolled.
“Expanding and extending short-term, limited-duration health plans, increasing enrollment in association health plans (AHPs), and relaxing rules for employer health reimbursement arrangements (HRAs) all increase adverse selection in insurance markets that serve millions of individuals and employers,” the health groups wrote to insurance regulators.
Given such concerns, it’s unclear if there will be any insurance carriers that want to sell Trump’s plans , which likely wouldn’t be available to buy until late next year for 2019 at the earliest. And analysts worry those policies that do reach the market won’t provide adequate benefits.” (G)

(A) The Republican tax bill is an American betrayal, by Ezra Klein, The Republican tax bill is an American betrayal, https://www.vox.com/policy-and-politics/2017/12/18/16782484/gop-tax-bill-cuts-reform-republican
(B) Republican tax bill fuels anxiety across the nation’s healthcare system by Noam N. Levey, http://www.latimes.com/politics/la-na-pol-tax-bill-healthcare-20171218-story.html
(C) Democrats Threaten to Allow Medicare Cuts to Save Obamacare, by Erik Wasson, https://www.bloomberg.com/news/articles/2017-12-16/democrats-threaten-to-allow-medicare-cuts-to-save-obamacare
(D) Alexander Expects His Bipartisan Obamacare Fix Will Be Passed This Week, by BLAKE FARMER, http://nashvillepublicradio.org/post/alexander-expects-his-bipartisan-obamacare-fix-will-be-passed-week#stream/0
(E) Why Susan Collins Will Vote to Kill Obamacare’s Insurance Mandate, by DAVID CATRON, https://spectator.org/we-interrupt-this-broadcast-who-speaks-for-america/
(F) ObamaCare mandate repeal would put pressure on states, by NATHANIEL WEIXEL, http://thehill.com/policy/healthcare/365182-obamacare-mandate-repeal-would-put-pressure-on-states
(G) Concerns Grow About Cheaper Trumpcare Plans, by Bruce Japsen, https://www.forbes.com/sites/brucejapsen/2017/12/17/concerns-grow-about-cheaper-trumpcare-plans/#135bc13557e4

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